| Plan |
MassHealth | |
| Date |
April 2006 (Enacted)
July 2007 (Implemented) | |
| Overall Approach |
Universal coverage through individual mandate and the creation of a state health insurance exchange | |
| Universal Coverage |
Yes | |
| Guaranteed Coverage |
Yes | |
| Portability |
Yes | |
| Voluntary Employer-Based System |
Yes | |
| New Programs |
Established the Commonwealth Health Insurance Connector, an insurance exchange providing individuals and small businesses access to easily comparable insurance products
| |
| Expansion of Existing Public Programs/Federal Law |
Expanded set of eligible individuals through the Massachusetts
Medicaid program (MassHealth)
Expansion of the state’s Medicaid program children with family incomes up to 300 percent FPL | |
| Insurance Pool |
Pooling mechanism created by the merging of the small and non-group health insurance markets and individual coverage mandate | |
| State Responsibility |
N/A | |
| Individual Mandate |
State residents required to purchase health insurance coverage, with limited exception
Individuals without coverage face financial penalties up to $912/year | |
| Employer Mandate |
Employers with 11 or more employees required to make a "fair and reasonable" contribution toward health insurance coverage for their employees
Employers not providing employee coverage required to pay a "Fair Share" contribution of up to $295 annually per employee and subject to "free rider assessment" for services provided to uncovered workers
Employers required to permit workers to purchase health care with pre-tax dollars cost standards | |
| Private Insurance Mandates |
Plans participating in the Commonwealth Health Insurance Connector required to meet certain coverage cost standards
Participating plans subject to a surcharge earmarked for Connector administrative and operational expenses
Eliminated new enrollments into non-group products | |
| Individual Subsidies |
Subsidized health coverage available for individuals with income below 300 percent of the federal poverty level | |
| Individual Vouchers |
No | |
| Employer Subsidies |
No | |
| Individual Plan/Provider Choice |
Yes | |
| National Health Board |
N/A | |
| Tax Changes |
Employers required to allow employees to pay health coverage with pre-tax dollars
Tax penalties paid for lack of coverage | |
| Premium/Co-Pay/Deductible |
For 2008, subsidized premiums for individuals between $0 and $330/mo and $0 and $792/mo for families
Sliding scale premiums based on income level
Sliding scale co-pays based on income level
Deductibles capped at $2,000 for an individual or $4,000 for a family each year
Annual cap on out-of-pocket spending of $5,000 for an individual or $10,000 for a family (for plans with up-front-deductibles or co-insurance on core services) | |
| Health Quality Improvement |
Carriers encouraged to develop select or tiered networks that favor more cost-efficient, high quality providers and to develop new chronic disease prevention and care management initiatives
Grants to providers to support improvements in community-based care, clinical support, care coordination services, disease management services, primary care services, and pharmacy management services.
Rate increases for MassHealth providers for meeting performance goals related to quality, efficiency, the reduction of racial and ethnic disparities, and improved patient outcomes | |
| Information Technology / Electronic Medical Records |
Not addressed | |
| Individual Responsibility for Health and Lifestyle |
Yes | |
| Preventive care |
Visits to the doctor for preventive care covered prior to a deductible
$7 million for a two-year smoking cessation pilot for MassHealth
Lower cost sharing responsibilities for healthy behaviors such as smoking cessation, diabetes screening, teen pregnancy prevention, cancer screening and stroke education | |
| Transparency |
Health Care Quality and Cost Council has called for the development of a website to provide consumers with cost and quality information to compare health care procedures at different hospitals | |
| Drug Reimportation |
N/A | |
| Medicare Rx Drug Price Negotiation |
N/A | |
| Medical Personnel Education |
Not addressed | |
| Mental Health Parity |
Yes | |
| Other Provisions |
Allows senior and disabled legal immigrants who don't qualify for federal Medicaid reimbursement to receive MassHealth Essential benefits | |
| Cost |
$869 million in 2009 | |
| Cost Containment |
Health Care Quality and Cost Council has called for the adoption of a standard measurement of annual health care spending for the state-the "Massachusetts Global Health Cost Indicator"
Renewal of participating insurers encouraged carriers to develop select or tiered networks that favor more cost-efficient, high quality providers
Renewal specifications set a target of no more than five percent for annual premium increases | |
| Financing |
Re-direction of existing funds spent on the uninsured through the Uncompensated Care Pool and disproportionate share hospital payments
New state and federal matching funds
Hospital, individual and employer assessments | |
| Source |
"Health Care Access and Affordability Conference Committee Report," Commonwealth Connector, April 3, 2006
"Massachusetts Health Care Reform Bill Summary," Blue Cross Blue Shield of Massachusetts Foundation, Accessed Jan. 16, 2009
Jeffrey Krasner, "Penalties to rise for shunning insurance," Boston Globe, Jan. 1, 2008
"Massachusetts Health Care Reform: Two Years Later," Kaiser Family Foundation, May 2008
"Individuals & Families," Commonwealth Connector, Accessed Jan. 16, 2009
"Health Plan Renewal Specifications," Commonwealth Connector, Dec. 4, 2007 | |
