Massachusetts
Status of reform effort: The state is currently implementing provisions of the 2006 health care reform law, including the individual mandate, which required all adult residents to have health insurance by December 31, 2007. As of March 2008, 439,000 previously uninsured individuals had obtained health insurance. In August 2008, the Governor signed legislation to control health care costs.
On April 12, 2006, Massachusetts enacted legislation, Chapter 58 of the Acts of 2006, which would provide near universal coverage for state residents.
The components of the legislation included:
- The Commonwealth Care program to provide subsidized coverage for individuals with incomes up to 300 percent of the federal poverty level;
- The Commonwealth Health Insurance Connector to “connect” individuals to insurance by offering affordable, quality insurance products;
- MassHealth (Medicaid program) expansion to children up to 300 percent of the federal poverty level.
- An individual mandate that requires all adults in the state to purchase health insurance by December 31, 2007;
- A requirement that employers with 11 or more employees provide health insurance coverage or pay a “fair share” contribution of up to $295 annually per employee;
The Commonwealth Connector Authority has been charged with implementing several aspects of the reform plan not specified in the legislation. The Board has defined minimum creditable coverage that people need to have in order to meet the individual mandate requirement to include “preventive and primary care, emergency services, hospitalization benefits, ambulatory patient services, mental health services and prescription drug coverage.” The coverage standards cap deductibles at $2,000 for individuals and $4,000 for families and limit out-of-pocket spending to $5,000 for individuals and $10,000 for families.
The Connector Authority also established affordability standards to determine the subsidy levels for individuals enrolled in Commonwealth Care and the premium amounts for families with incomes above 300 percent of the federal poverty level. About 2% of the population has been exempted from the individual mandate because insurance policies that meet the affordability standards set by the Authority are not available.
On August 10, 2008,Governor Patrick signed S. 2526 to control rising health care costs. The legislation establishes a commission to develop uniform billing and coding standards, sets a goal of adopting electronic health records by 2015, emphasizes educating providers on lower-cost drugs and medical treatments, and develops measures to increase the number of primary care doctors. It raises $100 million in state funds and fees on private companies to fund the state’s health reform law. The legislation also sets requirements limiting the gifts that drug companies give to medical professionals On August 8, 2008, the Governor signed H. 5022, which increases state funding for the health reform effort, and on September 30, 2008, the Centers for Medicare and Medicaid Services approved extending a waiver that provides federal funding to the program.
As of March 31, 2008, 439,000 of the estimated 600,000 uninsured individuals in the state had obtained health care coverage. About 176,000 people obtained coverage through the state’s subsidized Commonwealth Care program and the number of people with employer-based coverage increased by 159,000. State residents had until December 31, 2007 to comply with the mandate to purchase health insurance.*
