Healthcare reform may draw on Massachusetts model

As Congress and the Obama administration consider reform of the healthcare system, they may consider the experienceof Massachusetts. Speaking to the American Health Lawyers Association on May 19, 2009, Jon Kingsdale, director of the Massachusetts Health Connector outlined lessons to be drawn from the state's results: start slowly, promote shared responsibility, emphasize outreach and use "both carrots and sticks." Massachusetts reduced the percentage of the population without coverage by more than half within the first 18 months, Kingsdale said. By September 2008, 432,000 state residents were newly insured, he added.

The three componentsof the Massachusetts reform are: (1) mandatory insurance for individuals;(2) premium assistance and (3) "fair" contribution fromemployers. The "culture of coverage" in the state viewsthe responsibility of coverage as shared among individuals, the governmentand employers.

Individuals are required to purchase coverage.Insurers send a form to the department of revenue documenting thecoverage. The penalty for failure to insure is deducted from the individual'sincome tax refund.

The first year, penalty for noncompliancewas $219, deducted from the individual's tax refund. Uninsured individualswho owed tax paid no penalty. The penalty has increased substantially;in 2009, the penalty for the year may exceed $1,000.

Individualswith incomes below 300 percent of the federal poverty level (FPL)are insured through MassHealth (Medicaid) or CommCare. Adults withincomes up to 150 percent of FPL pay no premium. The CommCare premiumis charged on a sliding scale.

The Health Connector servesseveral functions. It establishes and administers CommCare, the subsidizedcoverage for low-income uninsured adults, and CommonwealthChoice,a commercial insurance marketplace offering standardized benefit plansand more affordable coverage for adults in a merged "small-group,no group" market. . The Connector makes policy decisions settingstandards for creditable coverage and for affordability. Finally,the Connector engages in extensive outreach and advertising to informindividuals and employers of their rights and responsibilities.

Employers with 11 or more employees must pay $219 per employeeif they do not offer or contribute to the minimum coverage. Accordingto Kingsdale, employers' primary complaint about the law is the reportingrequirement, which they consider burdensome. The number of peoplewith employer-based coverage has grown substantially. Because mostemployers in Massachusetts offer health insurance, the increase hasprimarily come from employees enrolling in plans that were alreadyavailable.

Dr. Thomas H. Lee, Network President of PartnersHealthcare System, said that the increase in coverage said that theprogram has increased patients' compliance with prescribed medicationand follow-up. He concurred with Kingsdale that outreach and advertisingmust be extensive and ongoing.

Providers have experienceda modest increase in the number of services delivered, Lee said. However,even with insurance, some people have difficulty finding a primarycare physician and continue to use the emergency department. Use ofthe emergency department has not declined, he said.

CCH Chicago Bureau, May 19, 2009