Health care reform massachusetts one year later
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Health Care Reform: Massachusetts One Year Later. Sarah Iselin Massachusetts Division of Health Care Finance and Policy October 26, 2007. The Massachusetts Law: Why So Much Attention?. Ambitious goal: Near universal coverage Transcends ideology Bipartisan support

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Health Care Reform: Massachusetts One Year Later

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Health care reform massachusetts one year later

Health Care Reform:Massachusetts One Year Later

Sarah Iselin

Massachusetts Division of Health Care

Finance and Policy

October 26, 2007


The massachusetts law why so much attention

The Massachusetts Law:Why So Much Attention?

  • Ambitious goal: Near universal coverage

  • Transcends ideology

    • Bipartisan support

    • Combines policy solutions from the right and the left

    • Partnership between federal government and state

  • Novel approaches

    • Individual mandate, employer responsibility, insurance market changes


Massachusetts the building blocks for reform

Massachusetts:The Building Blocks for Reform

  • Relatively low rate of uninsurance

  • History of health coverage expansions

  • Broad Medicaid program

    • 1115 Waiver

  • Uncompensated Care Pool

  • Highly regulated small group and individual health insurance markets


How will we get there

How Will We Get There?

  • Medicaid expansions and restorations

  • Subsidized coverage for low-income adults

  • Changes to the insurance market to help individuals and small businesses

  • Individual mandate

  • Employer responsibilities (for firms with > 11 employees)


Massachusetts health reform how do the pieces fit together

Massachusetts Health Reform:How Do the Pieces Fit Together?

Percent of State’s Total Uninsured Targeted by Different Aspects of Law


Medicaid 56 000 members

MassHealth Caseload

1,150,000

Commonwealth

Care

Health Care

• Discontinued

1,100,000

Reform

MassHealth Basic

• Premiums for some

Initial Gateway roll-

optional populations

out

1,050,000

1,000,000

950,000

900,000

MassHealth Essential

850,000

800,000

Jul-02

Jul-05

Jul-03

Jul-04

Jul-06

Jul-07

Jan-03

Oct-02

Oct-03

Oct-04

Jan-05

Oct-05

Jan-06

Oct-06

Jan-07

Apr-04

Jan-04

Apr-07

Apr-03

Apr-05

Apr-06

Medicaid: +56,000 Members

August 2007 1,090,000

1,034,000


Commonwealth care 127 000

Commonwealth Care: 127,000+


Commonwealth choice 6 plans 36 products 8 300 members

Commonwealth Choice: 6 Plans, 36+ Products, 8,300+ Members


Meanwhile uncompensated care demand is falling

Meanwhile, Uncompensated Care Demand is Falling

* Growth rate reflects October-August data in both periods


Individual mandate the benefits minimum creditable coverage

Individual Mandate: The Benefits (Minimum Creditable Coverage)

Benefits

  • Preventive and primary care (at least 3 visits prior to deductible)

  • Emergency services, hospitalization benefits, ambulatory patient services, mental health services and all state mandated benefits

  • Prescription drug coverage

    Cost-sharing

  • Deductible capped at $2,000 for individual coverage and $4,000 for family coverage

  • Separate drug deductible may not exceed $250 for individual and $500 for family coverage

  • Maximum out-of-pocket spending for in-network services capped at $5,000/$10,000

    • Must include the upfront deductible, most co-insurance, and any services that require $100 or more in co-payments


Individual mandate the affordability schedule

Individual Mandate: The Affordability Schedule


Individual mandate the tax form

Individual Mandate: The Tax Form


Employer responsibilities

Employer Responsibilities

  • Fair Share Contribution

    • Make “fair and reasonable” contribution to health insurance or pay assessment (no more than $295 per employee per year)

      • Employee take-up rate of 25% or more, or

      • Offer to pay 33% toward cost of coverage

  • Offer Section 125 Plans or could be subject to Free Rider Surcharge

    • Allow employees to make pre-tax contributions to health insurance or pay “fair share” charge

  • Applies only to employers with ≥ 11 full-time employees


Challenges ahead

Challenges Ahead

  • Education, outreach and enrollment

  • Sustaining public support

  • Ensuring access for the newly insured

  • Financing – strong state economy

  • Continued federal support for waiver renewal

  • Maintaining strong safety net for those who will remain uninsured

  • Moderating health care cost trends


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