Earlier this week, the Executive Office of Health and Human Services hosted an open meeting for stakeholders on ‘Implementing Federal Health Reform in Massachusetts.’ The meeting was an opportunity to share updates and learn more about ongoing work around the implementation of the Patient Protection and Affordability Care Act (PPACA or ACA) and what impact it will have on the Commonwealth of Massachusetts. This week’s meeting was the first meeting of planned quarterly meetings. EOHHS has established an internal Working Group on federal reform implementation representing multiple agencies across state government.
The diversity of the agencies involved — MassHealth, the Department of Revenue, the Connector Authority, and the Division of Insurance, to name a few — reflect the broad range of issues the Commonwealth needs to address over the next several years until reform nears full implementation in 2014.
The presentation from the meeting is available under “Stakeholder Meetings” on the state’s national health care reform web page: www.mass.gov/nationalhealthreform.
The following provides a snap shot of the highlights of what residents of Massachusetts can expect as the implementation of health care reform progresses.
Access to coverage in Massachusetts and nationally
Massachusetts already provides free or subsidized insurance to people well above the new federal minimum of 133% of the Federal Poverty Level (FPL) or $19,378 for a family of two, by covering up to 300% FPL ($43,710 for a family of two) through MassHealth and Commonwealth Care.
Here in Massachusetts, the ACA will bring a number of positive changes in federal reimbursement and coverage.
- People with incomes between 133% and 300% FPL currently served by Commonwealth Care at 50% state cost will be eligible for coverage through the Insurance Exchange with 100% federally-funded subsidies saving the Commonwealth taxpayer dollars.
- People between 300% and 400% ($58,280 for a family of two) will also be eligible for federally-funded subsidized coverage through the Exchange. This is effective January 1, 2014.
- Legal immigrants, currently barred from federally-funded Commonwealth Care, will also be eligible for subsidies through the Exchange.
There are also areas where the ACA is less generous than our state policy, and the health care reform workgroup will need to address how to handle these differences. Decisions need to be made regarding:
- Whether to supplement the federal subsidies and benefits, because:
- The federal tax credit is less generous than the current state subsidies for those between 133% and 300% FPL;
- The affordability standard under ACA is less generous than the state standard at most income levels;
- Benefits are not yet known but may be less comprehensive than Commonwealth Care – the state may want to provide
- The evolution of the Connector to the Massachusetts exchange will need to be defined; and
- The role of Commonwealth Care in 2014 and beyond has yet to be determined.
Employer responsibility in Massachusetts, nationally
The ACA requires employers with 50 or more FTEs to pay an assessment if one or more of their employees uses a tax credit to purchase insurance through the exchange. The assessment differs depending on whether the employer offers health insurance to its employees. Massachusetts’ 2006 health care reform effort mandates employers with 11 or more FTEs pay an assessment if they do not make a sufficient contribution to employer-sponsored insurance.
National reform imposes a larger assessment on employers of 50 or more than Massachusetts currently does on employers of 11 or more; these differences are an issue that must be addressed by the health care reform working group in the short-term.
Payment reform and the development of a national quality strategy
By January 1, 2011, the US Department of Health and Human Services will establish a national strategy to improve the delivery of health care services, patient health outcomes and population health. Among other components, the strategy will seek to align public and private payers with regard to quality and patient safety efforts. In January, the CMS Center for Medical Innovation will also begin processing proposals from states about ways to reform the delivery and payment system.
The quality strategy will identify priorities that will improve health outcomes, efficiency, and patient-centeredness. It will enhance the use of data to improve quality, efficiency, transparency, and outcomes; improve health care provided to patients with high-cost chronic conditions; and identify best practices to improve patient safety and reduce medical errors, preventable readmissions, and health care-associated infections.
Payment reform demonstrations will need to align the expected outcomes to the quality priorities established by the Secretary of the US Department of Health and Human Services. By setting quality standards, Secretary Sebelius will ensure that quality improves or is maintained while reforming the payment and delivery system.
These are just some of the issues we discussed in the open meeting earlier this week. Many of the reforms in the ACA became effective this week in the form of insurance protections that Massachusetts residents have enjoyed for a long time. The ACA also provides for many new public health and wellness promotion initiatives.
I invite you to read more about implementing national health care reform in Massachusetts by visiting: www.mass.gov/nationalhealthreform.