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Massachusetts health insurance

MA lawmakers support ACA, but reform rollout is troubled

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Massachusetts is a leader in public health and health care reform, enacting legislation in 2006 that resulted in the nation’s lowest uninsured rate. The state’s reform strategies – such as an exchange where private insurers compete, a requirement that individuals have coverage or pay a penalty, and subsidies to help those who can’t afford coverage – served as the model Affordable Care Act.

Here’s a snapshot of where Massachusetts currently stands on health rankings and health care reform.

Massachusetts health ratings

The Commonwealth Fund ranked Massachusetts No. 2 among the states and the District of Columbia in its 2014 Scorecard on State Health System Performance, unchanged since the 2009 evaluation. Massachusetts ranked first in four of five categories: Access, Prevention & Treatment, Healthy Lives, and Equity. However, Massachusetts was 30th in Avoidable Hospital Use & Cost. See how Massachusetts scored on the individual measures within each of the categories.

In America’s Health Rankings, Massachusetts is ranked fourth based on a low prevalence of obesity, its low uninsured rate, and good access to primary care physicians and dentists. However, Massachusetts does have some health challenges, including a high prevalence of binge drinking, a high rate of preventable hospitalizations, and inequities in health status by level of education completed.

Another source of public health information and comparisons is the 2014 edition of Trust for America’s Health; see Key Health Data About Massachusetts.

Finally, compare health ranking for Massachusetts counties through the data published by the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.

Massachusetts and the Affordable Care Act

Democrats dominate Massachusetts politics at the federal and state level, and support for the ACA is solid.

When the Affordable Care Act was up for a vote in the U.S. Senate, Massachusetts was represented by John Kerry and Scott Brown. Sen. Kerry voted yes of the ACA, while Brown voted no. Brown was elected in a special election following the death of Edward (Ted) Kennedy, who championed health care issues throughout his political career.

Brown was defeated in his re-election bid in 2012 by Elizabeth Warren. Ed Markey was selected in a special election after Kerry assumed the role of U.S. Secretary of State. Warren and Markey both support the ACA.

In the U.S. House of Representatives, nine of 10 representatives voted in favor of the ACA. Rep. Stephen Lynch voted against the ACA, in part because the final legislation did not include a public option.

At the state level, Gov. Deval Patrick in 2012 signed two bills to bring Massachusetts’ existing exchange and policies into compliance with the federal health care reform law. In addition, Massachusetts adopted the ACA’s expansion of Medicaid.

The ACA rollout in Massachusetts

The rollout of the ACA in Massachusetts did not go smoothly. While the ACA is modeled on Massachusetts’ previous health care reform initiatives, the state had to modify many of the specifics of its programs to comply with the ACA.

Technical upgrades were needed to make the Health Connector ACA-compliant. The upgrades were not implemented correctly or on time, causing many enrollment delays and requiring manual workarounds. The problems with the Health Connector affected not only those who were seeking to enroll for the first time, but also those who had existing state-subsidized coverage.

Prior to the ACA, Massachusetts operated Commonwealth Care, for individuals with incomes below 300 percent of the federal poverty level (FPL), and Commonwealth Choice, for uninsured adults who made too much to qualify for Commonwealth Care. Depending on income levels, some people previously enrolled in Commonwealth Care were transitioned to Medicaid. The rest of the Commonwealth Care population and the Commonwealth Choice population become eligible for federal subsidies to purchase new health plans through Health Connector.

Given the problems with the Health Connector, Massachusetts was forced to keep many people enrolled in their Commonwealth Care plans and temporarily enroll new applicants in the Medicaid program. These temporary fixes expire at the end of the year, and about 400,000 people have to re-apply for coverage by Dec. 31, 2014.

After much analysis, Massachusetts has decided to fix the Health Connector rather than transition to the federal marketplace for 2015 open enrollment. The cost is not yet known.

Massachusetts enrollment in QHPs

About 31,700 Massachusetts residents enrolled in qualified health plans (QHPs) during 2014 open enrollment.

Enrollment in QHPs would have been much higher if it were not for the technical problems with the Health Connector. About 160,000 new applicants with incomes above 133 percent of poverty level who should have been enrolled in QHPS were instead temporarily enrolled in Medicaid and about 112,200 people are staying on their Commonwealth Care plans through the end of 2014.

Massachusetts Medicaid/CHIP

Through ACA Medicaid expansion, Massachusetts covers most nonelderly adults up to 138 percent of FPL. Based on eligibility criteria that pre-date the ACA, children in families with incomes up to 305 percent of FPL qualify for Medicaid or the Children’s Health Insurance Program (CHIP).

Medicaid and CHIP are called MassHealth in Massachusetts. Learn how to apply for MassHealth.

Other ACA reform provisions

The ACA’s Consumer Operated and Oriented Plan (CO-OP) Program encourages new, non-profit health insurers to enter the market. Twenty-four CO-OPs received loans totaling $2.09 billion as of January 2014. In Massachusetts, Minuteman Health, Inc. received more than $156 million in federal loans. See the states where CO-OPs were launched.

While Minuteman Health signed up only about 1,500 people during 2014 open enrollment, it expects better results for 2015 when the Health Connector is working better. Minuteman Health announced in December 2013 that it is expanding to New Hampshire in time for the 2015 coverage year.