Health Care Reform: Massachusetts Two Years Later

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Health Care ReformMassachusetts Two Years Later

• Sarah Iselin
• Massachusetts Division of Health Care
• Finance and Policy
• July 2008

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April 2006

• Chapter 58
• is signed!

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The Massachusetts LawWhy So Much Attention?

• Ambitious goal Near universal coverage
• Transcends ideology
• Bipartisan support
• Combines policy solutions from the right and the
  left
• Partnership between federal government and state
• Novel approaches
• Individual mandate, employer responsibility,
  insurance market changes

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Where We Started in 2006 Uninsured In
Massachusetts
Sources Health Insurance Status of
Massachusetts Residents, 1998, 2000, 2002, 2004,
2006 Massachusetts Division of Health Care
Finance and Policy. BCBS Foundation/Urban
Institute, Census Bureau.
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The Goal Near Universal Coverage

• Principles of Reform
• Build upon the existing base fill in gaps
• Shared responsibility
• Individuals
• Employers
• Government
• Shift financing from opaque bulk payments to
  safety net providers to health insurance for
  individuals

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Where are we now?
Uninsurance for working-age adults has been
nearly cut in half
Fall 2006
Fall 2007
Source Getting Ready for Reform, Sharon Long and
Mindy Cohen, the Urban Institute, May 2008.
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Lessons from Massachusetts

• Seize the moment
• 1115 Waiver
• New House Speaker
• Governor presumed running for President
• Make the moment
• Ballot initiative
• Roadmap to Coverage

No reform is possible without strong organizing
and advocacy
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Lessons from Massachusetts

• Our law is as much a political blueprint as a
  policy blueprint
• Get everyone to the table and keep them there
• Many different tables
• Relationships matter

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WHO STILL SUPPORTS THE MASSACHUSETTS HEALTH
REFORM LAW?
Mass Medical Society
MASSACHUSETTS LEAGUE OF COMMUNITY HEALTH
CENTERSGood health.  Right around the corner.
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Lessons from Massachusetts

• Our law is as much a political blueprint as a
  policy blueprint
• Get everyone to the table and keep them there
• Many different tables
• Relationships matter

• Compromise
• Everyone got something and also gave something
  up

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Everyone got something

• Consumers Medicaid expansion, subsidies,
  employer responsibility
• Providers Medicaid rate increases
• Business Lower assessment than might have
  otherwise been, sets no precedent since based on
  pool, individual mandate, expanded subsidies for
  small employers and their low-wage workers
• Insurers New potential members, young adult
  products, individual mandate

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And traded something off

• Consumers Individual mandate, potential for
  increased cost sharing
• Providers More pay for performance, less money
  than they wanted (but still a LOT)
• Business More assessment than they wanted
• Insurers Subsidized plans limited to current
  Medicaid managed care organizations for the first
  three years, less flexibility on benefit design
  than they wanted

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Lessons from Massachusetts

• Our law is as much a political blueprint as a
  policy blueprint
• Get everyone to the table and keep them there
• Many different tables
• Relationships matter
• Compromise
• Everyone got something and also gave something
  up

• Create shared ownership
• Passing law is only the first step
• Continued coalition and collaboration after
  passage
• Advocates must have capacity to participate in
  implementation

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Lessons from Massachusetts

• On-going framing and messaging are critical
• Understanding and shaping public opinion

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Support for reform is still strong
Support amongst working-age Massachusetts adults
Fall 2006
Fall 2007
Source Getting Ready for Reform, Sharon Long and
Mindy Cohen, the Urban Institute, May 2008.
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Challenges Ahead

• Education, outreach and enrollment
• Sustaining public support
• Ensuring access for the newly insured
• Maintaining strong safety net for those who will
  remain uninsured
• Financing need a strong state economy
• Continued federal support for waiver renewal
• Moderating health care cost growth

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GLOBE EDITORIAL
July 15, 2008
Patrick makes a tough choice
THE GOOD news is that enrollment in the state's
new subsidized health insurance program has
greatly exceeded projections. The bad news is
that this has raised the first-year cost of
Commonwealth Care from an expected 472 million
to 630 million. To fill the gap, the Patrick
administration has devised a plan that spreads
the pain relatively equally among health reform's
major stakeholders, from providers to employers
to insurers and the state itself. The most
important stakeholders - the individuals and
families who have signed up for the state's
pioneering effort at universal coverage - have
already done their bit. In April, their premiums
rose 10 percent and their co-payments also
increased. The Legislature should approve the
governor's proposal or come up with a better one
before it adjourns at the end of this month.
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July 15, 2008
Business balking at health changes
Many firms and insurers oppose 100m price tag
Public backs Patrick idea to close gap in funding
Governor Deval Patrick's proposal to ask
businesses, insurers, and hospitals to kick in
about 100 million to close a gap in funding for
the state's landmark health insurance law is
threatening to fracture the fragile coalition
whose support was instrumental in passing the
measure
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Wednesday, July 30, 2008
Biz groups Health care reform costs are unfair
Bay State business groups are fighting a state
plan to collect more money for health-care
reform, saying the effort will place too much of
an economic burden on businesses at the wrong
time. Health-care reform and increased access to
health care is a societal benefit that should be
borne by all the citizens of the commonwealth
rather than disproportionately by employers,
Associated Industries of Massachusetts Executive
Vice President Brian Gilmore wrote in a letter to
the groups 7,000 member companies. The Greater
Boston Chamber of Commerce, the Massachusetts
Business Roundtable and the Massachusetts
Taxpayers Foundation also oppose the plan. The
criticism comes as state representatives debate a
plan to generate an additional 89 million for
the health-care reform law.
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Individual Mandate
Insurance Market Reforms
Affordable Products
Young Adult Products
Medicaid Expansions
Commonwealth Care