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Volume 27, Issue 465 |
April 17, 2006 |
MASSACHUSETTS GOING FOR FULL COVERAGE
By Anna C. Spencer
Massachusetts lawmakers overwhelmingly approved a bill aimed at achieving universal coverage. The statute is the first in the country to feature pay-or-play for individuals. It is expected to expand coverage to 90 percent to 95 percent the Commonwealth's 500,000 to 600,000 uninsured residents. By July 2007, uninsured residents who are ineligible for Medicaid and do not get insurance through their employers will be required to show they have coverage or face a penalty. Those who do not have insurance after the first year would lose their personal state tax exemption, worth about $150, and eventually face stiffer penalties equal to half the cost of the most affordable health insurance premiums, which could amount to $1,200 annually. Residents will be required to provide proof of their policies on their state income tax returns, and waivers will be issued to individuals who can't find affordable insurance.
To bring insurance into reach, the bill creates several new options. Commonwealth Care, a new state subsidized program, will cover uninsured individuals earning between 100 percent and 300 percent of the federal poverty level (FPL) – $28,700 for a single person. The state will cover in full health insurance premiums for individuals who earn less than 100 percent of the FPL, and subsidized policies will be available for individuals who earn between 100 and 300 percent of the FPL. Individuals will be required make small co-payments for emergency room visits and other services.
The newly created "Commonwealth Health Insurance Connector" will guide individuals and small businesses to insurance policies that have been certified by the Connector. Individuals will be able to buy coverage from the connector using pre-tax dollars. This insurance connector is expected to lower costs by pooling purchasing power and sharing overhead costs. It will help individuals who change jobs to take their policies with them; their new employers will be able to contribute to premiums through the Connector. The plan also encourages insurers to offer low-cost, limited-benefit plans to people aged 19 to 26, the age group likeliest to turn down coverage.
Under the pay-or-play provision, companies with 11 or more employees will be required to pay $295 a year for every employee who does not receive insurance through his or her employer. Any excess funds will go into a pool to subsidize low-cost policies. In addition to this charge, which is set at the average portion of a premium that is shifted to provide care for the uninsured, a “Free Rider Surcharge” will be imposed on employers who do not provide insurance and whose employees use free care. The surcharge will be triggered when an employee receives free care more than three times a year, or a company has five or more instances of employees' getting free care in a year. The surcharge will range from 10 percent to 100 percent of the state’s costs of services provided to employees, with revenue – estimated to total $45 million per year – from the surcharge being deposited into the Commonwealth Care Trust Fund.
Insurance market rules are also changed to make coverage more available and affordable. Non-group and small-group markets are merged in July 2007, leading to an estimated drop of 24 percent in non-group premium costs. The bill lets HMOs offer high-deductible, lower-priced plans linked to Health Savings Accounts. Young adults will be able to stay on their parents’ insurance plans for two years past the loss of their dependent status or until they turn 25 (whichever occurs first).
Medicaid Expanded
Coverage will be offered to 92,500 uninsured residents by expanding eligibility requirements for children and adults under MassHealth, the state’s Medicaid program. Children in families earning up to 300 percent of the FPL will be eligible for MassHealth, which is available now for children in families earning up to 200 percent of the FPL. All MassHealth benefits that were cut in 2002, including dental, vision and chiropractic services, as well as prosthetics, will be restored.
Lawmakers are banking on residents buying in to the individual investment piece of the bill. A Health Care Access and Affordability Conference Committee report released April 3rd notes that every taxpayer pays for the care of those who are uninsured and need emergency care, and concludes that those who can afford to pay for care but don’t should be required to pay their fair share. However, research has shown that voluntary measures aren’t enough to encourage people to purchase health insurance. Requiring everyone to have coverage brings those who are healthy and currently uninsured into the insurance risk pool and thus helps stabilize the cost of premiums for the insured.
The measure, which is estimated to cost more than $1 billion annually, will be funded through $125 million in new state spending, money from existing programs, fees from businesses and penalties recouped from individuals who do not opt to purchase health insurance coverage. The federal government will contribute $650 million a year in matching Medicaid payments.
“The bottom line is that [the law] will provide coverage for thousands of individuals over the next three years,” said John McDonough, executive director of Health Care For All. It should create “more affordable products in the health insurance market, it establishes a base minimum contribution towards health insurance by employers, and it establishes an individual responsibility” to purchase health insurance when it is deemed affordable, he added. “All in all, this is a good start.”
As SHN went to press, Gov. Mitt Romney had signed the bill but vetoed the business payment requirement, as well as the restorations to MassHealth. The General Assembly is expected to override the Governor’s veto.
For more on other pay-or-play bills, please go to this NCSL Web site.
EXPLORING ACCREDITATION FOR PUBLIC HEALTH AGENCIES
By Anna C. Spencer
Should state and local public health agencies be voluntarily accredited? The idea has gained currency as state and local health departments gear up to deal with such public health threats as a flu pandemic, West Nile virus, bioterrorist attacks and other public health emergencies.
Public health experts note that there is wide variation in the quality of care delivered at the state and local level, as well as the capacity of health departments and emergency response plans to deal with emergencies. While some states already have systems in place that gauge how well their public health departments are functioning and assess whether they are serving the needs of their communities, a national accreditation system would assure residents that their health departments have met the same standards that are applicable across the nation.
Now the National Association of County and City Health Officials (NACCHO) and the Association of State and Territorial Health Officials (ASTHO) are exploring the feasibility of a voluntary accreditation system under an initiative launched in September 2005 and seeking comments from interested individuals.
Funded by The Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention, Exploring Accreditation is examining all aspects of the accreditation issue including:
- Governance structures,
- Roles of federal, state, and local governmental public health entities,
- Financing, and
- Research and evaluation components.
In April 2006, the project’s 25-member Steering Committee reached consensus on several aspects of a model system:
- The goal of the system is to improve and protect the health of the public by enhancing the quality and performance of state and local public health agencies.
- The governing system will be a new single non-governmental, not- for- profit entity, which will adopt standards and make final conformance decisions.
- Agency performance should achieve continuous quality improvement, pursuit of excellence, accountability, evidence-based best practice, and creation of benchmarks for success.
- Benefits of the system include meeting nationally accepted standards of quality and performance, proficiency in functions performed, sharing of best practices, and meeting or exceeding local, state and national public health legal requirements.
- Financing for the system should treat capitalization and operation separately. Grant makers, government and future applicants should fund start-up. Ongoing operations should be funded by the applicants and accredited agencies through fees and other funding sources.
The project's Steering Committee will construct a draft model for a voluntary national accreditation system for state and local public health agencies. The draft model will be shared widely for public comment and feedback during the spring and early summer. Elected officials are among the key constituencies the project hopes to engage during the comment period. “I think [this initiative] has tremendous potential for bringing to fruition probably a decade of various work on improving performance and quality in public health,” said Kaye Bender, dean of the School of Nursing at University of Mississippi Medical Center and Chair of the Steering Committee for the Exploring Accreditation project.
All comments, issues and problems that interested parties believe need exploration are welcome via: feedback@exploringaccreditation.org. For questions, or to speak to project staff, please contact: Grace Gorenflo, NACCHO, at ggorenflo@naccho.org or (202) 783-5550, Ext. 222 or Pat Nolan, ASTHO, at pnolan@astho.org or (202) 371-9090, Ext. 1678.
For more background on the project, please visit: www.exploringaccreditation.org.
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