Managed Healthcare Executive - December 2008 - (Page 18)

State Report Massachusetts COMMONWEALTH FUND STATE PERFORMANCE RANKING (2007): 8 TWO NEW STUDIES BY THE Urban Institute examine how the Massachusetts health insurance law has affected uninsured residents in the state. In late 2006, Massachusetts implemented landmark legislation to provide nearly all state residents with healthcare coverage. The law imposes an individual mandate for the purchase of health insurance and calls for shared responsibility in nancing coverage. The legislation includes Medicaid expansions, subsidized private insurance coverage for adults whose family income is less than 300% of the federal poverty level, and creation of a purchasing pool for workers in small rms and individuals without access to employer-sponsored insurance. The state’s health reform initiative includes expanded coverage options for young adults, insurance market reforms, an individual mandate that requires adults to have health insurance if they have access to an a ordable health plan, and requirements for employers. While the state has faced a number of challenges implementing the plan, it has been extremely successful in expanding coverage. The state’s share of uninsured working-age adults (those between the ages 18 to 64) fell from 13% to 7% between Fall 2006 and Fall 2007, according to Urban Institute researchers. What’s more, reform has led to better access to healthcare and reductions in the nancial burden of obtaining healthcare. MASSACHUSETTS Number of residents 6.34 million Healthcare Expenditures (2004) $43 billion Average Annual Percent Growth in Expenditures per Capita (1991-2004) 6% Healthcare Expenditures per Capita $6,683 with the number of uninsured men dropping by half while the share of uninsured women dropped by one-third. Uninsurance among employees at small businesses fell by 10 percentage points, compared with a three point drop among employees in larger rms. The second study examines whether enforcing mandatory health insurance would force people—particularly those with low incomes—into plans that provide little nancial protection. The study, which gauged underinsurBENEFITTING FROM REFORM ance according to two di erent de niThe new studies, which were funded tions, found the share of insured adults by the Robert Wood Johnson Foun- who were underinsured dropped by dation, the Blue Cross and Blue Shield about two percentage points under of Massachusetts Foundation and the both de nitions between Fall 2006 Commonwealth Fund, explore who and Fall 2007. Lower-income adults has gained the most under the reform and insured adults with health proband whether people in the state are ad- lems—the two groups most vulnerable equately insured. to the risks of uninsurance—saw the The rst study nds lower-income greatest reduction in underinsurance. adults, young adults and minorities exWhile healthcare reform has led to a perienced the greatest gains in coverage. reduction in underinsurance, the MasMen made greater gains than women, sachusetts Commonwealth Health Insurance Connector Authority’s board took additional steps to address the DISTRIBUTION OF EXPENDITURES, 2004 (IN MILLIONS) problem. The board voted unanimously Hospital Care to proceed with new minimum stan4% Other $16,865 (39%) 1% Medical Durables dards for health coverage. With some 4% Home Physician/Professional Services Healthcare exceptions, the standards, which take $10,406 (24%) e ect Jan. 1, 2009, mandate that state5% Drugs/Medical Nondurables Dental approved plans o er bene ts for pre$5,462 (13%) Services scription drugs, preventive and primary Nursing Home Care care, hospitalization, mental health and $4,124 (10%) substance use services, and emergency 10% Dental Services services. Those who do not have insurNursing Home $2,276 (5%) 39% Hospital Care ance, or cannot prove that their coverHome Healthcare age meets these standards, will face an $1,743 (4%) 13% Drugs annual tax penalty. MHE Other Personal Healthcare $1,633 (4%) Medical Durables $501 (1%) Total $43,009 18 DECEMBER 2008 24% Physician/ Professional Services MHE Sources: Centers for Medicare & Medicaid Services; Urban Institute; Kaiser Family Foundation; U.S. Census Bureau; The Commonwealth Fund.

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Managed Healthcare Executive - December 2008 For Your Benefit Editorial Advisors Contents News Analysis Politics & Policy Letter of the Law Puerto Rico’s PLAN State Report Bundled Payment Technology Drug Class Overview Managed Care Outlook Desktop Resource Ad/Edit Index

Managed Healthcare Executive - December 2008

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