TPM Reader GR reports in on the situation in Massachusetts and their mandate-based quasi-universal plan ...

Your friendly Berkshire's pseudo-stringer here to give my impression of the Mass Health Experiment.

As a person to subject Massachusetts insurance laws, I can tell you it is a mixed bag but better than most. Many, if not most moderate to lower income folks have some sort of subsidized insurance. Those without employer sponsored plans usually end up with a very solid public plan called Mass Health. Those with lower incomes who purchase privately or have employer sponsored plans are eligible for premium subsidies via "The Connector" which uses a sliding scale to determine how much comes out of your pocket.

There is no true public option in Mass, but the public plans available to the people with lower incomes tend to be as comprehensive and solid as the best private insurance, and it is cheaper per person.

The problems come when you start getting into the upper half of the incomes in the state. At about 300% of poverty, people do not qualify for subsidized healthcare and that can eat as much as 23% of someone's take home pay. Of course, if you are young and in good health, you can find a private "hit by a bus" plan that costs far less than a truly comprehensive plan.

Three things have struck me in the two years since the plan has taken effect:

1. The plan has come in with only slightly higher than projected costs. It has not been the financial nightmare that many have predicted and not even close to a worst case scenario. It's small fees on non-insuring businesses did not run companies out of town. In this regard it has been a success.

2. The huge influx of newly insured people caused a primary care crisis, especially in the non-urban areas of the state. Many practices have limited their acceptance of the various public Mass Health plans. However, it lightened the load on much more expensive emergency room care. Long term, this problem will convert to a plus.

3. Private health insurance has not changed much in any substantial way that I can see. My private plan, a supposedly solid Blue Cross HMO via my wife's employer, still has a million bureaucratic hassles. Last year they denied over $4000 of our claims for my wife's chronic illness because we saw out of network specialists in another state (Stanford has a great clinic for my wife's disorder. It was worth it.) not to mention that they require letters of necessity for almost every non-generic prescription. The premiums for this plan went up around 12% last year.

Working in the food business, many of my colleagues qualify for the subsidized programs and it has been wonderful for them. On the other hand, having a combined family income that puts me slightly above the median state income, we are stuck with whatever the employer offers. But unlike the rest of the country, if we should lose a job or want to become entreprenuers, we know we could get decent coverage on the private market for about the same price, but without state or employer subsidies.

In other words, Massachusetts has fixed some, but not all of the major issues surrounding health insurance without falling into the Atlantic. Oh, and we have the lowest divorce rate in the country despite what the religious right predicted. So they can stuff all their complaints about my blue state in their craw.

Happy Labor Day. Go play with your kids.