Lessons from Massachusetts for

Implementing National Health Care Reform

Jon Kingsdale, Ph.D.Executive Director

Mass. Health Connector

Families USAJanuary 28, 2010

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Overview

1. Key elements of reform

2. Progress report on Massachusetts

3. The challenge of implementing

4. Selling insurance—outreach, allies and exchanges

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Mass. Model for National Reform

1. Medicaid Eligibility Expansion

2. Shared Responsibility

- Individual mandate

- Employer contribution

- Public subsidies

3. Insurance Market Reform

4. Insurance Exchange

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Progress Report on Mass.

1. 2.7% uninsured after 3 years

2. Of newly insured, 35% private pay

3. 98% compliance (taxpayer filings)

4. 59% - 75% voter approval rating

5. Net new state costs ~ $350 million

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There’s More to the Story

“If I didn’t have health insurance, I would never have made an appointment with my doctor because of the cost. The cancer would have spread and I would not be alive today to tell you my story.” - Jaclyn Michalos, 27

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There’s More to the Story

Before moving to Mass in 2007, she was told by an insurance agent in her home state: “You’ll never get insurance, so don’t waste your time.”

After discovering Commonwealth Choice: “I did the whole thing online and got a very good plan. I was just thrilled!” Abbie von Schlegell , Commonwealth Choice member

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Strong Voter Support

Source: Kaiser Family Foundation/Harvard School of Public Health/BCBS of Mass Foundation Surveys, 2006-2008; Harvard School of Public Health/Boston Globe Massachusetts Health Reform Poll (conducted September 14-16, 2009)

Public Support for I ndividual Mandate and Health Care Reform in Mass, 2006-2008

52%57% 58%61%

67% 69%

59%

2006 2007 2008 2009

Support for MandateSupport for Reform

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Implementation Challenge for U.S.

All the challenges of Mass., plus…

• Federal vs. state systems, e.g. eligibility determination

• Timelines for a law that is perhaps 15 times more ambitious

• Massive, organized opposition

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“It’s a campaign!” - Tom O’Neill

1. Coordinate government agencies

2. Communicate like crazy

3. Build and sustain coalitions, across the health care sector

4. Make progress monthly

5. Manage expectations

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• Countless moving parts• Strong centralized coordination needed

to track progress and share information

• Secretary of Health and Human Services convened weekly cross agency meetings

• HCR project leaders from each agency reported progress and challenges

Coordinate Agencies

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• One front door for subsidized health programs (MassHealth, Commonwealth Care, and the Health Safety Net)

• Medicaid program has the staffing and systems required to determine income eligibility

• Adding CommCare rules to the existing

eligibility system ensured maximum benefits for applicants & notice of eligibility for all family members

Used Existing MassHealth Infrastructure

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These programs can be applied for online using the Virtual Gateway:

1. MassHealth, including:– Children's Medical Security Plan– Healthy Start– Health Safety Net– CommCare

2. Child Care 3. Food Stamps4. Women Infants Children (WIC) 5. Women’s Health Network6. Department of Mental Retardation services7. Mass. Rehabilitation Commission services 8. Elder services9. Mass. Commission for the Blind Services10. Commission for the Deaf/Hard of Hearing services11. Veterans’ Services/Chelsea Soldiers’ Homes

Virtual Gateway – Front Door for Many Programs

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Communicate Like Crazy

Launch an aggressive public education campaign to:

• Provide information about the new law and raise awareness

• Promote the availability of new plans all certified by the state for quality and value

• Promote the Connector’s ability to offer unprecedented choice

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Connector’s Public Information Unit (November ’06)

• Created to focus on calls regarding Health Care Reform law and business questions

• Alleviated pressure on two call centers for enrollment

• Handled up to 2,500 calls/e-mails a week.

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“Connect to Health” Campaign Launched May ‘07

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Elements of the Campaign

• Media Outreach • Direct Mail• Seminars & forums (over 150 presentations) • Grassroots Outreach • Paid Advertising• Public Information Unit• Grants to Community Organizations• Coalitions of corporate and civic organizations:

– health care community - employer assns– consumer advocacy groups - businesses– faith communities - sports teams

- unions

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Health Care Reform Coalition

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Coalition Partners

• Other State Agencies• Greater Boston Interfaith Organization

– Developed train the trainer materials – Educational workshops following weekend services– Went door to door– Helped at grassroots outreach events

• CVS– Window Signage, info at pharmacy counters,

overhead radio announcements• Shaw’s and Star Market Supermarkets

– Messaging in circulars, messages on store receipts

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Coalition Partners

• Associated Industries of Massachusetts, (AIM) – Partnered with key business associations to

co-sponsor 16, three-hour sessions across the state.

• Retailers Association, NFIB, Bank of America– helped with business outreach

• IBEW– Messaging on lighted billboard on Expressway

• Comcast– pro bono advertising

• Zip Car– website link

• Massachusetts Health Plans– MMCOs and commercial plans advertised

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Other State Agencies

• Department of Revenue– Postcards to tax filers (3.1 million), letters to

employers (193,000) and uninsured • MassHealth (Office of Medicaid)

– EOHHS Outreach and Enrollment Grants• Division of Insurance & Division of Health Care Finance

and Policy– Presentations

• Registry of Motor Vehicles– Notices to new Mass. residents via new license

process • Division of Unemployment Assistance

– Inserts in resident mailings• MBTA

– Advertising on subway cars and buses

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Grassroots Outreach

• 20 community-based enrollment events during Fall & Winter 2007

• Partnered with:– Legislators – Mayors/City Councilors– Local Hospitals – Community Health Centers– Community Groups– Health Plans– MMCOs– School systems

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Advertising

• Television, including N.E. Sports Network• Radio • Print, including community, ethnic and

college newspapers• Internet• Transit• Targeted to all geographies

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Our Message

• There's a new law - you need health insurance

• Unprecedented choice of plans

• Easy comparison of plans and prices through our website

• State Seal of Approval for quality and value

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10,000

20,000

30,000

40,000

50,000

60,000

5/5

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J uly 1st: Mandate goes into effect.

Nov. 15th: Final push to sign-up to avoid 2007 tax penalties

Spike in visits to web site around major promotional efforts (6 & 11/07)

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Rapid Expansion of Coverage

1. July 1, 2006: eligibility for MassHealth expanded

2. October 1, 2006: CommCare enrollment begins for uninsured below 100% FPL

3. January 1, 2007: enrollment expands to eligible individuals who contribute toward monthly premiums (101%-300% FPL).

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Rapid Ramp-Up

CommCare: Monthly enrollment since inception (Oct '06)

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200,000

Nov '06 Dec '06 Jan '07 Feb '07 Mar '07 Apr '07 May '07 Jun '07 Jul '07 Aug '07 Sep '07 Oct '07 Nov '07 Dec '07 Jan '08 Feb '08 Mar '08 Apr '08 May '08 Jun '08 Jul '08 Aug '08 Sep '08 Oct '08 Nov '08 Dec '08 Jan '09 Feb '09 Mar '09 Apr '09 May '09 Jun '09 Jul '09 Aug '09 Sep '09 Oct '09 Nov '09 Dec '09

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Over 300,000 newly insured

December 5, 2007

Massachusetts State House

World SeriesTrophy helps us celebrateHCR Milestone!

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Manage Expectations: Exchanges

Easy shopping

Value: select networks & premier brands

Trust/consumer protection

Administrative simplification