Key Elements of Mass. HealthCare Reform

1
Key Elements of Mass. HealthCare Reform

• Jon Kingsdale
• Bipartisan Congressional Health Policy Conference
  January 13, 2007

2
Programmatic Elements

• Subsidized premiums (Commonwealth Care)
• Individual mandate
• Incentives for employer participation (gt10) -S.
  125 plans
• -Fair Reasonable contribution
• Market reform (Commonwealth Choice)
• Enhanced Medicaid payments

3
A Relatively Small Problem

• MA Population 6.2 million
• Insured 5.8 million
• Uninsured 372,000
• 300 of FPL 140,000
• gt300 of FPL 160,000
• Other 70,000

4
Political Recipe for Reform

• Lots of money already in the system
• Well organized, funded respected advocacy
• Bi-partisan commitment to health care reform
• Provider and insurer support for reform
• 385 mm federal carrot/stick
• Business acquiescence (culture of reform)

5
HCR 5 years in the making

• 7/1/06 Medicaid expansion
• 1/1/07 C-Care implemented
• 7/1/07 Individual mandate Employer
  assessment Non-discrimination
• C-Choice
• 10/1/07 UCP re-write
• 1/1/08 Real mandate in effect

• 2003 Governor,BCBSMA, ACT
  commit
• 11/04 Roadmap to Coverage Sen.
  Pres. commits
• 2/05 1-year extension of
  federal waiver
• 3-6/05 Governors Plan
• Sen. Pres bill
• Governors bills
• 11/05 Speakers bill
• 4/06 Enactment

6
Progress to Date

• Commonwealth Care for adults lt 100 FPL
• October 1, 2006 start date
• Target population of 60,000
• 50,000 individuals confirmed eligible
• 40,000 enrolled in health plans
• Commonwealth Care for adults 100 to 300 FPL
• January 1, 2007 start date
• Target population of 80,000

7
Market Reform

• Create credible, non-group risk pool
• Merge small- non-group rating
• Expand product options
• Create a new market for choice (Commonwealth
  Choice)

8
Commonwealth Choice
Commonwealth Connector
MMCOs
Blue CrossBlue Shield
Tufts
NHP
Harvard Pilgrim
Health NewEngland
Fallon
9
Commonwealth Choices Value Proposition

• Individual choice
• Administrative simplicity
• Pre-tax premium payment
• Portability of coverage

10
Commonwealth Choices Value Proposition

• Sales to date 0