Massachusetts’ Healthcare Reform Act Essay

Exercise Content
State Strategies (20% of grade) The purpose of this assignment is to familiarize students with health reform strategies adopted by states. Students will select a state health policy reform innovation and describe the rationale, how it was adopted (e.g., federal waivers, passage by state legislature), the funding structure, and (to the extent statistical data are available) its impact. Students should summarize their findings in a 1-2 page, single-spaced memo. Sample memo attached. A memo is required, see attached sample. A few examples of state innovations include Vermont’s single payer system, Massachusetts’ health reforms and Kentucky’s Medicaid healthcare program (none of these can be used). Please see attached rubric..  Massachusetts’ Healthcare Reform Act Essay
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Memo
To: Prof. Thomas Smith
From: Student- Jane Doe
Reference: Health Care Policy
Date: March 18, 2018
Subject: Massachusetts’ Healthcare Reform Act

Massachusetts’ Healthcare Reform Act
Rationale
Massachusetts State is among the states that have made a number of attempts aimed at reforming the state’s healthcare system to make access to quality healthcare available for its residents. Recently in 2006, Massachusetts passed the Healthcare Reform Act, which was later, signed into law by former Governor Mitt Romney (Van der Wees et al., 2013). The rationale for this healthcare reform was to provide near-universal health insurance coverage for Massachusetts’ residents.  Massachusetts’ Healthcare Reform Act Essay
Adoption of the Reform
The Massachusetts Healthcare Reform Act was passed by the State legislators after years of negotiation between Mitt Romney and the legislators with a compromise reached in 2006 resulting in the enactment of the reform that was effectively signed into law by Romney on 12 April 206. The reform has made several changes to its healthcare system in a move aimed at achieving a near-universal healthcare coverage for the residents of the state. The first change was made to the state’s Medicaid program that was broadened by providing a MassHealth waiver, extending health insurance coverage to children in low-income families with up to 300% of the federal poverty level (FPL) (Kaiser Family Foundation, 2012). Massachusetts created what is called Commonwealth Care, which provides the residents of the state with access to subsidized health insurance for eligible individuals with earnings below 300% of FPL. Under this new healthcare reform, individuals with income below 150% of FPL also have the option of selecting a plan without a monthly premium and low-cost sharing. However, eligible individuals with earnings falling between 150-300% PL are subsidized by the state using a sliding scale.  Massachusetts’ Healthcare Reform Act Essay
The Massachusetts Healthcare Reform Act also saw the state expand its Insurance Partnership Program by providing incentives and subsidies to the employers to give and workers to enroll in the state’s employer-sponsored insurance. In this respect, Massachusetts State subsidized insurance costs for the workers in the state who would otherwise be eligible for programs subsidized by the government. However, small businesses are only eligible for up to $1,000 in support per qualified worker who falls below the 300% FPL (Van der Wees et al., 2013). Under the program, the state government pays the portion of qualified workers’ premiums that is equal to what the employees would be expected to pay if employees were on a subsidized plan. Additionally, under this new healthcare reform, any employer in the state who fails to provide health insurance to its workers is expected to pay what is called a ‘fair share’ assessment to the government of up to $295 per worker every year (Kaiser Family Foundation, 2012).
The reform also created what is called the Commonwealth Health Insurance Connector whose primary aim is to link those without access to employer-sponsored insurance and companies with 50 or fewer employees that provide insurance coverage for its workers. According to this health reform, small businesses with 50 of fewer employees have the option of buying insurance coverage on their own or via the Connector (Rapoza, 2012). Massachusetts’ Healthcare Reform Act Essay

Funding Structure
Although Romney and the state legislators agreed on most of the components of the bill, agreeing on how this healthcare reform would be financed was a major issue as it was clear that financing the reform would result in an increase in healthcare cost. However, following a compromise that was reached, the state legislators agreed that the reform would be financed by individuals, employers and the government. First, the Massachusetts Healthcare Reform is funded by the existing $320 million obtained in hospital assessments and covered levies (Van der Wees et al., 2013). Second, the Massachusetts state legislators agreed that the health reform would also be financed through by federal safety-net payments of $610 million as well as federal matching payments on the MassHealth expansion. Additionally, part of the money to be used in financing the health care reform is to come from rate increases projected at $299 million. Further, $295 fair assessment for employers per employee and the Free Rider Surcharge also generates revenue used to finance the ambitious health care reform in Massachusetts (Kaiser Family Foundation, 2012). Massachusetts’ Healthcare Reform Act Essay
Impacts
The impacts of this Massachusetts Healthcare Reform Act have been so profound. The first major achievement of this healthcare reform is that it has increased access to affordable coverage to residents of Massachusetts. Because the law requires all residents of Massachusetts to have a health insurance or pay a fine, the law had seen more that 99% of the residents of the state now get health insurance coverage up from 90% before this healthcare reform was introduced. According to Rapoza (2012), prior to 2006, more than 24% of low-income residents of Massachusetts had no health insurance. However, by 2012, only 8% of low-income adults in the state were still without healthcare coverage. Overall, about 650,000 Massachusetts residents who lacked health insurance are now covered.
Another significant achievement of the Massachusetts health insurance is that it has increased insurance status of higher income persons for the self-employed who did not qualify for MassHealth. According to Urban Institute, the population of higher income earners who were without health insurance before 2006 has dropped from 5% then to below 1% three years after the reform (Kaiser Family Foundation, 2012).
The only notable shortcoming of this healthcare reform is the cost burden associated with its implementation. The health cost in the state has risen to a historic high following the introduction of this healthcare reform was introduced. By 2007, just one year after the reform, Massachusetts healthcare expenditure accounted for about 15.2% of its GDP, which is higher than the nation’s average of 13.7% as a whole (Kaiser Family Foundation, 2012). Massachusetts’ Healthcare Reform Act Essay

