Post on 27-Mar-2015
transcript
…and the rest of the story
Massachusetts Health Reform
Kaiser Family FoundationAlliance for Health Reform
Grace-Marie TurnerGalen Institute
May 19, 2008
Massachusetts Connector optionsMassachusetts Connector options
Four premium levels for similar coverage Four premium levels for similar coverage through the subsidized Commonwealth through the subsidized Commonwealth Care programCare program
Approved health insurance plans offer Approved health insurance plans offer coverage through the unsubsidized coverage through the unsubsidized Commonwealth Choice planCommonwealth Choice plan
Commonwealth Care Commonwealth Care Enrollment Nov ‘06 – Dec ‘07Enrollment Nov ‘06 – Dec ‘07
Enrollment (thousands) as of the first of the month
0
20
40
60
80
100
120
140
160
Nov '06 Dec '06 J an '07 Feb '07 Mar '07 Apr '07 May '07 J un '07 J ul '07 Aug '07 Sep '07 Oct '07 Nov '07 Dec '07
Premium-paying
No premium
Commonwealth Care Commonwealth Care Enrollment Sept ‘07 – May ‘08Enrollment Sept ‘07 – May ‘08
Enrollment (thousands) as of the first of the month
0
50
100
150
200
Sep '07 Oct '07 Nov '07 Dec '07 J an '08 Feb '08 Mar '08 Apr '08 May '08
Premium-payingNo premium
Summary of Costs by Plan TypeSummary of Costs by Plan Type
Plan 1Plan 1 Plan 2Plan 2 Plan 3Plan 3 Plan 4Plan 4
Monthly Monthly PremiumPremium
$0$0 $0-$35$0-$35 $70-$70-$105$105
Depends Depends upon plan upon plan choicechoice
Max OOPMax OOP
(Med/Rx)(Med/Rx)
$36 / $36 / $200$200
$250 /$250 /
$250$250
$500 /$500 /
$500$500
Phased Phased out 7/1out 7/1
Largest enrollment in no-cost plansLargest enrollment in no-cost plansEnrollment by Plan Type as of May 1st
Total: 176,879 enrolled individuals
Type 1 (0-100% FPL), 79,039,
45%
Type 2A (100-150% FPL),
47,469, 27%
Type 2B (150-200% FPL),
29,234, 17%
Type 3 (200-300% FPL, low
premium), 16,716, 9%
Type 4 (200-300% FPL, low copays), 4,421,
2%
Enrollment in Enrollment in Commonwealth ChoiceCommonwealth Choice
14,69815,922
17,161 17,490 17,907 18,122
0
5,000
10,000
15,000
20,000
Dec '07 Jan '08 Feb '08 Mar '08 Apr '08 May '08
1. Enrollment (members) as of the first of the month
Typical connector pricesTypical connector prices
CoverageCoverage Annual premiumAnnual premium
Young adultYoung adult $$2,0002,000 deductible deductible $2,280$2,280
HMO/ no ded.HMO/ no ded. $6,096$6,096
Young familyYoung family $1,500/$3,000 ded.$1,500/$3,000 ded. $7,200$7,200
HMO/ low ded.HMO/ low ded. $18,300$18,300
Empty-nest coupleEmpty-nest couple $2,000/$4,000 ded.$2,000/$4,000 ded. $7,800$7,800
HMO/ no ded.HMO/ no ded. $21,804$21,804
0
40,000
80,000
120,000
160,000
200,000
240,000
280,000
Medicaid Enrolled Paying somepremium
300+%
Enrolled Yet to be addressed
Est.: 89,000
Est.: 207,500
Est.: 228,000 *
87,000*
176,000
Commonwealth Care
} 48,961 17,000
Connector coverage through March 1, 2008
Risks moving forwardRisks moving forward
For consumers…For consumers…– State approved a 12% insurance rate increase State approved a 12% insurance rate increase
for next yearfor next year– Fines to individuals continue to riseFines to individuals continue to rise
$219 in first year$219 in first year
Up to $912 this year; $1,824 for uninsured couplesUp to $912 this year; $1,824 for uninsured couples– Shortage of doctors in some areas taking new patientsShortage of doctors in some areas taking new patients
Rising costs for taxpayersRising costs for taxpayers
Crowd-out of job-based insuranceCrowd-out of job-based insurance
Taxpayer costs are risingTaxpayer costs are rising
State budget calls for $869 million in fiscal State budget calls for $869 million in fiscal 2009, but the bill could be closer to $1.1 billion2009, but the bill could be closer to $1.1 billion
About 330,000 Massachusetts residents are About 330,000 Massachusetts residents are newly enrolled in coverage, but at least 263,000 newly enrolled in coverage, but at least 263,000 are in free or subsidized plansare in free or subsidized plans
Concerns about crowd-outConcerns about crowd-out
Up to 40,000 workers are offered health insurance at Up to 40,000 workers are offered health insurance at work, but can’t afford the premiums and earn under work, but can’t afford the premiums and earn under 300% of poverty. 300% of poverty.
