Massachusetts Health Reform Round Three

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Massachusetts Health Reform Round Three

• Brian Rosman Fawn Phelps
• Health Care For All, Massachusetts

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Presentation Outline

• Health Care For All Background
• Brief History of Massachusetts Reform
• Round 3 What Massachusetts Passed
• The National Stakes
• Stay Informed

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Health Care For All What We Do

• Policy Coalitions to Make Change
• Coalitions on MassHealth, childrens coverage,
  disparities, oral health, private market
  concerns, and health reform
• Also work on E-Health, quality issues
• Programs to Help Consumers
• Consumer Helpline, Outreach, legal
• Communication to Inform Everyone
• www.hcfama.org, blog, regular emails

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Brief 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• Never Implemented/Repealed 1996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-gtMassHealth 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 Problems

• 500,000 uninsured growing
• Decline in employer-provided coverage
• 4th largest percentage drop nationally
• Main reason high cost of care
• Federal Medicaid Waiver (MassHealth) renewal
  must implement July 2006
• Providers underpaid by MassHealth

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Round 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 Waiver

• Section 1115 feds can waive Medicaid rules
• 19972005 Two waivers, no change
• Includes 385M supplemental payments to public
  hospital-sponsored managed care plans for
  uninsured
• 2005 Feds demand changes
• Payments to institutions must shift to coverage
• Deadline in place by 7/1/06

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Round 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 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 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 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 fpl
• No deductibles
• Below 100 MassHealth cost-sharing, dental,
  prescription, mental health benefits

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Chapter 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 Individuals

• Individual Mandate
• All residents must obtain health coverage if
  affordable coverage available
• Board of Connector defines affordable
• We will advocate to only apply to fairly well-off
  people
• Enforced through tax system
• Begins July 2007

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Chapter 58 Employers

• Fair Share Contribution
• Employers who dont offer coverage with 11
  employees pay 295/ worker
• Employer 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 Insurance

• Insurance Market Reforms
• Does not authorize high deductibles as Romney
  wanted
• Non-group (individual) health insurance market
  merges into small group market
• Could 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 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 Whats Next?

• Overrides of Romney vetoes of individual
  provisions
• Need federal approval
• Implementation challenges are huge
• Funding depends on continued commitment of
  political leaders, economy staying healthy

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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 whats possible?
• Next challenge cost and quality

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More information

• Educate yourself
• www.hcfama.org/act bill text, summaries,
  analysis
• www.hcfama.org/blog latest news