Massachusetts Health Care Reform

1
Massachusetts Health Care Reform

• November 20, 2006 Briefing
• STATE HEALTH REFORM INITIATIVES
• Are There Lessons for Federal Policymakers?
• Sponsored by The Alliance for Health Reform and
  The Commonwealth Fund
• Presentation of Amy Lischko, Director
• Massachusetts Executive Office of Health and
  Human Services

2
Agenda

• Overview of Massachusetts Healthcare Reform
• Implementation Update

3
Massachusetts healthcare problem

• Growing number of uninsured 460,000 in 2004
• -Expensive emergency room care
• -Poor preventative, primary care
• Double-digit insurance premium rate hikes
• Businesses dropping benefits nationally
• Hard for individuals and small businesses to buy
• insurance
• Free-riders
• 1.3 billion cost of free care - growing bigger
  every year

4
The Uninsured in Massachusetts

• Total Commonwealth Population 6,400,000
• Currently insured (93) 5,940,000
• Employer, individual, Medicare or Medicaid
• Currently uninsured (7) 460,000
• lt100 FPL Medicaid eligible but unenrolled
  106,000
• -100-300 FPL Low Income 150,000
• -gt300 FPL Middle Income 204,000
• Note Based on August 2004 Division of Health
  Care Finance and Policy statewide survey
• August 2006 Division of Health Care Finance and
  Policy stateside survey shows 372,000 uninsured
  residents

5
Organizing principles for a fully insured
population

• ?Stabilize the small group insurance market and
  keep
• small businesses from dropping insurance
• ?Introduce lower-priced, comprehensive health
  insurance
• products
• ?Bring younger, healthier people into the risk
  pool
• ?Create a Connector to permit pre-tax premium
• payments
• ?Facilitate the purchase of insurance by
  part-time
• employees and employees with multiple employers
• ?Promote a culture of insurance and personal
• responsibility
• ?Control costs for system sustainability

6
Responsibility for key elements of the law
7
Benefits of the law
8
Agenda

• Overview of Massachusetts Healthcare Reform
• Implementation Update

9
Progress to date

• ?Connector up and running
• ?Commonwealth care benefit packages and subsidies
• determined
• ?Commonwealth Care enrollment began Oct 1, 2006
• ?Medicaid expansions implemented
• ?Fair Share regulation completed
• ?Free Rider regulation completed
• ?Education of employers has begun

10
Whats left to do?

• ?Determination of what constitutes creditable
  coverage
• ?Specifications for affordable insurance benefit
  packages
• ?Determination of how affordability for people
  over
• 300 FPL will be handled
• ?Determine eligibility and services for Safety
  Net Care
• ?Merger of nongroup and small group markets
• ?Reporting requirements for employers (HIRD)
• ?Rules for Section 125 Plans
• ?Anti-discrimination rules and guidance
• ? Education, marketing and enrollment

11
Good news so far but

• Recent Survey of MA residents found
• -80 had heard of the law (about a quarter of
  them knew a lot)
• -64 support the law
• -More support for Medicaid expansion for kids
  and business requirement to offer or pay
  penalty than for individual mandate
• -Support across subgroups of insured and
  uninsured and socio-economic status
• -Some skepticism expressed about implementation
• -Concerns about small businesses
• -Continued support will depend on affordability
  of premiums
• (Results from Survey of MA residents conducted by
  Robert Blendon for BCBS Foundation)