Upload
andrew-padilla
View
226
Download
0
Tags:
Embed Size (px)
Citation preview
Implementing Massachusetts Implementing Massachusetts Health Reform Health Reform
Families USABrian Rosman ([email protected])Health Care For All (www.hcfama.org)January 2007
Presentation OutlinePresentation Outline
What Is Health Care For All MA Health Reform History – Why ‘Third Wave?’ Round 3: Chap. 58 Acts of ‘06 – What Passed?
Insurance Connector: Subsidized Coverage – CCHIP MassHealth Expansions & Restorations Individual and Employer Responsibility Insurance Market Reforms Quality, Costs, Health Disparities and more
Why and How Did Chapter 58 Happen? What’s Happening with Implementation? Is Chapter 58 a National Model? What’s the Emerging Political Window of
Opportunity for Health Care Access Reform?
Health Care For All: Who We AreHealth Care For All: Who We Are
Just Massachusetts We Run Health Policy Coalitions
Affordable Care Today (ACT!!) Children’s Health Access Coalition (CHAC) Racial & Ethnic Health Disparities Action Network (DAN) Oral Health Advocacy Task Force Private Market Consumer Coalition Emerging projects on e-Health and Quality
We Run Programs to Help Consumers Consumer Helpline (telephone/email), Outreach &
Enrollment, Health Law Advocates We Communicate to Inform Everyone
www.hcfama.org, email updates, Blog (blog.hcfama.org)
Brief History of MA Health ReformBrief History of MA Health Reform
1988: Universal Health Care Law $1680 Pay or Play Employer Mandate
Delayed three times/Repealed 1996 CommonHealth, Student Insurance Mandate, Medical Security
Plan (unemployed), Healthy Start (pregnant)
1996: MassHealth Waiver Expansion law Medicaid->MassHealth; Enrollee growth from 670,000 (’95) to
1,020,000 (’01) Uninsurance Drop: 680,000 to 365,000 Coverage for all children – CMSP Senior Pharmacy Program
Both reform waves inspired national action 1988 Leads to state-based innovations 1996 Leads to Creation of SCHIP
April 12, 2006: Chapter 58April 12, 2006: Chapter 58
Medicaid Expansions and RestorationsMedicaid Expansions and Restorations
MassHealth ( = Medicaid waiver): Children’s coverage expands to 300% fpl from 200% fpl MassHealth enrollment caps lifted
Essential, CommonHealth, HIV Optional Benefits Restored: dental, dentures, eyeglasses,
other adult services New smoking cessation and wellness benefits $3M outreach/enrollment grants $270M ($90 per year) rate hikes to hospitals and physicians
Years 2/3 tied to Pay for Performance/Racial Ethnic health disparities benchmarks
Bottom Line: 53,000 new enrollees since July – half kids, half adults
Chapter 58 – Insurance Connector Chapter 58 – Insurance Connector and Commonwealth Careand Commonwealth Care
Insurance Connector set up as quasi-public authority – 10 member board Provides Commonwealth Care - subsidized
coverage for below 300% fpl Provides Commonwealth Choice – non-
subsidized “affordable” coverage for individuals and small business
Defines individual mandate
Subsidized CoverageSubsidized Coverage
“Commonwealth Care:” subsidized coverage for uninsured adults below 300% of poverty Rules:
No employer coverage available in past 6 months
COBRA or non group OKLegal residents OK, even Medicaid ineligible“private coverage” – offered by 4 Medicaid
MCOswww.macommonwealthcare.com
Subsidized CoverageSubsidized Coverage
Below 100%: No premium, no deductiblesMedicaid Drug copays ($1 / $3)comprehensive benefits, including dental
No major issues34,000 enrolled, mostly from charity care
program (“Uncompensated Care Pool”)
Subsidized CoverageSubsidized Coverage
100% - 300%: Sliding scale premiums, no deductiblescommercial copays ($10 - $30)comprehensive benefits, but no dental
Enrollment just getting startedWe’re pushing to add dentalTo be decided: employee buy-in for those
with employer coverageTop Issue: are premiums too high?
