1. Massachusetts Health Reform – Round Three Brian Rosman & Fawn Phelps Health Care For All, Massachusetts

2. Presentation Outline Health Care For All – Background Brief History of Massachusetts Reform Round 3 – What Massachusetts Passed The National Stakes Stay Informed

3. Health Care For All: What We Do Policy Coalitions to Make Change –Coalitions on MassHealth, childrens coverage, disparities, oral health, private market concerns, and health reform –Also work on E-Health, quality issues Programs to Help Consumers –Consumer Helpline, Outreach, legal Communication to Inform Everyone –www.hcfama.org, blog, regular emailswww.hcfama.org

4. Brief History of MA Reform 1988: Universal Health Care Law –Pay/Play Employer Mandate Never Implemented/Repealed 1996 –CommonHealth (working disabled), Student Mandate, Medical Security Plan (unemployment), Healthy Start (pregnant women) – still going strong 1996: MassHealth –Medicaid->MassHealth; Income-based not welfare- based – 350,000 new enrollees –Coverage for all children – CMSP –Senior Pharmacy Program Both reform waves inspired national action

5. Round 3 – the Problems 500,000+ uninsured – growing Decline in employer-provided coverage –4th largest percentage drop nationally Main reason: high cost of care Federal Medicaid Waiver (MassHealth) renewal: must implement July 2006 Providers underpaid by MassHealth

6. Round 3 – the Players Governor Mitt Romney (Republican lame duck – running for President) Legislature – overwhelmingly Democratic Federal officials – push to approve waiver Business Groups: –Small biz, ideological right-wing –Large biz, pragmatic, health infiltration Affordable Care Today Coalition (ACT!) –HCFA, GBIO (religious coalition), Providers, Labor, Grass-roots progressives MassACT – Ballot Initiative Committee

7. Round 3 – The Federal Waiver Section 1115 – feds can waive Medicaid rules 1997–2005: Two waivers, no change –Includes $385M supplemental payments to public hospital-sponsored managed care plans for uninsured 2005: Feds demand changes –Payments to institutions must shift to coverage Deadline: in place by 7/1/06

8. Round 3 – Timeline 6/04: HCFA begins public activity around reform, begins drafting bill 11/04: Travaglini (Senate Pres.), Romney Announce Plans 8/05: MassACT Ballot Petition Filed 10/05: House bill released 11/05: House, Senate Pass Bills 12/05: Conference Committee Begins 4/06: Bill passes Legislature: 153-2 in House; 37-0 in Senate 4/06: Romney signs bill and vetoes 8 sections

9. Our Organizing Model Two Coalitions: –Broad coalition for legislative push –Narrow true believers pushed ballot initiative Grassroots Pressure + savvy lobbying by experienced pros Simple messages to the public –Fairness –Shared responsibility –Good for economy, small business Turning point was convincing House Speaker of policy

10. Chapter 58 – Medicaid MassHealth (Medicaid): –Kids coverage expanded to 300% fpl ($60,000/family of 4) –MassHealth Essential (long-term unemployed childless adults) enrollment cap increased –Dental, dentures, eyeglasses, other services restored for adults –$3 million in outreach grants to community groups

11. Chapter 58– Subsidized Coverage Commonwealth Care: subsidized coverage for low income uninsured below 300% of poverty ($30,000 / year) –Premiums: no premium if below poverty; sliding scale between 100%-300% fpl –No deductibles –Below 100%: MassHealth cost-sharing, dental, prescription, mental health benefits

12. Chapter 58– Rate Increases Medicaid Rate Increases: –$90 million additional per year for 3 years. Goes from ~80% of costs to ~95% of costs –Hospitals must meet quality benchmarks to get increase

13. Chapter 58– Individuals Individual Mandate –All residents must obtain health coverage if affordable coverage available –Board of Connector defines affordable –We will advocate to only apply to fairly well-off people –Enforced through tax system –Begins July 2007

14. Chapter 58– Employers Fair Share Contribution –Employers who dont offer coverage with 11+ employees pay $295/ worker –Employer must make a fair and reasonable premium contribution to be exempt Employers must facilitate pre-tax cafeteria plan for health insurance

15. Chapter 58– Insurance Insurance Market Reforms –Does not authorize high deductibles as Romney wanted –Non-group (individual) health insurance market merges into small group market Could cut non-group premiums 24% –19-24 year olds can stay on parents plans for 2 years –Special reduced-benefit plans available for 19- 26 year olds –Lots more

16. Chapter 58– And More Connector allows uninsured over subsidy level to buy coverage pre-tax –Portability; part-timers can aggregate contributions Disparities Council Quality and Cost Council –Cost and quality performance benchmarks –Website with findings Restores $20 million for public health prevention programs

17. Round 3 – Whats Next? Overrides of Romney vetoes of individual provisions Need federal approval Implementation challenges are huge Funding depends on continued commitment of political leaders, economy staying healthy

19. The National Stakes… Familiar Health Reform Refrain: –Who pays what to expand coverage? Political Right: –Health care should be individual responsibility Political Left: –More employer responsibility (assuming single payer not viable for now) This bill: Combines both in untested way. Does this change political sense of whats possible? Next challenge: cost and quality

20. More information … Educate yourself –www.hcfama.org/act – bill text, summaries, analysiswww.hcfama.org/act –www.hcfama.org/blog – latest newswww.hcfama.org/blog