Key Elements of Mass. HealthCare Reform

Jon Kingsdale

Bipartisan Congressional Health Policy Conference January 13, 2007

2

Programmatic Elements

• Subsidized premiums (Commonwealth Care)

• Individual mandate

• Incentives for employer participation (>10)-S. 125 plans

-”Fair & Reasonable” contribution

• Market reform (Commonwealth Choice)

• Enhanced Medicaid payments

3

A Relatively Small Problem

MA Population 6.2 million

Insured 5.8 million

Uninsured 372,000

≤ 300% of FPL 140,000

>300% of FPL 160,000

Other 70,000

4

Political Recipe for Reform

• Lots of money already in the “system”

• Well organized, funded & respected advocacy

• Bi-partisan commitment to health care reform

• Provider and insurer support for reform

• $385 mm federal carrot/stick

• Business acquiescence (“culture of reform”)

HCR: 5 years in the making

2003 Governor,BCBSMA, & ACT

commit

11/04 Roadmap to Coverage Sen. Pres. commits

2/05 1-year extension of federal

waiver

3-6/05 Governor’s Plan Sen. Pres’ bill

Governor’s bills

11/05 Speaker’s bill

4/06 Enactment

7/1/06 Medicaid expansion

1/1/07 C-Care implemented

7/1/07 Individual mandate Employer

assessment Non-discrimination

C-Choice

10/1/07 UCP re-write

1/1/08 Real mandate in effect

Progress to Date

• Commonwealth Care for adults < 100% FPL

October 1, 2006 start dateTarget population of ~60,000 50,000 individuals confirmed eligible 40,000 enrolled in health plans

• Commonwealth Care for adults 100% to 300% FPL

January 1, 2007 start dateTarget population of ~80,000

Market Reform

• Create credible, non-group risk pool

• Merge small- & non-group rating

• Expand product options

• Create a new market for choice (Commonwealth Choice)

8

Non-offeredIndividuals

SmallBusinesses

SoleProprietors

Non-workingIndividuals

Blue CrossBlue Shield

FallonHarvard Pilgrim

Commonwealth Connector

Commonwealth Choice

Health NewEngland

MMCOsTufts NHP

Commonwealth Choice’s Value Proposition

• Individual choice

• Administrative simplicity

• Pre-tax premium payment

• Portability of coverage

Commonwealth Choice’s Value Proposition

Sales to date = 0