Workers eligible for Commonwealth Care can switch Workers eligible for Commonwealth Care can switch from job-based coverage, under certain conditionsfrom job-based coverage, under certain conditions
The employee share of job-based coverage often costs more The employee share of job-based coverage often costs more than subsidized Commonwealth Care. E.g. $70/mo vs. 39/mo. than subsidized Commonwealth Care. E.g. $70/mo vs. 39/mo.
If only 10% of those eligible shift from job-based insurance to If only 10% of those eligible shift from job-based insurance to C-Care, the total cost next year alone could be an additional C-Care, the total cost next year alone could be an additional $90 billion, potentially reaching $550 billion by 2012 for this $90 billion, potentially reaching $550 billion by 2012 for this population.population.
Growing pains?Growing pains?
Or are the costs and complexities of major Or are the costs and complexities of major changes to the health sector, even in a state changes to the health sector, even in a state that had a head start on the rest of the that had a head start on the rest of the country, far greater than anticipated?country, far greater than anticipated?
Example: Just one set of regulations by one Example: Just one set of regulations by one of Massachusetts’ new health reform boards of Massachusetts’ new health reform boards and commissions to deal with just one and commissions to deal with just one problem…problem…
Minimum Coverage Standards -- 2009Minimum Coverage Standards -- 2009
Prescription drug coverage.Prescription drug coverage.
Visits to the doctor for preventive care, before a deductible.Visits to the doctor for preventive care, before a deductible.
Deductibles that are capped at $2,000 for an individual or Deductibles that are capped at $2,000 for an individual or $4,000 for a family each year.$4,000 for a family each year.
An annual cap on out-of-pocket spending at $5,000 for an An annual cap on out-of-pocket spending at $5,000 for an individual or $10,000 for a family (for plans with up-front-individual or $10,000 for a family (for plans with up-front-deductibles or co-insurance). deductibles or co-insurance).
No cap on total benefits for a particular sickness or for a No cap on total benefits for a particular sickness or for a single year.single year.
No cap on payment toward a day in the hospital.No cap on payment toward a day in the hospital.
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2008 Draft Affordability Schedule 2008 Draft Affordability Schedule Proposed March 20Proposed March 20thth
Individuals Couples Families
Annual Gross Income Range
2008 Proposed
Annual Gross Income Range
2008 Proposed
Annual Gross Income Range
2008 Proposed
$0 - $15,612 (150%) $0 $0 - $21,012 (150%) $0 $0 - $26,412 (150%) $0
$15,613 - $20,808 (200%) $39 $21,013 - $28,008 (200%) $78 $26,413 - $35,208 (200%) $78
$20,809 - $26,016 (250%) $77 $28,009 - $35,016 (250%) $154 $35,209 - $44,016 (250%) $154
$26,017 - $31,212 (300%) $116 $35,017 - $42,012 (300%) $232 $44,017 - $52,812 (300%) $232
$31,213 - $37,500 (360%) $165 $42,013 - $52,500 (375%) $297 $52,813 - $70,000 (398%) $352
$37,501 - $42,500 (408%) $220 $52,501 - $62,500 (446%) $396 $70,001 - $90,000 (511%) $550
$42,501 - $52,500 (505%) $330 $62,501 - $82,500 (589%) $550 $90,001 - $110,000 (625%) $792
>$52,501 n/a >$82,501 n/a >$110,001 n/a
Signing ceremonySigning ceremonyApril 12, 2006April 12, 2006