1. …and the rest of the story Massachusetts Health Reform Kaiser Family Foundation Alliance for Health Reform Grace-Marie Turner Galen Institute May 19, 2008

2. Massachusetts Connector options Four premium levels for similar coverage through the subsidized Commonwealth Care program Approved health insurance plans offer coverage through the unsubsidized Commonwealth Choice plan

3. Commonwealth Care Enrollment Nov 06 – Dec 07

4. Commonwealth Care Enrollment Sept 07 – May 08

5. Summary of Costs by Plan Type Plan 1 Plan 2 Plan 3 Plan 4 Monthly Premium $0$0-$35 $70- $105 Depends upon plan choice Max OOP (Med/Rx) $36 / $200 $250 / $250 $500 / $500 Phased out 7/1

6. Largest enrollment in no-cost plans

7. Enrollment in Commonwealth Choice

8. Typical connector prices Coverage Annual premium Young adult $ 2,000 deductible $2,280 HMO/ no ded. $6,096 Young family $1,500/$3,000 ded. $7,200 HMO/ low ded. $18,300 Empty-nest couple $2,000/$4,000 ded. $7,800 HMO/ no ded. $21,804

9. Est.: 89,000 Est.: 207,500 Est.: 228,000 * 87,000* 176,000 Commonwealth Care } 48,961 17,000 Connector coverage through March 1, 2008

10. Risks moving forward For consumers… –State approved a 12% insurance rate increase for next year –Fines to individuals continue to rise $219 in first year Up to $912 this year; $1,824 for uninsured couples –Shortage of doctors in some areas taking new patients Rising costs for taxpayers Crowd-out of job-based insurance

11. Taxpayer costs are rising State budget calls for $869 million in fiscal 2009, but the bill could be closer to $1.1 billion About 330,000 Massachusetts residents are newly enrolled in coverage, but at least 263,000 are in free or subsidized plans

12. Concerns about crowd-out Up to 40,000 workers are offered health insurance at work, but cant afford the premiums and earn under 300% of poverty. Workers eligible for Commonwealth Care can switch from job-based coverage, under certain conditions The employee share of job-based coverage often costs more than subsidized Commonwealth Care. E.g. $70/mo vs. 39/mo. The employee share of job-based coverage often costs more than subsidized Commonwealth Care. E.g. $70/mo vs. 39/mo. If only 10% of those eligible shift from job-based insurance to C-Care, the total cost next year alone could be an additional $90 billion, potentially reaching $550 billion by 2012 for this population.

13. Growing pains? Or are the costs and complexities of major changes to the health sector, even in a state that had a head start on the rest of the country, far greater than anticipated? Example: Just one set of regulations by one of Massachusetts new health reform boards and commissions to deal with just one problem…

14. Minimum Coverage Standards -- 2009 Prescription drug coverage. Visits to the doctor for preventive care, before a deductible. Deductibles that are capped at $2,000 for an individual or $4,000 for a family each year. An annual cap on out-of-pocket spending at $5,000 for an individual or $10,000 for a family (for plans with up-front- deductibles or co-insurance). No cap on total benefits for a particular sickness or for a single year. No cap on payment toward a day in the hospital.

15. 15 2008 Draft Affordability Schedule Proposed March 20 th IndividualsCouplesFamilies Annual Gross Income Range 2008 Proposed Annual Gross Income Range 2008 Proposed Annual Gross Income Range 2008 Proposed $0 - $15,612 (150%) $0 $0 - $21,012 (150%) $0$0 - $26,412 (150%) $0 $15,613 - $20,808 (200%) $39 $21,013 - $28,008 (200%) $78$26,413 - $35,208 (200%) $78 $20,809 - $26,016 (250%) $77 $28,009 - $35,016 (250%) $154$35,209 - $44,016 (250%) $154 $26,017 - $31,212 (300%) $116 $35,017 - $42,012 (300%) $232$44,017 - $52,812 (300%) $232 $31,213 - $37,500 (360%) $165 $42,013 - $52,500 (375%) $297$52,813 - $70,000 (398%) $352 $37,501 - $42,500 (408%) $220 $52,501 - $62,500 (446%) $396$70,001 - $90,000 (511%) $550 $42,501 - $52,500 (505%) $330 $62,501 - $82,500 (589%) $550$90,001 - $110,000 (625%) $792 >$52,501n/a >$82,501n/a>$110,001n/a

16. Signing ceremony April 12, 2006