1. Health Care Reform: Massachusetts Two Years Later Sarah Iselin Massachusetts Division of Health Care Finance and Policy July 2008

2. Massachusetts Division of Health Care Finance and Policy - 2 April 2006 Chapter 58 is signed!

3. Massachusetts Division of Health Care Finance and Policy - 3 The Massachusetts Law: Why So Much Attention? Ambitious goal: Near universal coverage Transcends ideology  Bipartisan support  Combines policy solutions from the right and the left  Partnership between federal government and state Novel approaches  Individual mandate, employer responsibility, insurance market changes

4. Massachusetts Division of Health Care Finance and Policy - 4 Where We Started in 2006: Uninsured In Massachusetts Sources: “Health Insurance Status of Massachusetts Residents,” 1998, 2000, 2002, 2004, 2006 Massachusetts Division of Health Care Finance and Policy. BCBS Foundation/Urban Institute, Census Bureau.

5. Massachusetts Division of Health Care Finance and Policy - 5 The Goal: “Near Universal” Coverage Principles of Reform: Build upon the existing base: fill in gaps “Shared responsibility”  Individuals  Employers  Government Shift financing from “opaque bulk payments” to safety net providers to health insurance for individuals

6. Massachusetts Division of Health Care Finance and Policy - 6 Where are we now? Source: Getting Ready for Reform, Sharon Long and Mindy Cohen, the Urban Institute, May 2008. Uninsurance for working-age adults has been nearly cut in half Fall 2006Fall 2007

7. Massachusetts Division of Health Care Finance and Policy - 7 Lessons from Massachusetts Seize the moment  1115 Waiver  New House Speaker  Governor presumed running for President Make the moment  Ballot initiative  Roadmap to Coverage No reform is possible without strong organizing and advocacy

8. Massachusetts Division of Health Care Finance and Policy - 8 Lessons from Massachusetts Our law is as much a political blueprint as a policy blueprint  Get everyone to the table – and keep them there –Many different tables –Relationships matter

9. Massachusetts Division of Health Care Finance and Policy - 9 MASSACHUSETTS LEAGUE OF COMMUNITY HEALTH CENTERS Good health. Right around the corner. WHO STILL SUPPORTS THE MASSACHUSETTS HEALTH REFORM LAW? Mass Medical Society

10. Massachusetts Division of Health Care Finance and Policy - 10 Lessons from Massachusetts Our law is as much a political blueprint as a policy blueprint  Get everyone to the table – and keep them there –Many different tables –Relationships matter  Compromise – Everyone got something and also gave something up

11. Massachusetts Division of Health Care Finance and Policy - 11 Everyone got something… Consumers: Medicaid expansion, subsidies, employer responsibility Providers: Medicaid rate increases Business: Lower assessment than might have otherwise been, sets no precedent since based on pool, individual mandate, expanded subsidies for small employers and their low-wage workers Insurers: New potential members, young adult products, individual mandate

12. Massachusetts Division of Health Care Finance and Policy - 12 And traded something off… Consumers: Individual mandate, potential for increased cost sharing Providers: More pay for performance, less money than they wanted (but still a LOT) Business: More assessment than they wanted Insurers: Subsidized plans limited to current Medicaid managed care organizations for the first three years, less flexibility on benefit design than they wanted

13. Massachusetts Division of Health Care Finance and Policy - 13 Lessons from Massachusetts Our law is as much a political blueprint as a policy blueprint  Get everyone to the table – and keep them there –Many different tables –Relationships matter  Compromise – Everyone got something and also gave something up  Create shared ownership –Passing law is only the first step –Continued coalition and collaboration after passage –Advocates must have capacity to participate in implementation

14. Massachusetts Division of Health Care Finance and Policy - 14 Lessons from Massachusetts On-going framing and messaging are critical  Understanding and shaping public opinion

15. Massachusetts Division of Health Care Finance and Policy - 15 Support for reform is still strong Source: Getting Ready for Reform, Sharon Long and Mindy Cohen, the Urban Institute, May 2008. Fall 2006Fall 2007 Support amongst working-age Massachusetts adults

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19. Massachusetts Division of Health Care Finance and Policy - 19 Challenges Ahead Education, outreach and enrollment Sustaining public support Ensuring access for the newly insured Maintaining strong safety net for those who will remain uninsured Financing – need a strong state economy Continued federal support for waiver renewal Moderating health care cost growth

20. Massachusetts Division of Health Care Finance and Policy - 20 GLOBE EDITORIAL Patrick makes a tough choice July 15, 2008 THE GOOD news is that enrollment in the state's new subsidized health insurance program has greatly exceeded projections. The bad news is that this has raised the first-year cost of Commonwealth Care from an expected $472 million to $630 million. To fill the gap, the Patrick administration has devised a plan that spreads the pain relatively equally among health reform's major stakeholders, from providers to employers to insurers and the state itself. The most important stakeholders - the individuals and families who have signed up for the state's pioneering effort at universal coverage - have already done their bit. In April, their premiums rose 10 percent and their co-payments also increased. The Legislature should approve the governor's proposal or come up with a better one before it adjourns at the end of this month….

21. Massachusetts Division of Health Care Finance and Policy - 21 Business balking at health changes Many firms and insurers oppose $100m price tag; Public backs Patrick idea to close gap in funding July 15, 2008 Governor Deval Patrick's proposal to ask businesses, insurers, and hospitals to kick in about $100 million to close a gap in funding for the state's landmark health insurance law is threatening to fracture the fragile coalition whose support was instrumental in passing the measure…

22. Massachusetts Division of Health Care Finance and Policy - 22 Biz groups: Health care reform costs are unfair Wednesday, July 30, 2008 Bay State business groups are fighting a state plan to collect more money for health-care reform, saying the effort will place too much of an economic burden on businesses at the wrong time. “Health-care reform and increased access to health care is a societal benefit that should be borne by all the citizens of the commonwealth rather than disproportionately by employers,” Associated Industries of Massachusetts Executive Vice President Brian Gilmore wrote in a letter to the group’s 7,000 member companies. The Greater Boston Chamber of Commerce, the Massachusetts Business Roundtable and the Massachusetts Taxpayers Foundation also oppose the plan. The criticism comes as state representatives debate a plan to generate an additional $89 million for the health-care reform law.

23. Massachusetts Division of Health Care Finance and Policy - 23 Medicare Medicaid Employer Coverage Individual Mandate Medicaid Expansions Employer Responsibility Insurance Market Reforms Affordable Products Young Adult Products Connector Commonwealth Care