In 2006 the state of Massachusetts wanted to help its millions of citizens who were uninsured. The state legislators as well as the governor put into place a plan to help citizens get insurance. A law was passed to reform insurance in Massachusetts, which was known as Chapter 58 of the Acts of 2006 of the Massachusetts General Court; its long form title is An Act Providing Access to Affordable, Quality, Accountable Health Care. The newly enacted law decreed that almost all of Massachusetts’ residents obtain a minimum level of insurance coverage. It also gave free health care insurance for Massachusetts residents that earned less than 150 percent of the federal poverty level. It also decreed that all…show more content…
The rising costs of unpaid emergency room expenditures were an issue that had to be addressed by state authorities. EMTALA required that all persons be treated, however, it did not include any legislation to reimburse payment that left hospital left with unpaid bills and growing expenses. The state of Massachusetts had a tax set up to help pay for the expenses of the uninsured emergency room visits. The tax was known as Uncompensated Care Pool, and nicknamed free care pool. It also covered uninsured hospital admissions and community health centers. The free pool care was always underfunded and was raised annually. An MIT professor determined that the amount of money in the free pool care would be enough to fund reform legislation without needing to raise any more taxes or have additional funding. Another issue was the fact the large employers that received self-insurance were progressively giving up health insurance as an employee benefit. They also mandated that only full-time employees would be eligible for the insurance benefit. These issues among others are why advocacy groups and state legislators felt very strongly that some kind of health insurance reform was necessary. The actual statute consisted of key provisions, one of which was the employer Fair Share Contribution and Free Rider Surcharge. Another was a requirement that each individual must have proof of coverage Massachusetts’ Healthcare Reform Act Essay

According to the U.S. Department of Health and Human Services the Health policy broadly describes actions taken by governments national, state, and local to advance the public’s health. It is not a single action but requires a range of legislative and regulatory efforts ranging from ensuring air and water quality to supporting cancer research. Health care policy deals with the organization, financing and delivery of health care services. This includes training of health professionals, overseeing the safety of drugs and medical devices, administering public programs like Medicare and regulating private health insurance (U.S. Department of Health and Human Services 2010). This analysis covers the federal statute enacted in 2010: the Patient Protection and Affordable Care Act (PPACA), which was designed to help families across the states gain access to quality, affordable health care. Massachusetts’ Healthcare Reform Act Essay

Many countries integrate a human rights viewpoint when creating their health care policies. The World Health Organization reports that every country in the world is party to at least one human rights treaty that addresses health-related rights, including the right to health as well as other rights that relate to conditions necessary for good health (World Health Organization, 2012). The United Nations’ Universal Declaration of Human Rights (UDHR) asserts that medical care is a right of all people (The United Nations, 2012).

UDHR Article 25: Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, and housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. Massachusetts’ Healthcare Reform Act Essay

Health care reform in the United States has a long history. In 1900 the American Medical Association (AMA) became a powerful national force. By 1910 the American Association for Labor Legislation (AALL) organized the first national conference on “social insurance”. Liberal activists argued for health insurance. In the 1930’s the Depression changed priorities, placing more importance on unemployment insurance and “old age” benefits. The Social Security Act was passed, omitting health insurance. By the 1940’s prepaid group healthcare began and was seen as radical. During the 2nd World War, wage and price controls were placed on American employers. To compete for workers, companies began to offer health care benefits, this employer-based system in place today. President Roosevelt asked Congress for “economic bill of rights,” including the right to adequate medical care. President Truman offered national health program plan, recommending a single system that would include all of American society. Truman’s plan was criticized by the American Medical Association (AMA), and is called a “Communist plot” by a House subcommittee. In the 1950s, hospital care cost doubled. In the early 1960s, President Lyndon Johnson signed Medicare and Medicaid into law. President Richard Nixon renamed health care plans to health maintenance organizations (HMOs), with regulations that provided federal endorsement, certification, and assistance. American medicine was viewed as being in a state of emergency. President Nixon’s plan for national health insurance was rejected by liberals & labor unions. In the 80’s Corporations began to integrate the hospital system (previously a decentralized structure), consolidating control. Healthcare shifted toward privatization and corporatizations. Massachusetts’ Healthcare Reform Act Essay In 1986 Congress passed and President Ronald Reagan signed into law COBRA, an option that former workers could stay on the company health care plan for 18 months after leaving a job, although the former employee would pay for the coverage. In 1988 prescription drug benefit and catastrophic care coverage was added to Medicare; Congress repealed the law the next year. Under President Reagan, Medicare moved to payments for diagnosis’s (DRG) rather than for treatment received. Health care costs increased at double the rate of inflation. Federal health care reform legislation failed passage for a second time in the U.S. Congress. By the end of the decade there were 44 million Americans, which was 16 % of the nation, with no health insurance at all. With a fresh era and Health care costs are on the upsurge again. Medicare is viewed by some as unmentionable under the current organization and must be “rescued” (Associated press, 2012). Massachusetts’ Healthcare Reform Act Essay

