Massachusetts Sets Out Provisions for Universal Coverage

Massachusetts is working hard to develop the rules and implement the mechanisms associated with the universal health care reform signed into law by Governor Mitt Romney in April. A team led by Health and Human Services Secretary Tim Murphy and comprised of representatives from multiple state agencies has been developing a health care reform implementation plan. A team within MassHealth is preparing for numerous changes to the state's public health program, including eligibility and benefit expansions, outreach plans, and implementation of the new Commonwealth Care Health Insurance Program, which will be distinct from MassHealth, the state's Medicaid program.

In late May, Jon Kingsdale, a senior vice president at Tufts Health Plan, was chosen to lead the Commonwealth Health Insurance Connector Authority, which will establish minimum benefit standards for "lower-cost" health plans. Health providers and consumers want to ensure these plans provide a reasonable level of coverage and do not leave providers with unpaid bills.

The Connector Authority is also determining the level of premiums that should be considered "affordable" for uninsured residents. Secretary Murphy announced in early June that the Romney administration estimated premiums for most low-income residents purchasing a new coverage plan would range from $40 to $130 a month, with premiums fully subsidized for individuals with incomes below the poverty line. The Authority is considering a variety of methods to keep premiums low, such as limiting provider networks, eliminating certain health care mandates, creating health savings accounts, or charging higher amounts for smokers.

Finally, the Division of Health Care Finance and Policy is in the process of defining terms such as "fair and reasonable" premium contributions by employers. Under the new reform, businesses face a $295 per worker annual assessment if they do not make a "fair and reasonable" premium contribution for their workers. The Division is also determining the fees for employers if they do not offer coverage and their workers access care through the state's "free care" pool. [1] It is also determining which companies will be eligible for pre-tax insurance deductions; the law allows employees at companies that don't offer coverage to pay their premiums with pre-tax dollars, similar to the manner in which some employees use pre-tax dollars in flexible spending accounts to pay for health expenses.

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[1] Massachusetts' "free care" or Uncompensated Care Pool reimburses hospitals and health centers for providing free or partially free care to uninsured or underinsured patients.