Massachusetts Health Reform – Massachusetts Health Reform – Round Three Round Three

Brian Rosman & Fawn PhelpsHealth Care For All, Massachusetts

Presentation OutlinePresentation Outline

Health Care For All – BackgroundBrief History of Massachusetts

ReformRound 3 – What Massachusetts

PassedThe National StakesStay Informed

Health Care For All: What We DoHealth Care For All: What We Do

Policy Coalitions to Make ChangeCoalitions on MassHealth, children’s

coverage, disparities, oral health, private market concerns, and health reform

Also work on E-Health, quality issuesPrograms to Help Consumers

Consumer Helpline, Outreach, legalCommunication to Inform Everyone

www.hcfama.org, blog, regular emails

Brief History of MA ReformBrief History of MA Reform

1988: Universal Health Care Law Pay/Play Employer Mandate

Never Implemented/Repealed 1996 CommonHealth (working disabled), Student

Mandate, Medical Security Plan (unemployment), Healthy Start (pregnant women) – still going strong

1996: MassHealth Medicaid->MassHealth; Income-based not welfare-

based – 350,000 new enrollees Coverage for all children – CMSP Senior Pharmacy Program

Both reform waves inspired national action

Round 3 – the ProblemsRound 3 – the Problems

500,000+ uninsured – growingDecline in employer-provided

coverage4th largest percentage drop nationally

Main reason: high cost of careFederal Medicaid Waiver

(“MassHealth”) renewal: must implement July 2006

Providers underpaid by MassHealth

Round 3 – the PlayersRound 3 – the Players

Governor Mitt Romney (Republican lame duck – running for President)

Legislature – overwhelmingly Democratic Federal officials – push to approve waiver Business Groups:

Small biz, ideological right-wing Large biz, pragmatic, health infiltration

Affordable Care Today Coalition (ACT!) HCFA, GBIO (religious coalition), Providers, Labor,

Grass-roots progressives MassACT – Ballot Initiative Committee

Round 3 – The Federal WaiverRound 3 – The Federal Waiver

Section 1115 – feds can “waive” Medicaid rules

1997–2005: Two waivers, no changeIncludes $385M supplemental payments

to public hospital-sponsored managed care plans for uninsured

2005: Feds demand changesPayments to institutions must shift to

coverageDeadline: in place by 7/1/06

Round 3 – TimelineRound 3 – Timeline

6/04: HCFA begins public activity around reform, begins drafting bill

11/04: Travaglini (Senate Pres.), Romney Announce Plans

8/05: MassACT Ballot Petition Filed 10/05: House bill released 11/05: House, Senate Pass Bills 12/05: Conference Committee Begins 4/06: Bill passes Legislature: 153-2 in House;

37-0 in Senate 4/06: Romney signs bill and vetoes 8 sections

Our Organizing ModelOur Organizing Model

Two Coalitions: Broad coalition for legislative push Narrow “true believers” pushed ballot initiative

Grassroots Pressure + savvy lobbying by experienced pros

Simple messages to the public Fairness Shared responsibility Good for economy, small business

Turning point was convincing House Speaker of policy

Chapter 58 – MedicaidChapter 58 – Medicaid

MassHealth (Medicaid): Kids coverage expanded to 300% fpl

($60,000/family of 4)MassHealth Essential (long-term

unemployed childless adults) enrollment cap increased

Dental, dentures, eyeglasses, other services restored for adults

$3 million in outreach grants to community groups

Chapter 58– Subsidized CoverageChapter 58– Subsidized Coverage

“Commonwealth Care:” subsidized coverage for low income uninsured below 300% of poverty ($30,000 / year)Premiums: no premium if below poverty;

sliding scale between 100%-300% fplNo deductiblesBelow 100%: MassHealth cost-sharing,

dental, prescription, mental health benefits

Chapter 58– Rate IncreasesChapter 58– Rate Increases

Medicaid Rate Increases:$90 million additional per year for 3

years. Goes from ~80% of costs to ~95% of costs

Hospitals must meet quality benchmarks to get increase

Chapter 58– IndividualsChapter 58– Individuals

Individual Mandate All residents must obtain health coverage

if “affordable coverage” availableBoard of Connector defines “affordable”We will advocate to only apply to fairly

well-off peopleEnforced through tax systemBegins July 2007

Chapter 58– EmployersChapter 58– Employers

“Fair Share” ContributionEmployers who don’t offer coverage with

11+ employees pay $295/ workerEmployer must make “a fair and

reasonable premium contribution” to be exempt

Employers must facilitate pre-tax “cafeteria plan” for health insurance

Chapter 58– InsuranceChapter 58– Insurance

Insurance Market ReformsDoes not authorize high deductibles as

Romney wanted Non-group (individual) health insurance

market merges into small group marketCould cut non-group premiums 24%

19-24 year olds can stay on parents’ plans for 2 years

Special reduced-benefit plans available for 19-26 year olds

Lots more

Chapter 58– And MoreChapter 58– And More

“Connector” allows uninsured over subsidy level to buy coverage pre-tax Portability; part-timers can aggregate

contributions Disparities Council Quality and Cost Council

Cost and quality performance benchmarks Website with findings

Restores $20 million for public health prevention programs

Round 3 – What’s Next?Round 3 – What’s Next?

Overrides of Romney vetoes of individual provisions

Need federal approval Implementation challenges are hugeFunding depends on continued

commitment of political leaders, economy staying healthy

The National Stakes…The National Stakes…

Familiar Health Reform Refrain: Who pays what to expand coverage?

Political Right: Health care should be individual responsibility

Political Left: More employer responsibility (assuming single

payer not viable for now) This bill: Combines both in untested way.

Does this change political sense of what’s possible?

Next challenge: cost and quality

More information … More information …

Educate yourselfwww.hcfama.org/act – bill text,

summaries, analysiswww.hcfama.org/blog – latest news