Maintaining Affordable Health Coverage in Massachusetts Suzanne Curry Health Care For All Families USA Health Action 2015 January 23, 2015

Massachusetts Health Reform

Determining Affordability o Community Catalyst study looked at: Greater Boston Interfaith Organization Study MassFESS (Family Economic Self-Sufficiency Standard) Economic Policy Institute Basic Family Budget o Showed people <300% FPL barely have enough income to cover basic needs (before health care costs)

Commonwealth Care o Comprehensive health coverage for adults at or below 300% FPL not eligible for MassHealth (Medicaid) o Run by the Health Connector (MA marketplace) o Sliding scale premiums based on income, copays also based on income: Plan Types 1, 2, 3 o Cannot be offered health insurance from job o As of December 31, 2013, about 220,000 enrollees

Why State “Wrap”* Needed Income $11,916 $23,900 $35,500 ConnectorCare Premiums ACA Premiums * “ConnectorCare”

ACA vs. MA Premiums & Cost Sharing

ConnectorCare o Coverage designed to look like Commonwealth Care o Eligibility o Meet eligibility standards for federal APTCs o Income at or below 300% FPL o Must choose from subset of plans offered through the Health Connector (mostly Medicaid MMCOs )

ConnectorCare Premiums

ConnectorCare Cost-Sharing o Co-pays only; no deductibles or co-insurance o Mirrors actuarial value of Commonwealth Care o Plan Type 1 (at or below 100% FPL): Medicaid- level co-pays (for prescription drugs only) (~99% AV) o Plan Type 2 ( % FPL): Low to moderate co-pays (~97% AV) o Plan Type 3 ( % FPL): Moderate co-pays (~95% AV)

ConnectorCare Funding o Federal APTCs + Federal Cost-Sharing Reductions + State Funds = ConnectorCare Subsidies o FY2015 Budget estimated cost at $235 million o State funding sources include a portion of the cigarette tax, individual mandate penalties, employer assessment o 50% federal reimbursement for premium wrap portion only (for citizens and qualified immigrants) through 1115 Medicaid Demonstration waiver

Thank you! Questions?