Loading…

Flash Player 9 (or above) is needed to view presentations.
We have detected that you do not have it on your computer. To install it, go here.

Like this presentation? Why not share!

Like this? Share it with your network

Share

Health Care Reform: Massachusetts One Year Later

on

  • 2,753 views

Presentation summarizing the state of healthcare reform in Massachusetts for the National Academy for State Health Policy's 20th Annual State Health Policy Conference, October 15, 2007, by Sarah ...

Presentation summarizing the state of healthcare reform in Massachusetts for the National Academy for State Health Policy's 20th Annual State Health Policy Conference, October 15, 2007, by Sarah Iselin.

Statistics

Views

Total Views
2,753
Views on SlideShare
2,752
Embed Views
1

Actions

Likes
1
Downloads
148
Comments
1

1 Embed 1

http://www.slideee.com 1

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
  • wow i didn't know there were so many health info problems in massachusetts! http://www.fithuman.net/
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Health Care Reform: Massachusetts One Year Later Presentation Transcript

  • 1. Health Care Reform: Massachusetts One Year Later Sarah Iselin Massachusetts Division of Health Care Finance and Policy October 2007
  • 2. April 2006 Chapter 58 is signed! Massachusetts Division of Health Care Finance and Policy - 2
  • 3. The Massachusetts Law: Why 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 Massachusetts Division of Health Care Finance and Policy - 3
  • 4. Massachusetts: The Building Blocks for Reform • Relatively low rate of uninsurance • History of health coverage expansions • Broad Medicaid program •1115 Waiver • Uncompensated Care Pool • Highly regulated small group and individual health insurance markets Massachusetts Division of Health Care Finance and Policy - 4
  • 5. Where We Started in 2006: Uninsured In Massachusetts 800,000 748,000 700,000 657,000 644,000 682,000 627,000 600,000 549,000 496,000 534,000 500,000 439,000 460,000 395,000 400,000 365,000 418,000 355,000 300,000 200,000 1998 2000 2002 2003 2004 2006 2007 State estimate CPS estimate Urban Institute 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. Massachusetts Division of Health Care Finance and Policy - 5
  • 6. 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 Massachusetts Division of Health Care Finance and Policy - 6
  • 7. How Will We Get There? • Medicaid expansions and restorations • Subsidized coverage for low-income adults • Changes to the insurance market to help individuals and small businesses • Individual mandate • Employer responsibilities (for firms with > 11 employees) Massachusetts Division of Health Care Finance and Policy - 7
  • 8. Massachusetts Health Reform: How Do the Pieces Fit Together? Percent of State’s Total Uninsured Targeted by Different Aspects of Law Medicaid Expansion 19% quot;Affordable Productsquot; and Individual Mandate (>300% FPL) Commonwealth Care 44% 37% Massachusetts Division of Health Care Finance and Policy - 8
  • 9. How Are We Doing?
  • 10. Medicaid: +56,000 Members MassHealth Caseload 1,150,000 Commonwealth August 2007 Care 1,090,000 Health Care • Discontinued 1,100,000 Reform MassHealth Basic • Premiums for some Initial Gateway roll- optional populations out 1,050,000 1,034,000 1,000,000 950,000 900,000 MassHealth Essential 850,000 800,000 Ap 3 O2 Ap 5 O5 O6 Ap 7 04 O3 Ja 3 Ap 6 Ja 6 07 Ja 2 04 Ja 4 Ja 5 07 Ap 4 03 05 06 0 0 0 0 0 0 0 0 -0 -0 -0 -0 -0 0 n- l- n- l- r- l- n- l- n- r- l- l- n- r- r- r- ct ct ct ct ct Ju Ju Ju Ju Ju Ju O Massachusetts Division of Health Care Finance and Policy - 10
  • 11. Subsidized Insurance: Commonwealth Care Monthly Premium Schedule FPL Individual Couple Couple with children <151% $0 $0 $0 150.1 - $35 $70 $70 200% 200.1 – $70 $140 $140 250% 250.1 – $105 $210 $210 300% www.macommonwealthcare.com Massachusetts Division of Health Care Finance and Policy - 11
  • 12. Commonwealth Care: 127,000+ Enrollment (thousands) as of the first of the month 120 Premium-paying No premium 100 80 60 40 20 0 Nov '06 Dec '06 Jan '07 Feb '07 Mar '07 Apr '07 May '07 Jun '07 Jul '07 Aug '07 Sep '07 Massachusetts Division of Health Care Finance and Policy - 12
  • 13. Pool caseload has declined by nearly 30%. Comparison of UCP Caseload to Commonwealth Care Enrollment October 2006 through July 2007 UCP Caseload Commonw ealth Care 300,000 246,183 250,000 225,090 240,166 183,603 179,022 200,000 170,629 179,207 183,161 173,838 172,769 150,000 92,046 79,800 100,000 62,979 69,328 52,045 44,938 34,343 50,000 18,327 3,654 0 0 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 •The UCP caseload has declined by 27% since October 2006. •The UCP caseload does not include people with MassHealth or Commonwealth Care or emergency room bad debt. Massachusetts Division of Health Care Finance and Policy - 13
  • 14. Uncompensated Care Pool to Health Safety Net • We will continue to need a strong health safety net to protect those who remain without health coverage and the providers that care for them. HSN policies reflect the following principles: • Promotion of enrollment in health insurance coverage • If eligible for MassHealth or Commonwealth Care, no HSN • Consideration and alignment of policies with those of other state health programs (Commonwealth Care, Commonwealth Choice and MassHealth) • MassHealth Standard benefits, co-payments consistent with Commonwealth Care • Promotion of the delivery of care in the most appropriate and efficient setting Massachusetts Division of Health Care Finance and Policy - 14
