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Health-Care Coverage the New Revolution in Massachusetts

By Michael Reynolds

In late 2004, the state of Massachusetts faced a health-care crisis.

The state had been allocating nearly $1 billion to subsidize health care at hospitals for uninsured individuals, which numbered about 500,000. But

because it is unlawful for state emergency rooms to refuse to administer treatment, the Massachusetts ERs were being inundated with uninsured patients.

According to Mitt Romney, then governor of Massachusetts, instituting a mandate for health care, while providing taxpayer subsidies for poor, disabled and elderly residents, would be a more effective use of the money. Romney cited research by Jonathan Gruber, a Massachusetts Institute of Technology economist, indicating that with the same level of funding, the state could fully insure every resident.

In 2005 and 2006, a coalition of advocates for affordable health care pushed for strong reforms. Among those was extending the federally funded MassHealth, the state’s version of Medicaid, to provide coverage for children from low-income families. That plan became law in 2006.

On employers with 11 or more full-time workers, the state assessed a $295 annual fee per employee. Those fees go into a pool of funding for uninsured individuals, renamed the “Health Safety Net.” Residents are required to prove coverage on their income tax returns. Failure to be covered will result in the loss of the personal tax credit, what has been termed a “fine” in the media. According to The Boston Globe, the $219 personal tax deduction will grow to $912 next year. In some instances, waivers were offered if affordability was an issue and the residents in question did not qualify for one of the state-subsidized programs.

The new law also mandated several new programs, including the Commonwealth Health Insurance Connector Authority. The Connector, as it is commonly known, oversees the implementation of Commonwealth Care, a program for residents with income of $30,610 or less in 2007 (three times the federal poverty level of $10,210) but who earn too much to qualify for the state’s Medicaid program.

The Connector also provides information for residents who need to purchase health insurance, and it can help arrange coverage for those who work where none is offered. It also defines what “affordability” is regarding an individual who purchases insurance and establishes a process that allows people to be exempted from the law if they demonstrate financial hardship.

The Commonwealth Care program offers access to four subsidized private insurance plans. For individuals who make $15,000 or less, there are no premiums charged. There are no deductibles on any of the plans offered by Commonwealth Care. As of Dec. 1, 2007, more than 158,000 people have enrolled in Commonwealth Care.

Another provision of the Massachusetts plan is insuring young adults who often have to maintain a full-time college course load and may not have health insurance once they graduate. Health insurance plans are required to insure young adults up to age 25 for up to two years past the young adult’s loss of dependent status. In July 2007, the Connector offered reduced-benefit plans for young adults up to age 26 who do not have access to employer-based coverage.

Another reform provides health care coverage to children whose parents earn less than $30,610, an expansion of S-CHIP (the State Children’s Health Insurance Program).

As part of the health-care reform plan, the Massachusetts Rehabilitation Commission (MRC) is overseeing services needed by individuals with disabilities, such as personal attendant care. According to the MassHealth Web site, independent living services are driven by consumer control; those who require those services are directed toward a list of independent living centers throughout the state. Services for independent living are tied to other services, such as vocational rehabilitation.

“People with disabilities have MassHealth unless they are working where they can buy coverage through Commonwealth Care,” said Charles Carr, MRC commissioner. The latter program, he said, would provide coverage for durable medical equipment and personal care assistance (PCA).

Although Hawaii has had mandated health insurance since 1974, many states are looking to Massachusetts to develop their own programs. Although many of Massachusetts’ reforms have been praised, there have been critics.

The Cato Institute, a non-profit think tank with libertarian leanings, has found fault with the Massachusetts program, such as government mandates imposed on the insurance industry, raising the age that adult children need to be covered, and the fact that, among those who make more than $30,000, 20 percent of adult men received waivers because the offered plans were not affordable.

Other groups, however, applaud the Massachusetts program. The Kaiser Family Foundation, a non-profit, private organization that focuses on major U.S. health-care issues, has claimed that the number of uninsured individuals has dramatically decreased because of the reform laws and points to the expansion of Medicaid funding as a basis for future state implementations.

In the state where the American Revolution began, some view it as fitting that it is also home to a revolution in U.S. health care.

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Michael Reynolds is a freelance writer and short movies producer.

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