1	Massachusetts Health Care Reform
2	Why healthcare reform in Massachusetts? Double-digit, annual increases in insurance premiums and the highest per capita healthcare spending in the nation 460,000 uninsured in 2004 state survey Small businesses and individuals facing significant barriers to entry for coverage Limited availability of information to consumers and businesses precludes informed health insurance purchase decisions Potential loss of at least $385 million in federal government Medicaid funding Two “universal” healthcare ballot initiatives $1 billion and growing of “free-care” forcing all stakeholders to deal with costs for uninsured and under-insured
3	The Uninsured in Massachusetts
4	Broad consensus that healthcare reform must be a “system”, not a “product” approach
5	Insurance market reforms: A good start
6	Insurance reforms will provide better value for consumers
7	The Connector is a breakthrough concept
8	The Connector makes it work
9	The Uninsured in Massachusetts
10	“Commonwealth Care” makes private insurance affordable for eligible individuals
11	Commonwealth Care: Key assumptions
12	Commonwealth Care: Premium assistance schedule
13	Redeploying existing funding makes the program financially sustainable
14	Connector funding
15	Employers will remain the cornerstone for the provision of health insurance
16	Employer implementation issues The law requires most employer requirements to be implemented in an expeditious manner Guiding policy principles Be mindful of the potential for ERISA challenges Do not create incentive for employers to drop Agreement was that everyone will contribute to the UCP assessment Offering employers already paying in Guiding administrative principles Keep it simple for smaller employers Part-time, seasonal, temporary, and foreign workers are important part of the workforce Conducted informational hearings across the state Attended mostly by employers
17	Employer responsibility provisions: “Free Rider” surcharge
18	Employer responsibility provisions: “Fair Share” assessment
19	“Fair Share” test Two-step test Primary Test: Take-up rate must be equal to or greater than 25% If the business passes this test, then no assessment If the business fails this test, then move to secondary test Secondary Test: The business must offer to contribute 33% or more towards health insurance The two-step test accomplishes the following objectives: The primary test ensures that the employer is covering not just offering insurance to its employees (thus paying into the UCP) It respects free market principles by allowing the employer and employee to determine a “fair and reasonable” employer contribution Employees “vote with their feet” by enrolling in the employer’s health plan The Commonwealth is measuring the result of the employer and employees’ wage and benefit negotiations The secondary test provides employers with a “safe harbor” from employees who turn down health insurance for reasons that the employer has no control over
20	The law contributes to market stability by addressing cost shifting
21	Personal responsibility: health insurance is the law
22	Encouraging efficiency and cost containment strategies Program integrity efforts Provider re-credentialing Non-custodial parent responsibility Increased funding for Medicaid Fraud Control Unit and State Auditor Cost, Quality and Patient Safety initiatives Improving the Commonwealth’s purchaser and consumer website Funding for Betsy Lehman Center for Patient Safety Statewide infection and prevention control program Health Care Quality and Cost Council Funding for certain public health programs to help raise public awareness Diabetes Renal disease Cancer screening “Pay-for-Performance” measures Mandated for the Medicaid program MassHealth Payment Policy Board Working with other payers and providers to ensure consistency
23	The law provides the guidelines, but success will be measured by its implementation