Subsidized CoverageSubsidized Coverage
Premiums for lowest cost plan (per month): 100%-150% $18
($9,800 - $14,700)
150%-200% $40($14,700 - $19,600)
200%-250% $70($19,600 - $24,500)
250%-300% $106($24,500 – $29,400)
note: income amounts rounded
Individual ResponsibilityIndividual Responsibility
Individual Mandate Beginning 7/1/07, all residents 18+ must obtain health
insurance coverage. Penalty if no coverage on 12/31/07 Penalties assessed if “affordable coverage” is available 2007: loss of personal tax exemption 2008+:tax penalty=½ cost of affordable plan per month
Issue: what is affordable? Coalition doing focus groups, research. Decision this spring.
What is “Minimum Creditable Coverage?” that meets mandate. Initial proposal: $1,500 deductible, generics only. We issued policy guidance.
Employer ResponsibilityEmployer Responsibility
Employer “Mandate”“Fair Share” Employer Contribution
Employers (11+ workers) who don’t offer “fair and reasonable” coverage must pay $295 per worker
Definition of “fair and reasonable” neither: either pay 25% of premium, or cover 33% of workers
We’re filing bill for 50% of premium, 50% of workers, include part-timers
ERISA issue?????
Employers must facilitate Section 125 “cafeteria plan” for pre-tax health insurance, or pay “Free Rider Surcharge”
Non-Subsidized CoverageNon-Subsidized Coverage
Commonwealth ChoicePlans for individuals and small business3 levels: high, mid and “minimum
creditable coverage”Tough new issues for us to learn:
List billing Brokers and intermediaries Actuarial equivalents etc . . .
Starts July 1
Chapter 58– Insurance Market and Chapter 58– Insurance Market and Other ReformsOther Reforms
Small/Nongroup Insurance Market Reforms Non-group (individual) market will merge with small group
market on 7/1/07. Study commission found non-group goes down 15%, small group up 1.5%
Young adults (19-25) can stay on parents’ plans for 2 years after lose dependency
Reduced-benefit plans for 19-25 year olds Other Reforms
$20M Public Health/Prevention Restorations Diabetes, cancer, infection control, more
Quality and Cost Council Sets cost and quality benchmarks Produces website with data/findings
Racial/Ethnic Health Disparities Council Statewide Disparities Council Pay for Performance benchmarks
Computerized Prescription Order Entry – $5 million
How Do the Pieces Fit Together?
17%
40%
29%
14%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
MassHealth(Medicaid) expansions
Commonwealth Care(subsidized coverage)
AffordableCoverage/IndividualMandate? (income
300-600% FPL)
Individual Mandate(those with incomes
>600% FPL)
Percent of State’s Total Uninsured Targeted by different approaches
Coalition Role After Bill PassesCoalition Role After Bill Passes
Coalition continues strong. ACT! is now ACT!!
Monitoring implementation – central source of information
Administrative advocacy with Connector and state agencies (Division of Insurance, Medicaid)
Introduced legislation with 15 provisions It’s never over
Is Chapter 58 a National Model…?Is Chapter 58 a National Model…?
Reasons why not… Different makeup of uninsured population
Lower proportion of uninsured Lower proportion of lower-income uninsured
Highly regulated insurance market Guaranteed issue, prohibition on medical
underwriting, modified community rating Essential protections for individual responsibility
Robust Safety Net/Deep Federal Financing Reasons why…
Individual/Employer/Government responsibility Confronting the affordability challenge Less a policy blueprint/More a political one
MedicareMedicaid
Employer Coverage
IndividualIndividualMandateMandate
MedicaidExpansions
EmployerResponsibility
InsuranceMarket
Reforms
AffordableProducts
Young Adult
Products
Connector
CommonwealthCare
Where From Here?Where From Here?
State Actions – 2007-08 New, invigorated conversation CA, CO, CT, MI, MO, NY, OH, RI, WA, WI, IL… 10 states now Democratic Gov and leg (was 3)
Congressional Action – 2007-08 SCHIP expires 9-30-07 Medicare issues Access – is there room on the agenda?
2008 Presidential Campaign Changed dynamic for all Democrats Changes dynamic for all Republicans Different kind of conversation in 2008