Summary of Health Access Reform Bill

Tomorrow, 10/31, the MA House Joint Committee on Health Care Financing will approve its version of health care reform.  Here's the Globe's preview. (Expect a lot of "trick or treat", "scary" clichés from the press and lobbyists. Yuk yuk.) We'll have more on this tonight and going forward -- there's a lot of good, some bad, some practical, and some improbable.

I hate pdf's because they require opening another program, and they don't really seem "interactive" enough for blogging, so I'm just cutting and pasting the entire text of their "highlights". Here's the pdf if you insist.

A) MassHealth Expansion
The bill expands MassHealth coverage for children, parents and childless adults. Currently, children in families up to 200% of the Federal Poverty Level (FPL) are eligible for MassHealth. The bill increases eligibility to children in families earning up to 300% FPL ($38,500/yr for a family of 2). MassHealth coverage for parents would be expanded from 133% FPL to 200% FPL ($32,200/yr for a family of 3).

This bill also provides MassHealth coverage for all childless adults up to 100% FPL ($9,600/yr). Currently, the majority of childless adults are not eligible for Medicaid at any income level, unless eligible because of circumstances such as disability or long-term unemployment.

The bill enhances outreach and enrollment for Medicaid-eligible families and individuals by providing support to community-based agencies for sustainable outreach programs. An additional $80 million is provided to increase Medicaid hospital rates, while keeping within the budget neutrality limits of federal financing under the new Medicaid waiver. These rate increases are tied to performance goals of quality, efficiency, and improved outcomes for patients. The bill also creates a 2-year pilot program for smoking cessation treatment for MassHealth enrollees, and restores dental services that were cut in 2002.

B) Commonwealth Health Insurance Connector
The bill creates a public, central purchasing mechanism, called the Commonwealth Health Insurance Connector. It connects individuals and small businesses with health insurance products. The Connector certifies and offers products of high value and good quality. Individuals who are employed are able to purchase insurance using pre-tax dollars. The Connector allows for portability of insurance as individuals move from job to job, and permits more than one employer to contribute to an employee’s health insurance premium. New, lower-cost, specially designed products are offered through the Connector to 19 to 26-year-olds. The Connector is to be operated by the Group Insurance Commission and overseen by a separate, appointed Board of private and public representatives.

C) Commonwealth Care Insurance Program
The bill creates a subsidized insurance program called the Commonwealth Care Insurance Program. Individuals who earn less than 300% FPL and are ineligible for MassHealth will qualify for coverage. Premiums for the program will be set on a sliding scale based on household income. The program will be operated through the Connector, and retain any employer contribution to an employee’s health insurance premium. The subsidized products must be certified by the Connector as high value and good quality.

D) Individual Investment in Health Care
The bill provides that all residents of the Commonwealth shall maintain health insurance coverage. Individuals for whom there are not affordable products available will not be penalized for not having insurance coverage. A sliding scale schedule of affordability for insurance products will be set by the Board of the Connector.

Beginning in 2007, Massachusetts residents shall confirm health insurance coverage by reporting on state income tax forms, and coverage will be verified through a database of insurance coverage for all individuals. The Department of Revenue shall enforce this provision with penalties based upon a portion of what an individual would have paid toward an affordable premium.

E) Employer Contributions to a Healthy Workforce
The bill eliminates the current $160 million Uncompensated Care Pool assessment on insurers and businesses. All businesses with more than 10 employees will make a contribution, based on their total payroll, to a new “Commonwealth Care Fund.” Businesses with 10 or fewer employees will be exempted from this contribution. Employers will receive a credit for their employee health expenses. Revenue from the assessment, along with other state and federal funds, will support the subsidized Commonwealth Care Insurance Program.

F) Reduction of Racial and Ethnic Health Disparities
The bill aims to reduce racial and ethnic health disparities by requiring hospitals to collect and report on health care data related to race, ethnicity and language. In addition, the bill creates a study of a sustainable Community Health Outreach Worker Program to target vulnerable populations in an effort to eliminate health disparities and remove linguistic barriers to health access.

G) Health Safety Net Fund
The current Uncompensated Care Pool is eliminated by this legislation. The bill maintains the safety net by creating the Health Safety Net Fund to reimburse hospitals and community health centers for uncompensated care. Hospital reimbursements will be made using a new standard fee schedule, instead of the current charges-based payment system. The plan anticipates the transfer of funds to the Commonwealth Care Insurance Program as free care use declines.

H) Funding
The plan leverages federal dollars to enhance and match state spending, and uses revenue generated by employer contributions to fund health insurance coverage. The bill applies tobacco settlement funds that the state receives each year toward health coverage for Massachusetts residents.