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Existing Massachusetts Health Policy

What is existing Massachusetts Health Policy?

Basic MA health facts & figures

History of Reform

The passage of the 2006 Massachusetts health care reform bill had its foundation in almost two decades of efforts. Past reforms that provided this foundation include the 1988 passage of legislation under Governor Michael Dukakis that established policy models that survive today, such as a CommonHealth program that provided coverage to adults and children. Furthermore, in June 1996 a bill known as “Chapter 203” instituted a new Medicaid program known as MassHealth that extended coverage to over 300,000 people.

In 2005, momentum for further reforms was gaining steam due to a combination of pressures and incentives. Because of a federal Medicaid waiver that required the state to redirect funds from safety net hospitals to insurance coverage, Massachusetts stood to lose $385 million in Medicaid funds if it did not pass comprehensive health reform. This significant financial pressure was a major catalyst for reform.  The prospect of appealing to a growing base of grassroots and health consumer advocacy voices that called for universal coverage provided an incentive for elected officials to pass reform. Powerful support for reform was also provided by state business leaders, often non – profit hospitals and insurers, who argued that reform was in the economic interest of the state.

In November 2005 both the House and Senate passed comprehensive health reform legislation, which were referred to a legislative conference committee tasked with producing a final bill from the two different sets of legislation. After a series of speeches by Senator Edward Kennedy in March 2006, efforts to finalize the bill were moved forward. In April the final bill, Chapter 58 of the Acts of 2006, An Act Providing Affordable, Quality, Accountable Health Care, was passed by the legislature and signed into law by Governor Romney.

Chapter 58 is a health insurance model, not a universal health care plan. Below is an outline of the key components of the plan. You can find more about the history of reform in MA [3] and a resource – rich timeline of Chapter 58’s passage from the Health Care for All MassACT! Coalition website. [2]

Components of the Plan

Individual Mandate

The individual mandate requires all adults in the state to purchase health insurance, with financial noncompliance penalties of up to 50 percent of the cost of a health insurance plan. The state provides waivers to the individual mandate for those who do not qualify for subsidized care but cannot afford insurance at their income level.

Employer Responsibility

Employers are required to pay a “fair share” contribution or provide health insurance to their employees if they have eleven or more employees.

Commonwealth Health Insurance Connector

The Connector is an insurance exchange for private plans that sets standards and provides opportunity for comparison shopping for consumers. The Connector offers a range of options, among them a special lower – cost plan for 19-26 year olds. Individuals and small businesses can purchase these plans through the Connector.

Commonwealth Care Health Insurance Program

The Commonwealth Care Program plays a central role in the plan, providing sliding – scale subsidies to low income individuals with incomes up to 300 percent of the federal poverty level to help with purchasing insurance. Adults with incomes up to the 150 percent FPL receive comprehensive health insurance that is completely subsidized.

MassHealth Expansion

This component expands Medicaid coverage to children up to 300 percent FPL, providing them with completely subsidized comprehensive care. The expansion also raised enrollment caps on Medicaid programs for adults.

Insurance Market Reforms

Reforms to the insurance market included merging the individual and small – group insurance markets, which theoretically decreases individual premiums (Kaiser Commission on Medicaid and the Uninsured Fact Sheet, June 2007).

Preservation of the Safety Net

The Health Safety Net replaced the Uncompensated Care Pool (also known as Free Care) to provide health services for residents with incomes below 400 percent FPL and who do not receive MassHealth or Commonwealth Care. Uncompensated Care Pool funds are combined with other Medicaid funds to reimburse providers.

Commonwealth Care Bridge

Not part of the original 2006 health reform plan, the CommCare Bridge was created after special status (Permanent Legal Resident) legal immigrants lost their Commonwealth Care coverage in August 2009. The Bridge offers much of what Commonwealth Care does, excepting dental care, vision services, hospice, or skilled nursing care. The Bridge was set to expire on August 31st, 2010.

Impact of the 2006 Massachusetts health reform

Influences National Health Policy

While certain components (and catalysts for) the plan could not be replicated in other states, the landmark bill managed to inspire imitation in a number of states in the year following passage. Both California and New York announced health reform initiatives, aiming for policy similar to that of Massachusetts, and numerous states began looking to shore up coverage of children.

Massachusetts also provided the model for national health reform at the federal level in 2009.

During formation of the national health care bill, the late Senator Edward M. Kennedy, who was instrumental in the creation and implementation of Massachusetts reform, asserted that “To those who say these challenges can’t be met, I say, ‘Look at Massachusetts”.

Improvements in Access to Care

–          Massachusetts now has the lowest uninsurance rate in the nation at 2.6%

(Health Care in Massachusetts: Key Indicators – Report May 2009 [1])

–          Only 11% of insured individuals reported cost as a barrier to care in 2008 as compared to 17% in 2006 (Community Catalyst Fact Sheet – Massachusetts Health Reform: The Facts, June 2009 [4])

–          Usage of the Health Safety Net in the first six months of HSN08 declined, indicating that more people have access to primary care (Health Care in Massachusetts: Key Indicators, May 2009 [5])

–          From 2006 to 2008 key statistics showed access improving. Adults were more likely to have the following: a place to go for care, a preventive care visit in the past 12 months, and a dental care visit in the past 12 months (Sharon, Long and Paul Masi, Access and Affordability: An Update on Health Reform in Massachusetts, Fall 2008 [8])

Second Phase of Reform – Costs and Primary Care Shortage

Chapter 58 of the Acts of 2006 was designed for providing insurance, not tackling cost containment or managing shortages of primary care doctors, or other challenges facing the health care system.

In 2008 Chapter 305 of the Acts of 2008 – An Act to Promote Cost Containment, Transparency, and Efficiency in the Delivery of Quality Health Care – was passed to tackle health care costs and establish a framework for analyzing health care spending. Among other measures, the new legislation required annual public hearings to investigate influences on cost and recommend cost reduction mechanisms, banned gifts to physicians from pharmaceutical companies and provided education to physicians on cost – effective prescription practices, and established mechanisms for attracting primary care providers to rural and underserved areas.

The legislature also created a Special Commission on the Health Care Payment system, which recommended in July 2009 that the Commonwealth switch from a fee – for – service payment system to one in which providers share the responsibility for the patient’s care.

Moving Forward

The almost exclusive focus on insurance in the 2006 reform ignored the need for comprehensive and equitable health policy that addresses factors beyond coverage. Many residents, as well as having disproportionately less access to insurance and/or care also find their right to health violated by the barriers to health they face in every day life. Unaffordable health care, sub – par care quality, and disparities in health outcomes are issues that persist in the Commonwealth. The 2008 legislation tackling health care spending was a step in the right direction, but more needs to be done[s1] [7] .

Community Assistance

As future medical professionals, you may be undergoing hands – on training working with patients or at a health clinic. Health Care For All [6] provides a Consumer Health Helpline. You can refer patients, friends, or family to the Helpline to find out more about their health coverage options in Massachusetts, or use it as a resource for learning more about the consumer side of Massachusetts health policy.

[s1] [9]Can we have a more nuanced analysis here? If not, this is okay…but this should be a call to action with specifics…this is a little watery….