Like the community organizations that must increase outreach efforts to formerly disenfranchised healthcare consumers, the administrators who fulfill the law’s mandates, and citizens who will be comparing new health plans, hospitalists may find themselves working harder once the law is implemented.
Massachusetts’ lawmakers garnered huge headlines across the nation in April when the Democratic-dominated state legislature passed a health insurance reform bill nearly unanimously, and Republican Governor Mitt Romney signed the bill into law. This summer, health policy experts are hard at work implementing the first of many mandated stages of the legislation. Other states will watch Massachusetts in the next year as administrators hammer out details of the much-heralded bipartisan statute. Much remains to be done, however, and effects of the statute on patients, hospitals, and physicians remain unclear.
The hope is that the state can ensure nearly universal health insurance coverage for its estimated 500,000 citizens who currently have none. The Massachusetts statute aims to accomplish this feat by offering subsidized insurance coverage to those earning up to 300% of the federal poverty level (facilitated by a Medicaid waiver now being finalized between the state and CMS); assessing $295 per employee from businesses with 11 or more employees who do not provide coverage; and requiring purchase of affordable individual insurance products by those to whom such products are available.
Can the complex, market-driven compromise work? If all staged implementations go into effect as planned, will they be sustainable? Once in place, how might these reforms play out for the practice of hospital medicine? The Hospitalist recently solicited opinions from several hospitalists, physicians, a network president, and health policy experts to get some idea of what the future may hold for healthcare delivery in Massachusetts.
Key Features of the Legislation
As the number of uninsured Americans continues to grow, and reform at the federal level has stalled, many states have been working on their own plans to increase access to insurance and healthcare. The linchpin of individuals’ and businesses’ shared responsibility, health policy experts say, was key to the bipartisan support shown for the Massachusetts insurance reform bill. As of July 1, 2007, every citizen over 18 will be required to obtain health insurance. Businesses with 11 or more employees must pay $295 per employee if they do not offer coverage. (This provision was vetoed by Governor Romney when he signed the bill, but it was subsequently overridden by the legislature.)
The legislation—hundreds of pages long—stipulates an approximate two-year timeline for implementing all phases of the plan, and includes state tax penalties for individuals who don’t comply with the requirement to obtain insurance. The law also creates a state authority, The Commonwealth Health Insurance Connector, to set eligibility standards for subsidized policies, expand Medicaid enrollment, determine affordability guidelines, and approve of plans submitted by private insurers to be offered to consumers. It is anticipated that The Connector (its nickname) will act as a clearinghouse, linking individuals and small businesses with choices of affordable health plans paid for with pretax dollars.
Some of the features lauded by most—even critics—include expansion of Medicaid enrollment; policies with no to low premiums and no deductibles, on a sliding scale, for individuals and families earning up to 300% of the federal poverty line ($29,400 for individuals and $60,000 for families in the contiguous 48 states); and portability of the policies. In addition, young adults can remain covered through their parents’ policies until they become independent or reach age 25. Other specially designed low cost, limited coverage plans will be offered to young adults between ages 19 and 26.