• Massachusetts Individual Mandate Gaming, Continued

    Apparently there are no studies that report the selection effects of gaming the Massachusetts individual mandate. This is according to Amy Lischko, Tufts University Assistant Professor of Public Health and Family Medicine and former Commissioner of Health Care Finance and Policy and Director of Health Care Policy under governor Mitt Romney. Lischko is also an investigator on a project studying risk selection in state health insurance programs.

    She wrote in an e-mail that the Boston Globe’s investigation has produced all that is known on gaming the mandate. “The Division of Insurance is investigating this as well but they have not released results yet. There hasn’t been any academic research on this issue,” she wrote.

    Also, in my prior post on Kay Lazar’s reporting in the Globe I didn’t note that it implicitly answered some of my earlier questions. Namely,

    • Does Massachusetts have an open enrollment period? No.
    • Does an exclusion period for pre-existing conditions exist in Massachusetts? No, though I thought the answer was yes. But Lazar wrote in the Globe, “[W]aiting periods for coverage … was effectively disallowed by the 2006 law … [Governor Patrick's proposal] would also bring back the rule allowing insurers to exclude coverage for preexisting conditions for six months …”

    So, there doesn’t seem to be much to prevent gaming in Massachusetts. And yet the problem of gaming has not yet been established as a significant one. Why is there so much uncertainty about this? I suspect that access to data has been difficult. More should be known about Massachusetts’ health reform, especially considering we’re going to implement something like it nationally.

    To channel Kevin Drum, “Get cracking, scientists.” (Of course, I’m one of them. Though I’m not funded to study anything about Massachusetts.)

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    • I am also curious as to where the numerator and denominator for the 97% figure are sourced. Another factor in the Mass. plan is that the minimum coverage restrictions are less draconian, allowing for cheaper plans to exist.

    • Speaking of numerator and denominator, my back of the envelope calculation suggests that, if all of the excess cost associated with short-stay subscribers to Blue Cross, as reported in the Globe story, is attributed to gaming then the cost is about $1.7 million. Question: what is that as a % of the total small group and non group premiums for Blue Cross?

      • @hlthcaremike – You could probably find a per-person non-group premium on the web. But how many lives are covered? That you might find in NAIC data (no, I don’t know how to get hold of it). Maybe there are other sources.