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Key Elements of Mass. HealthCare Reform

Key Elements of Mass. HealthCare Reform. Jon Kingsdale Bipartisan Congressional Health Policy Conference January 13, 2007. Programmatic Elements. Subsidized premiums (Commonwealth Care) Individual mandate Incentives for employer participation (>10) -S. 125 plans

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Key Elements of Mass. HealthCare Reform

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  1. Key Elements of Mass. HealthCare Reform Jon Kingsdale Bipartisan Congressional Health Policy Conference January 13, 2007

  2. Programmatic Elements • Subsidized premiums(Commonwealth Care) • Individual mandate • Incentives for employer participation (>10)-S. 125 plans -”Fair & Reasonable” contribution • Market reform (Commonwealth Choice) • Enhanced Medicaid payments

  3. A Relatively Small Problem MA Population 6.2 million Insured 5.8 million Uninsured 372,000 ≤ 300% of FPL 140,000 >300% of FPL 160,000 Other 70,000

  4. Political Recipe for Reform • Lots of money already in the “system” • Well organized, funded & respected advocacy • Bi-partisan commitment to health care reform • Provider and insurer support for reform • $385 mm federal carrot/stick • Business acquiescence (“culture of reform”)

  5. 2003Governor,BCBSMA,& ACT commit 11/04Roadmap to Coverage Sen. Pres. commits 2/051-year extension of federal waiver 3-6/05Governor’s Plan Sen. Pres’ bill Governor’s bills 11/05Speaker’s bill 4/06Enactment 7/1/06 Medicaid expansion 1/1/07 C-Care implemented 7/1/07 Individual mandate Employer assessment Non-discrimination C-Choice 10/1/07 UCP re-write 1/1/08Real mandate in effect HCR: 5 years in the making

  6. Progress to Date • Commonwealth Care for adults < 100% FPL • October 1, 2006 start date • Target population of ~60,000 • 50,000 individuals confirmed eligible • 40,000 enrolled in health plans • Commonwealth Care for adults 100% to 300% FPL • January 1, 2007 start date • Target population of ~80,000

  7. Market Reform • Create credible, non-group risk pool • Merge small- & non-group rating • Expand product options • Create a new market for choice (Commonwealth Choice)

  8. Non-offeredIndividuals Non-workingIndividuals SmallBusinesses SoleProprietors Commonwealth Choice Commonwealth Connector MMCOs Blue CrossBlue Shield Tufts NHP Harvard Pilgrim Health NewEngland Fallon

  9. Commonwealth Choice’s Value Proposition • Individual choice • Administrative simplicity • Pre-tax premium payment • Portability of coverage

  10. Commonwealth Choice’s Value Proposition Sales to date = 0

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