Massachusetts is a leader in public health and healthcare reform, enacting legislation in 2006 that resulted in the nation’s lowest uninsured rate – a designation the state continues to hold. Massachusetts’ 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.
Massachusetts runs a state-based health insurance exchange called Massachusetts Health Connector and has expanded Medicaid. Additionally, it provides additional state-based subsidies to exchange enrollees eligible for its ConnectorCare program. As of 2017, those with subsidized health insurance plans through the Massachusetts exchange will no longer have to pay copays for outpatient substance abuse treatment or medications.
Here’s a snapshot of where Massachusetts currently stands on health rankings and healthcare reform.
Massachusetts health ratings
Massachusetts consistently performs among the top five states in several public health ratings. For 2015, it ranked third in America’s Health Rankings. With the nation’s lowest uninsured rate and highest number of primary care physicians per 100,000 people, the state has clear strengths when it comes to access to healthcare. According to this particular report, the state’s biggest public health challenge is a large disparity in health status – Massachusetts ranked 49th for that measure.
The Commonwealth Fund ranked Massachusetts fourth among the states and the District of Columbia in its 2015 Scorecard on State Health System Performance. Again, The Bay State topped the charts with its low uninsured rate, which contributed to its #1 ranking for the Access category. Massachusetts placed lowest in the Avoidable Hospital Use & Costs category, for which it placed 31st. See the Massachusetts scorecard for additional details on the state’s performance in several categories and key indicators.
Another source of public health information and comparisons is the 2016 edition of Trust for America’s Health; see Key Health Data About Massachusetts. You can also 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.
2017 health insurance plans and rates
Massachusetts is another state whose exchange continues to include several carrier options. Of the 11 carriers that will offer 2017 health insurance plans through the Massachusetts exchange, three of them (Neighborhood Health Plan, Tufts Health Direct, Harvard Pilgrim) currently have more than two-thirds of the exchange enrollees.
Massachusetts 2017 exchange carriers and their rate requests are as follows:
- Ambetter(CeltiCare):6 percent increase
- Blue Cross and Blue Shield of Massachusetts HMO Blue: 6 percent increase
- Blue Cross and Blue Shield of Massachusetts: 2 percent increase
- Boston Medical Center HealthNet Plan: 3 percent decrease
- Fallon Community Health Plan: 3 percent increase
- Harvard Pilgrim Health Care (HMO): 2 percent increase
- Health New England: 6 percent increase
- Minuteman Health (ACA CO-OP): 4 percent increase
- Neighborhood Health Plan: 9 percent increase
- Tufts HMO: 6 percent increase
- Tufts Insurance Company: 4 percent increase
On average, the proposed rate increase for Massachusetts is far lower than the national average.
Massachusetts enrollment in qualified health plans
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.
Exchange enrollment has improved substantially ever since. For the 2016 open enrollment period, technology issues seemed to be a thing of the past and Massachusetts Health Connector, Massachusetts’ state-based exchange, exceeded its goal of 190,000 QHP enrollments, including renewals. When 2016 enrollment ended on January 1, there were 196,554 exchange enrollees. As of June 2, effectuated enrollment stood at 223,778. The majority of those individuals (171,000) were enrolled in ConnectorCare, a Massachusetts program that provides state subsidies in addition to federal ACA subsidies to those with incomes up to 300 percent of the poverty level. ConnectorCare enrollment lasts year-round.
Massachusetts and the Affordable Care Act
Democrats dominate Massachusetts politics at the federal and state level, and support for Obamacare is solid. When the Affordable Care Act was up for a vote in the U.S. Senate, John Kerry and Scott Brown represented Massachusetts. 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 healthcare 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.
Gov. Charlie Baker was sworn into office in 2015. Baker is a Republican, and has been critical of the ACA.
Massachusetts’ Obamacare implementation
The rollout of the ACA in Massachusetts did not go smoothly, despite the fact that the law was modeled on the state’s previous healthcare reform initiatives. The state had to modify many of its existing programs to comply.
Technical upgrades were needed to make Massachusetts’ state-based exchange, Massachusetts 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 had to re-apply for coverage by Dec. 31, 2014.
After much analysis, Massachusetts decided to fix the Health Connector rather than transition to the federal marketplace. By October 2015, the total cost of rebuilding Health Connector had reached $285 million and expectations for a stronger 2016 enrollment period were strong. The exchange did, indeed, turn a corner during 2016 and had its most successful enrollment period since ACA implementation.
Through ACA expansion, Massachusetts Medicaid 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). From 2013 to June 2016, Massachusetts saw its average monthly Medicaid enrollment increase about 27 percent.
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.
Minuteman Health expanded to New Hampshire for the 2015 coverage year. It remains in operation despite the closure of most CO-OPs.
Massachusetts Medicare enrollment
Massachusetts Medicare enrollment reached 1,218,036 in 2015, about 18 percent of the state population. Historically, about 83 percent of the state’s Medicare beneficiaries qualify based on age alone, while 17 percent are eligible due to disability.
Medicare spends about $8,861 annually per enrollee in Massachusetts, which is above the national average of $8,790. In terms of overall Medicare spending, as of 2009, the state ranks 12th with $11.7 billion per year.
In Massachusetts, Medicare recipients can select a Medicare Advantage plan instead of Original Medicare if they wish to receive additional benefits, and about 19 percent of them do. Nationally, 31 percent of Medicare recipients select Medicare Advantage instead of traditional Medicare.
Medicare recipients can also buy Medicare Part D plans. In 2015, about 48 percent of Massachusetts Medicare beneficiaries chose stand-alone prescription drug coverage, compared with to the national Rx plan enrollment of 45 percent.
State-based health reform legislation
Recent state-based legislation related to health reform includes: