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Massachusetts health insurance

MA retains nation’s lowest uninsured rate, improves exchange

Massachusetts is a leader in public health and healthcare 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 healthcare reform.

Massachusetts health ratings

Massachusetts ranked third in America’s Health Rankings for 2014. With a low uninsured rate and ready availability of primary care physicians, the state has clear strengths when it comes to access to healthcare. Nevertheless, a high rate of preventable hospitalizations and a large disparity in health status by educational attainment are challenges Massachusetts’ population faces.

The Commonwealth Fund ranked Massachusetts No. 4 among the states and the District of Columbia in its 2014 Scorecard on State Health System Performance, down two positions from the previous year’s evaluation. See how the state scored — see the Massachusetts scorecard on the individual measures within each of the categories.

Another source of public health information and comparisons is the 2015 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.

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.

Massachusetts enrollment in qualified health plans

Prior to Obamacare’s individual mandate taking effect in 2014, Massachusetts had the lowest uninsured rate in the nation: 4.9 percent. By the end of 2014, that rate had dropped to 3 percent, where it remained by mid-2015.

About 31,700 Massachusetts residents enrolled in qualified health plans (QHPs) during 2014 open enrollment. Of course, this number was somewhat mangled due to problems with Health Connector.

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.

As of June 30, 2015, effectuated enrollment for QHPs was 156,448, with 73 percent of individuals enrolled in a plan with advanced premium tax credits and 59.4 percent receiving cost-sharing subsidies.

Eleven carriers will offer health plans through Connector during 2016 open enrollment:

  • Ambetter(CeltiCare)
  • Blue Cross and Blue Shield of Massachusetts
  • Boston Medical Center HealthNet Plan
  • Fallon Community Health Plan
  • Harvard Pilgrim Health Care
  • Health New England
  • Minuteman Health
  • Neighborhood Health Plan
  • Network Health
  • Tufts Health Plan
  • United Healthcare

Rates for private, exchange-based plans will increase an average of 6.3 percent for 2016 coverage. This rate is said to be lower than the overall average increase in many states; however it is significantly higher than the 2015 average increase of 1.6 percent.

Massachusetts Medicaid/CHIP

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 2015, 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) Programencourages 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 many CO-OPs in 2015.

Massachusetts Medicare enrollment

Massachusetts Medicare enrollment reached 1.2 million in 2015, about 18 percent of the state population. Historically, about 81 percent of the state’s Medicare beneficiaries qualify based on age alone, while 19 percent are eligible due to a disability.

Medicare spends about $11,277 annually per enrollee in Massachusetts, which makes the state one of about 20 that spend more than $10,000 per recipient annually. In terms of overall Medicare spending, 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 22 percent of them do. Nationally, 32 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 43 percent.

State-based health reform legislation

Recent state-based legislation related to health reform includes: