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Massachusetts Health Care Reform

November 20, 2006 BriefingSTATE 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

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Agenda

• Overview of Massachusetts Healthcare Reform

• Implementation Update

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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

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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*

<100% FPL Medicaid eligible but unenrolled 106,000-~100-300% FPL Low Income 150,000->300 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

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Organizing principles for a “fully insured” population

Stabilize the small group insurance market and keepsmall businesses from dropping insuranceIntroduce lower-priced, comprehensive health insuranceproductsBring younger, healthier people into the risk poolCreate a Connector to permit pre-tax premiumpaymentsFacilitate the purchase of insurance by part-timeemployees and employees with multiple employersPromote a culture of insurance and personalresponsibilityControl costs for system sustainability

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Responsibility for key elements of the law

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Benefits of the law

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Agenda

• Overview of Massachusetts Healthcare Reform

• Implementation Update

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Progress to date

Connector up and runningCommonwealth care benefit packages and

subsidiesdeterminedCommonwealth Care enrollment began Oct 1,

2006Medicaid expansions implementedFair Share regulation completedFree Rider regulation completedEducation of employers has begun

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What’s left to do?

Determination of what constitutes creditable coverageSpecifications for affordable insurance benefit packagesDetermination of how affordability for people over 300% FPL will be handledDetermine eligibility and services for Safety Net CareMerger of nongroup and small group marketsReporting requirements for employers (HIRD)Rules for Section 125 PlansAnti-discrimination rules and guidance Education, marketing and enrollment

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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)