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Massachusetts Connector options

…and the rest of the story Massachusetts Health Reform Kaiser Family Foundation Alliance for Health Reform Grace-Marie Turner Galen Institute May 19, 2008. Massachusetts Connector options. Four premium levels for similar coverage through the subsidized Commonwealth Care program

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Massachusetts Connector options

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  1. …and the rest of the storyMassachusetts Health ReformKaiser Family FoundationAlliance for Health ReformGrace-Marie TurnerGalen InstituteMay 19, 2008

  2. Massachusetts Connector options • Four premium levels for similar coverage through the subsidized Commonwealth Care program • Approved health insurance plans offer coverage through the unsubsidized Commonwealth Choice plan

  3. Commonwealth Care Enrollment Nov ‘06 – Dec ‘07

  4. Commonwealth Care Enrollment Sept ‘07 – May ‘08

  5. Summary of Costs by Plan Type

  6. Largest enrollment in no-cost plans

  7. Enrollment in Commonwealth Choice

  8. Typical connector prices

  9. Connector coverage through March 1, 2008 Est.: 228,000 * Est.: 207,500 176,000 Est.: 89,000 87,000* 48,961 17,000 } Commonwealth Care

  10. Risks moving forward • For consumers… • State approved a 12% insurance rate increase for next year • Fines to individuals continue to rise • $219 in first year • Up to $912 this year; $1,824 for uninsured couples • Shortage of doctors in some areas taking new patients • Rising costs for taxpayers • Crowd-out of job-based insurance

  11. Taxpayer costs are rising • State budget calls for $869 million in fiscal 2009, but the bill could be closer to $1.1 billion • About 330,000 Massachusetts residents are newly enrolled in coverage, but at least 263,000 are in free or subsidized plans

  12. Concerns about crowd-out • Up to 40,000 workers are offered health insurance at work, but can’t afford the premiums and earn under 300% of poverty. • Workers eligible for Commonwealth Care can switch from job-based coverage, under certain conditions • The employee share of job-based coverage often costs more than subsidized Commonwealth Care. E.g. $70/mo vs. 39/mo. • If only 10% of those eligible shift from job-based insurance to C-Care, the total cost next year alone could be an additional $90 billion, potentially reaching $550 billion by 2012 for this population.

  13. Growing pains? • Or are the costs and complexities of major changes to the health sector, even in a state that had a head start on the rest of the country, far greater than anticipated? • Example: Just one set of regulations by one of Massachusetts’ new health reform boards and commissions to deal with just one problem…

  14. Minimum Coverage Standards -- 2009 • Prescription drug coverage. • Visits to the doctor for preventive care, before a deductible. • Deductibles that are capped at $2,000 for an individual or $4,000 for a family each year. • An annual cap on out-of-pocket spending at $5,000 for an individual or $10,000 for a family (for plans with up-front-deductibles or co-insurance). • No cap on total benefits for a particular sickness or for a single year. • No cap on payment toward a day in the hospital.

  15. 2008 Draft Affordability Schedule Proposed March 20th

  16. Signing ceremonyApril 12, 2006

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