Massachusetts health care insurance reform law

Composition of Massachusetts Residents Newly C...
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The Massachusetts health care insurance reform law, enacted in 2006, mandates that nearly every resident of Massachusetts obtain a state-government-regulated minimum level of healthcare insurance coverage and provides free health care insurance for residents earning less than 150% of the federal poverty level. The law established an independent public authority, the Commonwealth Health Insurance Connector Authority, also known as the Health Connector. Among other roles, the Connector acts as an insurance broker to offer private insurance plans to residents.

The enacted statute, Chapter 58 of the Acts of 2006, established a system to require individuals, with a few exceptions, to obtain health insurance. Chapter 58 has several key provisions: the creation of the Health Connector; the establishment of the subsidized Commonwealth Care Health Insurance Program; the employer Fair Share Contribution and Free Rider Surcharge; and a requirement that each individual must show evidence of coverage on their income tax return or face a tax penalty, unless coverage was deemed unaffordable by the Health Connector. The statute also expands MassHealth (Medicaid and SCHIP) coverage for children of low income parents and restores MassHealth benefits like dental care and eyeglasses.

The legislation included a merger of the individual (non-group) insurance market into the small group market to allow individuals to get lower group insurance rates. What this did was transfer the cost to small businesses who are increasingly dropping healthcare insurance as a benefit according to the Boston Globe in July 2010. This has had multiple negative effects on the healthcare insurance reform effort as described in the Globe article.

The process of merging the two markets also froze the market for such insurance for a short period in April-May 2010 as the current government tried to keep the leading non-profit insurers (which insure over 90% of the residents) in the state from raising premiums for small businesses and individuals. Eventually the state’s non-partisan insurance board ruled that the government did not have the actuarial data and/or right to freeze the premiums. Five of the non-profit insurers then settled for slightly lower premium increases than they had initially requested rather than litigate further. The sixth litigated and won the right to implement all its original increases retroactively. These findings only affect 2010 and the premium increase/review/litigation process will have to begin again for the insurance period beginning January 1, 2011.

Payment rates were supposed to be increased to hospitals and physicians under the statute but that has not happened. The statute also formed a “Health Care Quality and Cost Council” to issue quality standards and publicize provider performance. There has been some activity by this council. Chapter 58 also set up a Disparities Council, funds automated prescription ordering in hospitals, and implements changes to the public health council, state insurance laws, mandated benefit requirements, and other health-related programs

The CT Mirror Reports:

Massachusetts new study: Update: Week of October 25, 2010

More than half of family physicians and nearly half the internists in the state are no longer taking new patients, according to a study released by the Massachusetts Medical Society. The shortage affects more than primary care. Eight of 16 specialty areas are considered to have severe or critical labor market conditions, three more than last year. Also, changes enacted in PPACA could exacerbate physician shortages, particularly as demand for care increases as baby boomers age, chronic disease rates rise and the aging medical workforce leads many doctors to retirement. Many patients coming into the system through health care reform will have likely gone without medical care for some time and require more medical care initially than others. The Massachusetts study predicts a continued migration of doctors from independent practices to salaried positions at, for example, hospitals. Doctors that remain independent could cut down or stop seeing certain groups of patients, such as those on Medicaid and Medicare, the study warned. Even primary care doctors who accept new patients aren’t able to see them quickly, according to the survey. New patients in Massachusetts wait an average of 29 days for an appointment with a family doctor, 53 days for an internist. Expanding health insurance coverage will have limited effects if the newly insured cannot access doctors for treatment.

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