THE COMMONWEALTH FUND Massachusetts Health Reform: A Giant Step Toward Universal Coverage? Anne Gauthier Assistant Vice President Deputy Director, Commission on a High Performance Health System The Commonwealth Fund Alliance.
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THE COMMONWEALTH FUND Massachusetts Health Reform: A Giant Step Toward Universal Coverage? Anne Gauthier Assistant Vice President Deputy Director, Commission on a High Performance Health System The Commonwealth Fund Alliance Briefing for Congressional Staff November 7, 2008 1 2 Percent of Nonelderly Ages 0–64 Uninsured by State 1999–2000 2006–2007 WA VT NH ME NH WA ND MT VT MT MN OR ID NY WI SD MI WY PA IA NE CA OH IN NV UT IL CO MA KS MO WV VA KY NJ RI CT MN OR ID MI PA IA NE CA IL CO KS MO AZ NM MS TX AL DE MD DC NC AZ GA NM OK SC AR MS LA TX AL GA LA FL AK VA NJ RI CT TN SC AR WV KY TN OK OH IN NV UT MA NY WI SD WY DE MD DC NC ME ND FL AK HI 20% or more 16%–19.9% HI 12%–15.9% Less than 12% THE COMMONWEALTH FUND Data: Two-year averages 1999–2000 (updated with 2007 Current Population Survey correction) and 2006–2007 from the Census Bureau’s March 2000–2001 and 2007–2008 CPS. Elements of the Massachusetts Health Plan • Mixed private-public system of universal coverage • MassHealth expansion for children up to 300% poverty; adults up to 100% poverty • Individuals must buy coverage or face a penalty as of July 1, 2007, with affordability provision; full premium subsidies between 100% and 150% of poverty and partial subsidies between 150% and 300% of poverty; individual assessment of 50% of minimum premium (raised January 2008) 3 Massachusetts' Uninsurance Rate Pre-Reform Lower than National Average 30% 20% 19.8% 13% 10% 0% Massachusetts U.S. Uninsurance Rate Among Working Age Adults, 2006 • Employers must offer coverage or pay fair share contribution ($295 per year) and allow employees access to pay premiums with pre-tax dollars • Connector to organize affordable insurance offerings through a group insurance exchange (open enrollment began July 2007) • Massachusetts Health Care Quality and Cost Council established to address cost containment and delivery system reform THE COMMONWEALTH FUND The Role of Employer Coverage: Massachusetts and the United States, 2006-07 Massachusetts Adults 19-64 1% 4 United States Adults 19-64 10% 20% Employer Individual 14% 6% 69% Medicaid Other Public 3% Uninsured 8% 6% 63% THE COMMONWEALTH FUND Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2007 and 2008 Current Population Survey (CPS: Annual Social and Economic Supplements). 5 Comparing Plans: President-elect vs. Massachusetts Aims to Cover Everyone Rules for Individual Insurance Market Employer Role in Providing Health Benefits Government Role in Providing Health Benefits Families’ Exposure to Health Care Costs Requirements to Have Coverage Leverage to Stimulate Improvement in Quality and Efficiency Uninsured Covered After 10 Years Massachusetts Obama Goal Goal Rigorous State Rules Uniform National Rules Fair Share contribution Expand Expand MassHealth, Subsidies through Connector Expand Medicaid/SCHIP Less than current Less than current Individual Mandate Children Only Little (Health Care Quality & Cost Council) More than current system Near universal 34 million* * Estimates of uninsured covered from L. Burman, S. Khitatrakun, G. Leiserson et al., An Updated Analysis of the 2008 Presidential Candidates’ Tax Plans, Urban Institute–Brookings Institution Tax Policy Center, Updated September 12, 2008. 6 Comparing Plans: President-elect vs. Massachusetts Principles for Reform Massachusetts Obama Covers Everyone ++ + Standard Benefit Floor ++ + Premium/Deductible/ Out-of-Pocket Costs Affordable Relative to Income + + Easy, Seamless Enrollment 0 + Choice + + Pool Health Care Risks Broadly ++ + Minimize Dislocation, Ability to Keep Current Coverage ++ ++ Administratively Simple + + Improve Health Care Quality and Efficiency + + 0 = Minimal or no change from current system; — = Worse than current national system; + = Better than current system; ++ = Much better than current system Source: S. R. Collins, C. Schoen, K. Davis et al., A Roadmap to Health Insurance for All: Principles for Reform (New York: The Commonwealth Fund Commission on a High Performance Health System, Oct. 2007). THE COMMONWEALTH FUND