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Massachusetts has the Lowest Rate of Uninsured. How did they do it?
By Branden A. McLeod
Some Positive Results
Massachusetts’ Health Care Reform, which was signed into law in April of 2006, has yielded positive results. According to an October report by the Massachusetts Health Insurance Connector Authority, “a look at available data begins to paint a picture of initial success, not only in the covering more individuals, but in improving access to routine care and reducing reliance on ‘free care.’” The most touted result of the Massachusetts’s health care reform plan is that the number of uninsured has fallen substantially. In fact, the number of people enrolled in private or subsidized health insurance plans has increased by 439,000 people (from June 2006 to March 2008), since health care reform was implemented. What is equally attractive is 95 percent of Massachusetts taxpayers are insured. Moreover, 57 percent of the 439,000 newly insured are enrolled in Commonwealth care or MassHealth and 43 percent are in private insurance.
Commonwealth Care is an insurance program for uninsured individuals with incomes around or below 300 percent of the federal poverty level (FPL). For example, 300 percent of FPL is $63,600 annually for a family of four. Beneficiaries of this program can choose a health plan and their own doctor.
MassHealth program (the state’s Medicaid program) provides comprehensive health insurance—or help in paying for private health insurance. The MassHealth program’s income standards are approximately at or below 60 percent of FPL ($12,720 for a family of four). The new Commonwealth Care program helps residents in the “grey area:” not poor enough to qualify for Medicaid but not covered by employer-based insurance.
In short, some positive results of the reform appear to be:
- Improved access to health care
- Shared responsibility (individuals, business, and government)
- More insured, less uninsured
- Lower deductibles, Lower premiums
- Prescription coverage
Popular Support
Popular support led to Massachusetts’ passage of health care reform. Also, a concerted public education effort about the Commonwealth Care program sparked enrollment growth during the time that individual mandate penalties came into effect at the end of 2007. Regarding the individual mandate to enroll in health insurance, of the 5 percent of taxpayers not enrolled in an insurance plan, 3% (97,000) were deemed able to afford coverage. This 3 percent also self-assessed a penalty for not having it, while the remaining 2% (71,000) were exempt from the requirement, either because they could not afford to purchase insurance, or because of their religious beliefs. This year the highest penalty for an individual not having health insurance was $912.
According to Massachusetts Department of Revenue (DOR), for tax year 2008, the penalty will be assessed for each of the months the individual did not meet the requirements of the health care mandate, provided that there is no penalty in the case of a lapse in coverage of 63 days or less.
- Individuals with incomes up to 150% of the Federal Poverty Level are not subject to any penalty for failure to purchase health insurance, as those at this income level are not required to pay an enrollee premium for Commonwealth Care health insurance.
- Penalties for individuals with incomes from 150.1 to 300% of the Federal Poverty Level will be half of the lowest priced Commonwealth Care enrollee premium that could be charged to an individual at the corresponding income level.
- Penalties for individuals with incomes more than 300% of the Federal Poverty Level will be:
- Half of the lowest priced Commonwealth Choice Young Adult Plan premium (without prescription drug coverage) for individuals up to age 26.
- Half the lowest priced Commonwealth Choice Bronze premium (without prescription drug coverage) for those 27 and above.
While the program’s popularity increased enrollment growth in the Commonwealth Care program, cost containment concerns follow. This has not stopped the state; however, from “embracing the moral imperative to cover the uninsured.” Moreover, the fact the program is a shared responsibility amongst individuals, business and government has proved attractive to voters. In fact, “a survey by the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation (HSPH/BCBSMA Foundation) showed that of the 93% of Massachusetts residents who say they know about the law, 69% support it.”
Implications for Maryland
Maryland can benefit! As Massachusetts is the torchbearer in health care reform, like many first timers there are learning opportunities, as well as areas for refinement. Maryland can and should pay close attention to Massachusetts’ success and areas to improve upon. Maryland has made a few good steps in health care this past legislative session, but we must not stop there. Once Maryland’s finances are back in order, it will be time for us to re-examine our priorities by “embracing the moral imperative to cover the uninsured” as Massachusetts has done.
Some prospects for national level health care reform efforts are similar to what Massachusetts has accomplished. Families USA has pointed out that many states have different proposals that address “expanding public programs, creating entirely new programs, or combining both approaches—but they all seek to make coverage more affordable and available.” However, few efforts focus on inequality in health care, namely increasing high quality care for all. Efforts for reform, going forward, whether on a national or state level, should also focus on high-quality care. Yet, progress towards reform on a national scale is far from certain. In the meantime, states must take the onus to reform their own individual health systems to improve coverage, quality and affordability for their residents until a sufficient national plan is in place.
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