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Massachusetts health care reform viewed as a model for national plan
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The recently passed national health care reform legislation was modeled in large part after the groundbreaking 2006 legislation passed by the state of Massachusetts.
In a new article from The Milbank Quarterly, Brandeis University health policy leaders explained how Massachusetts has handled the insurance requirement since 2006 and what lessons policymakers have learned.
The article is based on a case study using interviews with key stakeholders, state government representatives, and officials from the Commonwealth Health Insurance Connector Authority, according to a press release.
The 2006 Massachusetts legislation required all adults in the Commonwealth to have health insurance coverage through an individual mandate, setting a precedent for what eventually became the national plan.
“The individual mandate is the linchpin to making health care reform work,” Michael Doonan, PhD, lead author of the article and assistant professor at the Heller School at Brandeis University, stated in the release. “The individual mandate forces you to define affordability, coverage limitations and other key aspects of any successful health reform.”
Doonan added that moving toward universal coverage is important in the effort to prevent insurance companies from discriminating against people with pre-existing conditions.
How Massachusetts makes it work
Most Massachusetts residents still receive insurance through their employer with no changes, while the previously uninsured are covered through the expansion of existing subsidized health care programs such as MassHealth (the state’s Medicaid program), the Children’s Health Insurance Program and the employer-based Insurance Partnership Program. Reforms also led more people to sign up for coverage at work or to purchase coverage through the new Commonwealth Health Insurance Connector Authority exchange, according to the release.
Massachusetts currently enforces the insurance mandate by requiring residents to file proof of health insurance with their annual tax forms. Residents who cannot afford insurance may obtain a waiver, but most have not done so. Ninety-seven percent of Massachusetts adults—the highest rate in the nation—are now covered.
“Greatly expanded coverage”
The largest increase in enrollment was implemented through the newly created Commonwealth Care program, which allows those with a family income under the 300% federal poverty level to receive subsidized insurance. The Massachusetts mandate also limits the ability of insurers to exclude pre-existing conditions from coverage.
“While Massachusetts — like the rest of the country — still has problems with rising health care costs, this program greatly expanded coverage and access to health care services,” Doonan stated in the release. “The program also reduces the fear that insurance companies will drop coverage as soon as you get sick.”
- Reference:
www.milbank.org/880103.html
