Impact on Federal Government
- Federal funds previously used to cover healthcare delivered to the uninsured is redirected to cover subsidies to help the uninsured buy their own insurance.
Impact on States
- At this point, the state's costs for health care are going up.
- MassHealth, which covers non-elderly people in the state’s Medicaid program, expanded income eligibility, lifted enrollment caps, and restored benefits.
Impact on Insurers
- The plan was set to merge the individual and small-group insurance markets by July 2007.
- Fully insured plans must meet a new definition of “dependent,” meaning that some individuals will be covered until their 26th birthday or until two years have passed since they lost their dependent status according to federal tax rules.
Impact on Providers
- Created a new demand for primary care doctors that was difficult to meet.
- Aims to cut down the number of uninsured who had to be given uncompensated care.
Impact on Employers
- Employers with 11 or more full-time-equivalent employees may be subject to two different fees.
- They may be obligated to pay a “fair share” assessment of up to $295 per uninsured employee per year into the Commonwealth Care Trust Fund if they do not make a “fair and reasonable” contribution to their employees’ health insurance. This means either having at least 25% of FTEs enrolled in the employer’s health plan or offering to pay at least 33% of the employee insurance plan.
- They may be obligated to pay a “free rider surcharge” if they do not have a pre-tax payroll deduction plan for insurance and their employees instead use free care.
- Employers can no longer provide different levels of coverage (e.g., fully covered executive insurance coverage) to employees based on salary level.
Impact on Individuals
- In 2008, individuals must indicate on their tax forms if they had insurance coverage on December 31, 2007, or a waiver for religious reasons, or a waiver based on lack of affordable coverage. Otherwise they will face the loss of their personal exemption.
- Premiums proved unaffordable for a longer than anticipated number of people.
| Proponents/Opponents |
Proponents view the Massachusetts plan as a plausible experiment in what it would take to reduce the cost of uncompensated care. That there is a choice of insurance plans purchased through the Commonwealth Health Insurance Connector and that an individual can carry insurance from job to job are two features that draw praise from proponents.
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The AFL/CIO contends that the Massachusetts healthcare reform plan will bankrupt middle-class families while protecting the poor because the guidelines for affordable employer-sponsored insurance coverage are too vague, and the fines for employers who do not provide insurance are too trivial. Others point out that costs already exceed what was anticipated. Making premium's affordable and keeping costs down are challenging the plan.
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Notable Features
- The Massachusetts plan is hailed as one to watch for other states exploring healthcare reform legislation, in part because it featured cross-party and cross-interest-group collaboration, with contributors whose focus is politics, business, health care delivery, and public policy.
- The “minimum creditable coverage” requirement of the law makes Massachusetts the first state to define the basic level of coverage that insurers must provide.
- The plan relies on funding input from individuals, employers, and government and on reforms of the insurance industry.
Experts' Comments"There's good evidence, whether it's buying auto insurance or wearing seat belts or motorcycle helmets, that mandates don't work 100%.... We're talking about how close you can get to 100%, and to me, it's pretty evident you can't get as close without the mandate as you can with it."
--Jon Kingsdale,
Executive director, Commonwealth Health Insurance Connector Authority, to The New York Times
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