Health Care Reform In Theory and In Reality A firsthand look at the impact of MA Health Reform Eric Linzer, Vice Pres

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3. Historical Context Potential loss of MA Medicaid Waiver Proposed health care constitutional amendment An obligation and duty on the state legislature and executive officials to implement laws that will ensure that no Massachusetts resident lacks comprehensive, affordable, equitably financed health insurance coverage for all medically necessary preventive, acute and chronic health care and mental health care services, prescription drugs and devices 3

4. MA Health Care Environment Pre-Reform Who are the insured? 93% MA Insured Prior to Health Reform Who are the uninsured? 372,000 Uninsured MA Residents 88% (328,000) Between Ages of 19-64 56% Non-Elderly Adults Between 19-36 56% Non-Elderly Adults Earned Under 300% FPL 4

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7. MA Health Care Reform Major Provisions Connector Commonwealth Care Medicaid Expansion Commonwealth Choice Individual Mandate Small/Non-Group Merger Payment Reform Health Care Quality and Cost Council 7

8. MA Health Care Reform Payment Reform $540 MM provider rate increases over 3 years Hospitals are eligible to earn up to $20 MM in P4P payments Health Care Quality & Cost Council Charged with setting cost containment and quality improvement goals for the Commonwealth Development of a website to publish quality and cost information 8

9. Health Care Reform II Cost Control Hearings on Health Care Costs Health Plans & Providers Reporting & Prohibiting Billing of Never Events Strengthening the Determination of Need Process Uniform Coding Rx & Device Manufacturer Gift Ban Payment Reform Commission Study of Hospital & Health Plan Reserves Funding for CPOE & EHR Technology NPs as PCPs 9

10. Health Care Reform- In Theory and In Reality �A firsthand look at the impact ofMassachusetts Health ReformPatricia Andriolo-BullDirector, Commonwealth Choice2008 Texas Managed Care Conferenceand Trade ShowOctober 23, 2008Waterway Marriott Hotel and Convention Center, Houston TX

11. 11 Massachusetts Health Care Reform: Shared Responsibility

12. 12 Role of the Connector 1. Establish and administer Commonwealth Care, subsidized coverage for low-income, uninsured adults. 2. Establish and administer Commonwealth Choice, a commercial insurance �exchange�: Standardized benefit plans and More affordable coverage options (complements small-group/non-group market merger) 3. Make policy decisions as authorized by Health Care Reform Law: Definition of Minimum Creditable Coverage (MCC) Schedule of Affordability 4. Conduct outreach and advertising efforts to inform public of new opportunities and responsibilities.

13. 13 Phase In MassHealth expansion (July �06) Commonwealth Care � free (Nov. �06) Commonwealth Care � contributory (Feb. �07) Non-group reform (July �07) Individual mandate (July �07 � �08) Free care eligibility restricted (Oct �07 � April �08)

14. 14 Implementation Milestone:Launched Commonwealth Care � Oct �06 Commonwealth Care is a government-subsidized, comprehensive health insurance for uninsured individuals with incomes up to 300 percent of the federal poverty level (FPL) Coverage is through a choice of four private health insurance plans � Medicaid Managed Care Organizations (MMCOS) Sliding fee scale with least expensive enrollee contributions ranging from $0 to $116 per month:

15. 15 Making the market work better: Set standards Increase transparency Simplify consumer experience Create more affordable options Standardize benefit plans Making the market work better: Set standards Increase transparency Simplify consumer experience Create more affordable options Standardize benefit plans

16. 16 Implementation Milestone: Launched website with shopping functionality � May �07

17. 17 �I got it� advertising campaign Strategic partnerships Grassroots efforts Postcards from the Department of Revenue

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19. 19 Progress Report 1. Reasonably good progress to date 440,000 newly covered Popular and political support Acceptable costs per enrollee 2. Not the end, but the start of reform 3 years to enact, 3 more to implement Healthcare Reform II-healthcare cost control 3. Challenges Maintain support Find the money Improve value

20. 20 Results: 439,000 Newly Insured as of March 2008

21. 21 Results: Current Population Survey Shows Steep Decline in Number of Uninsured�

22. 22 Results: As did a 2006-2007 survey conducted by the Urban Institute/BCBS Foundation of MA�

23. 23 Results: As did Massachusetts state income tax returns for 2007�

24. 24 Results: Commonwealth Care enrollment (quarterly)

25. 25 Results: Commonwealth Choice enrollment (quarterly)

26. 26 Results: A majority of the newly insured with private, non-group coverage obtained it through Commonwealth Choice (as of March 2008)

27. 27 Results: Declining Reliance on Free Care

28. 28 Results: Public support continues to climb

29. 29 Results: Public support continues to climb

30. 30 Results: Employer support remains strong 55 percent of MA employers agree with requirement to offer or pay fair share contribution (41 percent oppose) Employers offering ESI in 2007: MA: 72 percent US: 60 percent Growth of ESI in MA, 12 months ending Jan. �08: 85,000 newly covered lives

31. 31 Results: Non-Group reform reduced premiums and increased benefits

32. 32 Challenges Ahead Clarify MCC Taxpayer acceptance Control costs of program Bend the trend in health care spending Minimize �crowd-out� Increase primary care capacity