Massachusetts Health Reform Round Three. Brian Rosman Health Care For All May 1, 2006
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1 Massachusetts Health Reform Round Three Brian Rosman Health Care For All May 1, 2006
2 Presentation Outline Health Care For All Background Brief History of Massachusetts Reform Round 3 What Was Just Passed The National Stakes Get Involved
3 Health Care For All: What We Do Policy Coalitions to Make Change Coalitions on MassHealth, children s 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 blog, regular s
4 Brief History of MA Reform 1988: Universal Health Care Law Pay/Play Employer Mandate Never Implemented/Repealed 1996 CommonHealth, Student Mandate, Medical Security Plan, Healthy Start still going strong 1996: Chapter 203 MassHealth Bill Medicaid-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
5 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
6 Round 3 the Players Governor Mitt Romney (lame duck running for President) Sen. Pres. Robert Travaglini + Senate House Speaker Sal DiMasi + House Federal officials want to approve waiver Business Groups: Small biz, ideological right-wing Large biz, pragmatic, health infiltration Affordable Care Today Coalition (ACT!) HCFA, GBIO, Providers, Labor, Others MassACT Ballot Initiative Committee
7 Round 3 The Federal Waiver Section 1115 feds can waive Medicaid rules : Two waivers, no change Includes $385M MCO supplemental payments to Cambridge Hospital s Network Health and Boston Medical Center s HealthNet 2005: Feds demand changes Payments to institutions must shift to coverage Deadline: in place by 7/1/06
8 Round 3 Timeline 11/04: Travaglini, Romney Announce Plans 4/05: Travaglini Bill Filed 7/05: Romney Bill Filed 8/05: MassACT Ballot Petition Filed 11/05: House, Senate Pass Bills 12/05: Conference Committee Begins 4/06: Bill Pass Legislature: in House; 37-0 in Senate 4/06: Romney signs bill and vetoes 8 sections
9 Chapter 58 MassHealth MassHealth: Kids coverage expanded to 300% fpl ($60,000/family of 4) Automatic transfer of CMSP kids Premiums and crowd-out provisions MassHealth Essential enrollment cap increased Dental, dentures, eyeglasses, other services restored for adults (vetoed) $3 million in outreach grants to community groups
10 Chapter 58 Pool Uncompensated Care Pool continues No changes in funding, regulations until 10/1/07 Then becomes Health Safety Net Trust Fund, administered by Office of Medicaid Payments then made on claims basis, using adjusted Medicare rates
11 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 if above 100% fpl No deductibles Below 100%: MassHealth cost-sharing, dental, prescription, mental health benefits
12 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
13 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
14 Chapter 58 Employers Fair Share Contribution (vetoed) Employers who don t 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
15 Chapter 58 - Connector Connector formed as independent authority Certifies insurance plans as good value; available pretax Plans available to uninsured individuals and small employers Allows portability if you change jobs Part-time workers can combine employer contributions
16 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% year olds can stay on parents plans for 2 years Special reduced-benefit plans available for year olds Lots more
17 Chapter 58 And More Disparities Council Quality and Cost Council Cost and quality performance benchmarks Website with findings Restores $20 million for public health prevention programs
18
19 Round 3 What s s 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
20 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. Other states are cutting, not expanding Next challenge: cost and quality
21 Getting Involved Educate yourself Take Action contact legislators Letters to editor
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