Chapter 58 The Basics of Massachusetts Health Reform.pptVIP

Chapter 58: The Basics of Massachusetts Health Reform John E. McDonough, DrPH, MPA Health Care For All () May, 2008 Brief History of MA Health Reform:Continuous Policy Improvement Eight Key Statutes: 1985 to 2006 Three major ones – 1988, 1996, 2006 Continuous Policy Improvement Medicaid/MassHealth Expansions, 1988, 1996, 1997 Uncompensated Care Pool (now Health Safety Net Trust Fund), 1985, 1988, 1997 Small Group Reform/Nongroup Market Reform, 1991, 1996 Patient Bill of Rights, 2000 1988: Universal Health Care Law $1680 Pay or Play Employer Mandate Delayed three times/Repealed 1996 CommonHealth, Student Insurance Mandate, Medical Security Plan, Healthy Start 1996: Chapter 203/MassHealth Waiver Medicaid-MassHealth; Enrollee growth from 670,000 (’95) to 1,020,000 (’01) Uninsurance Drop: 680,000 to 365,000 Coverage for all children – Children’s Medical Security Plan Senior Pharmacy Program Both reform waves inspired national action 1988 Leads to state-based innovations 1996 Leads to Creation of SCHIP The Power of Incrementalism Chapter 58 (1) – Insurance Connector, Commonwealth Care Choice Commonwealth Health Insurance Connector Authority – 10 member board Three principal responsibilities -- Commonwealth Care (subsidized 300%fpl) Subsidized coverage for uninsured with no other options No premium 150%fpl; sliding scale 150-300% fpl; Co-pays Commonwealth Choice (non-subsidized 300%fpl) Private plans for uninsured 300% fpl and small employers Define “affordability” for individual mandate and “minimum creditable coverage” Chapter 58 (2) – MassHealth Expansions and Restorations MassHealth: Kids’ coverage from 200 to 300% fpl ($63K family of 4) MassHealth enrollment caps lifted Essential, CommonHealth, HIV Optional Benefits Restored: dental, dentures, eyeglasses New smoking cessation and wellness benefits $3.5M outreach/enrollment grants $270M ($90M per year) hospitals/physicians rate hikes Pay for Performance/R/E Disparities benchmarks Chapter 58 (3) – Ind