Massachusetts Health Reform – Round Three Brian Rosman & Fawn Phelps Health Care For All,...
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Transcript of Massachusetts Health Reform – Round Three Brian Rosman & Fawn Phelps Health Care For All,...
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Massachusetts Health Reform – Massachusetts Health Reform – Round Three Round Three
Brian Rosman & Fawn PhelpsHealth Care For All, Massachusetts
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Presentation OutlinePresentation Outline
Health Care For All – BackgroundBrief History of Massachusetts
ReformRound 3 – What Massachusetts
PassedThe National StakesStay Informed
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Health Care For All: What We DoHealth Care For All: What We Do
Policy Coalitions to Make ChangeCoalitions on MassHealth, children’s
coverage, disparities, oral health, private market concerns, and health reform
Also work on E-Health, quality issuesPrograms to Help Consumers
Consumer Helpline, Outreach, legalCommunication to Inform Everyone
www.hcfama.org, blog, regular emails
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Brief History of MA ReformBrief History of MA Reform
1988: Universal Health Care Law Pay/Play Employer Mandate
Never Implemented/Repealed 1996 CommonHealth (working disabled), Student
Mandate, Medical Security Plan (unemployment), Healthy Start (pregnant women) – still going strong
1996: MassHealth Medicaid->MassHealth; Income-based not welfare-
based – 350,000 new enrollees Coverage for all children – CMSP Senior Pharmacy Program
Both reform waves inspired national action
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Round 3 – the ProblemsRound 3 – the Problems
500,000+ uninsured – growingDecline in employer-provided
coverage4th largest percentage drop nationally
Main reason: high cost of careFederal Medicaid Waiver
(“MassHealth”) renewal: must implement July 2006
Providers underpaid by MassHealth
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Round 3 – the PlayersRound 3 – the Players
Governor Mitt Romney (Republican lame duck – running for President)
Legislature – overwhelmingly Democratic Federal officials – push to approve waiver Business Groups:
Small biz, ideological right-wing Large biz, pragmatic, health infiltration
Affordable Care Today Coalition (ACT!) HCFA, GBIO (religious coalition), Providers, Labor,
Grass-roots progressives MassACT – Ballot Initiative Committee
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Round 3 – The Federal WaiverRound 3 – The Federal Waiver
Section 1115 – feds can “waive” Medicaid rules
1997–2005: Two waivers, no changeIncludes $385M supplemental payments
to public hospital-sponsored managed care plans for uninsured
2005: Feds demand changesPayments to institutions must shift to
coverageDeadline: in place by 7/1/06
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Round 3 – TimelineRound 3 – Timeline
6/04: HCFA begins public activity around reform, begins drafting bill
11/04: Travaglini (Senate Pres.), Romney Announce Plans
8/05: MassACT Ballot Petition Filed 10/05: House bill released 11/05: House, Senate Pass Bills 12/05: Conference Committee Begins 4/06: Bill passes Legislature: 153-2 in House;
37-0 in Senate 4/06: Romney signs bill and vetoes 8 sections
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Our Organizing ModelOur Organizing Model
Two Coalitions: Broad coalition for legislative push Narrow “true believers” pushed ballot initiative
Grassroots Pressure + savvy lobbying by experienced pros
Simple messages to the public Fairness Shared responsibility Good for economy, small business
Turning point was convincing House Speaker of policy
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Chapter 58 – MedicaidChapter 58 – Medicaid
MassHealth (Medicaid): Kids coverage expanded to 300% fpl
($60,000/family of 4)MassHealth Essential (long-term
unemployed childless adults) enrollment cap increased
Dental, dentures, eyeglasses, other services restored for adults
$3 million in outreach grants to community groups
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Chapter 58– Subsidized CoverageChapter 58– Subsidized Coverage
“Commonwealth Care:” subsidized coverage for low income uninsured below 300% of poverty ($30,000 / year)Premiums: no premium if below poverty;
sliding scale between 100%-300% fplNo deductiblesBelow 100%: MassHealth cost-sharing,
dental, prescription, mental health benefits
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Chapter 58– Rate IncreasesChapter 58– Rate Increases
Medicaid Rate Increases:$90 million additional per year for 3
years. Goes from ~80% of costs to ~95% of costs
Hospitals must meet quality benchmarks to get increase
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Chapter 58– IndividualsChapter 58– Individuals
Individual Mandate All residents must obtain health coverage
if “affordable coverage” availableBoard of Connector defines “affordable”We will advocate to only apply to fairly
well-off peopleEnforced through tax systemBegins July 2007
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Chapter 58– EmployersChapter 58– Employers
“Fair Share” ContributionEmployers who don’t offer coverage with
11+ employees pay $295/ workerEmployer must make “a fair and
reasonable premium contribution” to be exempt
Employers must facilitate pre-tax “cafeteria plan” for health insurance
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Chapter 58– InsuranceChapter 58– Insurance
Insurance Market ReformsDoes not authorize high deductibles as
Romney wanted Non-group (individual) health insurance
market merges into small group marketCould cut non-group premiums 24%
19-24 year olds can stay on parents’ plans for 2 years
Special reduced-benefit plans available for 19-26 year olds
Lots more
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Chapter 58– And MoreChapter 58– And More
“Connector” allows uninsured over subsidy level to buy coverage pre-tax Portability; part-timers can aggregate
contributions Disparities Council Quality and Cost Council
Cost and quality performance benchmarks Website with findings
Restores $20 million for public health prevention programs
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Round 3 – What’s Next?Round 3 – What’s Next?
Overrides of Romney vetoes of individual provisions
Need federal approval Implementation challenges are hugeFunding depends on continued
commitment of political leaders, economy staying healthy
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The National Stakes…The National Stakes…
Familiar Health Reform Refrain: Who pays what to expand coverage?
Political Right: Health care should be individual responsibility
Political Left: More employer responsibility (assuming single
payer not viable for now) This bill: Combines both in untested way.
Does this change political sense of what’s possible?
Next challenge: cost and quality
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More information … More information …
Educate yourselfwww.hcfama.org/act – bill text,
summaries, analysiswww.hcfama.org/blog – latest news