  • 15. Individual Mandate: The Benefits (Minimum Creditable Coverage) Benefits Preventive and primary care (at least 3 visits prior to deductible) • Emergency services, hospitalization benefits, ambulatory patient • services, mental health services and all state mandated benefits Prescription drug coverage • Cost-sharing Deductible capped at $2,000 for individual coverage and $4,000 • for family coverage Separate drug deductible may not exceed $250 for individual and • $500 for family coverage Maximum out-of-pocket spending for in-network services capped • at $5,000/$10,000  Must include the upfront deductible, most co-insurance, and any services that require $100 or more in co-payments Massachusetts Division of Health Care Finance and Policy - 15
  • 16. Individual Mandate: The Affordability Schedule SINGLES COUPLES FAMILIES WITH CHILDREN Monthly Monthly Monthly Annual Income Premium Annual Income Premium Annual Income Premium $0 - $15,315 $0 $0 - $20,535 $0 $0 - $25,755 $0 $15,316 - $20,420 $35 $20,536 - $27,380 $70 $25,756 – $34,340 $70 $20,421 – $25,525 $70 $27,381 - $34,225 $140 $34,341 - $42,925 $140 $25,526 – $30,630 $105 $34,225 - $41,070 $210 $42,926 - $51,510 $210 $30,631 - $35k $150 $41,071 - $50k $270 $51,511 - $70k $320 $35,001 - $40k $200 $50,001 - $60k $360 $70,001 - $90k $500 $40,001 - $50k $300 $60,001 - $80k $500 $90,001 - $110k $720 Over $50k Affordable Over $80k Affordable Over $110 k Affordable Massachusetts Division of Health Care Finance and Policy - 16
  • 17. Individual Mandate: The Tax Form Massachusetts Division of Health Care Finance and Policy - 17
  • 18. Commonwealth Choice: 6 Health Plans, 36+ Products Connector Seal of Approval Massachusetts Division of Health Care Finance and Policy - 18
  • 19. Commonwealth Choice: Lots of Action Massachusetts Division of Health Care Finance and Policy - 19
  • 20. The Ultimate Endorsement 05/22/2007 11:29 AM ET Connector teams up with Red Sox to build enrollment in new health insurance plans Other corporate/civic partnerships announced as part of public education campaign Massachusetts Division of Health Care Finance and Policy - 20
  • 21. Enrollment Picking Up: 8,300+ Members Enrollment by Health Plan as of 10/1 Harvard Pilgrim Total: 6,196 Subscribers Health Plan, 1,450, 23% Health New England, 201, 3% Neighborhood Health Plan, Fallon 1,147, 19% C ommunity Health Plan, 633, 10% Blue C ross Blue Tufts Health Shield of MA, Plan, 496, 8% 2269, 37% Massachusetts Division of Health Care Finance and Policy - 21
  • 22. Employer Responsibilities • Fair Share Contribution  Make “fair and reasonable” contribution to health insurance or pay assessment (no more than $295 per employee per year) – Employee take-up rate of 25% or more, or – Offer to pay 33% toward cost of coverage • Offer Section 125 Plans or could be subject to Free Rider Surcharge  Allow employees to make pre-tax contributions to health insurance or pay “fair share” charge • Applies only to employers with ≥ 11 full-time employees Massachusetts Division of Health Care Finance and Policy - 22
  • 23. Not Just Coverage • Quality and Cost Council  Goals adopted for FY 2008 – Reduce the annual rise in costs to no more than unadjusted growth in GDP by 2012 – Promote quality improvement through transparency – And more… • Disparities Council • MassHealth pay for performance • Public health/prevention restoration  Infection control, cancer, diabetes, and more Massachusetts Division of Health Care Finance and Policy - 23
  • 24. Familiarity of the public with the Massachusetts Health Reform Law Have heard of law 87% Only a little 25% Just some 27% Quite a bit 22% Great deal 12% Have not heard of law 13% Note: “Don’t know” responses not shown Harvard School of Public Health/BCBS of Mass. Foundation/KFF June 2007 Massachusetts Division of Health Care Finance and Policy - 24
  • 25. Support for Health Reform Law 67% Support 16% Oppose 16% Don't know Note: Of those who had heard of law. Harvard School of Public Health/BCBS of Mass. Foundation/KFF June 2007 Massachusetts Division of Health Care Finance and Policy - 25
  • 26. Massachusetts Division of Health Care Finance and Policy - 26
  • 27. Challenges Ahead • Education, outreach and enrollment • Sustaining public support • Ensuring access for the newly insured • Financing – strong state economy • Continued federal support for waiver renewal • Maintaining strong safety net for those who will remain uninsured • Moderating health care cost trends Massachusetts Division of Health Care Finance and Policy - 27
  • 28. The Biggest Challenge to Sustaining Coverage Expansions Increases in Health Insurance Premiums Compared to Other Indicators, 1988-2007 18.0% 18% Health insurance premiums Overall inflation 16% Workers earnings 14% 12.9%* 14.0% 12% 10.9%* 12.0% 11.2%* 10% 8.2%* 8% 9.2%* 8.5% 7.7% 6% 5.3%* 6.1% 4% 2% 0.8% 0% 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 * Source: Kaiser Family Foundation. Massachusetts Division of Health Care Finance and Policy - 28