Health Care Reform:Massachusetts Two Years Later

Sarah IselinMassachusetts Division of Health Care

Finance and PolicyJuly 2008

Massachusetts Division of Health Care Finance and Policy - 2

April 2006

Chapter 58 is signed!

Massachusetts Division of Health Care Finance and Policy - 3

The Massachusetts Law:Why So Much Attention?

• Ambitious goal: Near universal coverage

• Transcends ideology Bipartisan support

Combines policy solutions from the right and the left

Partnership between federal government and state

• Novel approaches Individual mandate, employer responsibility, insurance

market changes

Massachusetts Division of Health Care Finance and Policy - 4

Where We Started in 2006: Uninsured In Massachusetts

365,000

627,000549,000

644,000

534,000

355,000418,000 439,000 395,000

460,000

496,000

682,000

748,000

657,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

1998 2000 2002 2003 2004 2006 2007

State estimate CPS estimate Urban Institute

Sources: “Health Insurance Status of Massachusetts Residents,” 1998, 2000, 2002, 2004, 2006 Massachusetts Division of Health Care Finance and Policy. BCBS Foundation/Urban Institute, Census Bureau.

Massachusetts Division of Health Care Finance and Policy - 5

The Goal: “Near Universal” Coverage

Principles of Reform:

• Build upon the existing base: fill in gaps

• “Shared responsibility”

Individuals

Employers

Government

• Shift financing from “opaque bulk payments” to safety net providers to health insurance for individuals

Massachusetts Division of Health Care Finance and Policy - 6

Where are we now?

13%

7%

0%

5%

10%

15%

Source: Getting Ready for Reform, Sharon Long and Mindy Cohen, the Urban Institute, May 2008.

Uninsurance for working-age adults has been nearly cut in half

Fall 2006 Fall 2007

Massachusetts Division of Health Care Finance and Policy - 7

Lessons from Massachusetts

• Seize the moment

1115 Waiver

New House Speaker

Governor presumed running for President

• Make the moment

Ballot initiative

Roadmap to Coverage

No reform is possible without strong organizing and advocacy

Massachusetts Division of Health Care Finance and Policy - 8

Lessons from Massachusetts

• Our law is as much a political blueprint as a policy blueprint

Get everyone to the table – and keep them there

– Many different tables

– Relationships matter

Massachusetts Division of Health Care Finance and Policy - 9

MASSACHUSETTS LEAGUE OF COMMUNITY HEALTH CENTERSGood health.  Right around the corner.

WHO STILL SUPPORTS THE MASSACHUSETTS HEALTH REFORM LAW?

Mass Medic

al Societ

y

Massachusetts Division of Health Care Finance and Policy - 10

Lessons from Massachusetts

• Our law is as much a political blueprint as a policy blueprint

Get everyone to the table – and keep them there

– Many different tables

– Relationships matter

Compromise

– Everyone got something and also gave something up

Massachusetts Division of Health Care Finance and Policy - 11

Everyone got something…

• Consumers: Medicaid expansion, subsidies, employer responsibility

• Providers: Medicaid rate increases

• Business: Lower assessment than might have otherwise been, sets no precedent since based on pool, individual mandate, expanded subsidies for small employers and their low-wage workers

• Insurers: New potential members, young adult products, individual mandate

Massachusetts Division of Health Care Finance and Policy - 12

And traded something off…

• Consumers: Individual mandate, potential for increased cost sharing

• Providers: More pay for performance, less money than they wanted (but still a LOT)

• Business: More assessment than they wanted

• Insurers: Subsidized plans limited to current Medicaid managed care organizations for the first three years, less flexibility on benefit design than they wanted

Massachusetts Division of Health Care Finance and Policy - 13

Lessons from Massachusetts

• Our law is as much a political blueprint as a policy blueprint

Get everyone to the table – and keep them there

– Many different tables

– Relationships matter

Compromise

– Everyone got something and also gave something up

Create shared ownership

– Passing law is only the first step

– Continued coalition and collaboration after passage

– Advocates must have capacity to participate in implementation

Massachusetts Division of Health Care Finance and Policy - 14

Lessons from Massachusetts

• On-going framing and messaging are critical

Understanding and shaping public opinion

Massachusetts Division of Health Care Finance and Policy - 15

Support for reform is still strong

68% 71%

0%

20%

40%

60%

80%

100%

Source: Getting Ready for Reform, Sharon Long and Mindy Cohen, the Urban Institute, May 2008.

Fall 2006 Fall 2007

Support amongst working-age Massachusetts adults

Massachusetts Division of Health Care Finance and Policy - 16

Massachusetts Division of Health Care Finance and Policy - 17

Massachusetts Division of Health Care Finance and Policy - 18

Massachusetts Division of Health Care Finance and Policy - 19

Challenges Ahead

• Education, outreach and enrollment

• Sustaining public support

• Ensuring access for the newly insured

• Maintaining strong safety net for those who will remain uninsured

• Financing – need a strong state economy

• Continued federal support for waiver renewal

• Moderating health care cost growth

Massachusetts Division of Health Care Finance and Policy - 20

GLOBE EDITORIAL

Patrick makes a tough choice

July 15, 2008

THE GOOD news is that enrollment in the state's new subsidized health insurance program has greatly exceeded projections. The bad news is that this has raised the first-year cost of Commonwealth Care from an expected $472 million to $630 million. To fill the gap, the Patrick administration has devised a plan that spreads the pain relatively equally among health reform's major stakeholders, from providers to employers to insurers and the state itself.The most important stakeholders - the individuals and families who have signed up for the state's pioneering effort at universal coverage - have already done their bit. In April, their premiums rose 10 percent and their co-payments also increased. The Legislature should approve the governor's proposal or come up with a better one before it adjourns at the end of this month….

Massachusetts Division of Health Care Finance and Policy - 21

Business balking at health changes Many firms and insurers oppose $100m price tag; Public backs Patrick idea to close gap in funding

July 15, 2008

Governor Deval Patrick's proposal to ask businesses, insurers, and hospitals to kick in about $100 million to close a gap in funding for the state's landmark health insurance law is threatening to fracture the fragile coalition whose support was instrumental in passing the measure…

Massachusetts Division of Health Care Finance and Policy - 22

Biz groups: Health care reform costs are unfair

Wednesday, July 30, 2008

Bay State business groups are fighting a state plan to collect more money for health-care reform, saying the effort will place too much of an economic burden on businesses at the wrong time.“Health-care reform and increased access to health care is a societal benefit that should be borne by all the citizens of the commonwealth rather than disproportionately by employers,” Associated Industries of Massachusetts Executive Vice President Brian Gilmore wrote in a letter to the group’s 7,000 member companies.The Greater Boston Chamber of Commerce, the Massachusetts Business Roundtable and the Massachusetts Taxpayers Foundation also oppose the plan.The criticism comes as state representatives debate a plan to generate an additional $89 million for the health-care reform law.

Massachusetts Division of Health Care Finance and Policy - 23

Medicare

Medicaid

Employer Coverage

IndividualMandate

MedicaidExpansions

EmployerResponsibility

InsuranceMarket

Reforms

AffordableProducts

Young Adult

Products

Connector

CommonwealthCare