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After years of unsuccessful attempts by a series of Democratic presidents and a year of bitter partisan struggle, President Obama signed legislation on March 23, 2010, “to overhaul the nation’s health care system and guarantee access to medical insurance for tens of millions of Americans. The Affordable Care Act seeks to extend insurance to more than 30 million people, primarily by expanding Medicaid and providing federal subsidies to help lower- and middle-income Americans buy private coverage. It will create insurance exchanges for those buying individual policies and prohibit insurers from denying coverage on the basis of pre-existing conditions. To reduce the soaring cost of Medicare, it creates a panel of experts to limit government reimbursement to only those treatments shown to be effective, and creates incentives for providers to “bundle” services rather than charge by individual procedure”. (Henry J. Kaiser Foundation, 2010) Massachusetts’ Healthcare Reform Act Essay

According to research done by the New York Times the law will cost the government about $938 billion over 10 years, according to the nonpartisan Congressional Budget Office, which has also estimated that it will reduce the federal deficit by $138 billion over a decade (Andrews, 2012).

One feature of the Affordable Health Care Act is that insurance companies including all exchange plans will provide adequate benefits to their enrollees. The essential health benefits package will define the minimum set of benefits that new health plans must offer for private market individual and small group plans as well as for Medicaid enrollees in benchmark coverage and those covered by state Basic Health Programs. Many expected the Department of Health and Human Services to outline the services to be included in essential health benefits package; instead it specified that each state would select the package that best meets the needs of children and families (Merles, M. 2005). Massachusetts’ Healthcare Reform Act Essay

Essential health benefits (Ebbs) are the least amount benefits that the Affordable Care Act (ACA) requires to be offered by non-grandfathered health plans in the individual and small group markets. Section 1302 of the ACA identifies the requirements for the essential health benefits. This approach allows states have the discretion to choose a benchmark set of benefits from among the existing health plans. Section 1302 also establishes some specific guidelines in defining the Ebbs. Benefits may not be designed “in ways that discriminate against individuals because of their age, disability, or expected length of life” and are required to “take into account the health care needs of diverse segments of the population, including women, children, persons with disabilities, and other groups.”(Touschner, 2011) Massachusetts’ Healthcare Reform Act Essay

EHB packages must include benefit protections established in other parts of the ACA, including parity for mental health services and preventive services offered at no cost to enrollees. For infants, children, and adolescents, the preventive services requirement incorporates the services recommended in the American Academy of Pediatrics’ Bright Futures initiative (Touschner, 2011). Massachusetts’ Healthcare Reform Act Essay

The need for adequate Children’s benefits is critical due to their constant development and growth. Children have need of health services that are different than adults, which includes preventive screenings depending on their age and development stage. Children’s growing bodies may also require long-lasting medical equipment (like wheelchairs) on a more frequent schedule than adults. In its Scope of Health Care Benefits for Children policy statement, the American Academy of Pediatrics (AAP) outlines the services that are essential for children. (“Scope of health,” 2012) Massachusetts’ Healthcare Reform Act Essay

For many years, Americans have paid the price for policies that have allowed insurance companies to place barriers between them and their doctors, dropping their coverage for sickness, and discriminating against anyone for pre-existing conditions. Mississippi has one of the nation’s highest percentages (63.2 percent) of uninsured people who would qualify for Medicaid under the expansion in the United States (Kaiser 2010). The Affordable Care Act gives middle-class and low income families in Mississippi the health insurance coverage they deserve. The new health care law dictates that insurance companies are to play by the rules, they can no longer drop coverage if you get sick, sending you into bankruptcy because you have met your annual or lifetime limit, but most importantly they cannot discriminate against anyone with a pre-existing condition (U.S. Department of Health and Human Service, 2010). It is now mandated that health plans allow parents to maintain coverage of their children who are under the age of 26 and without insurance on their jobs. Resulting from this provision, As of December 2011, 37,000 young adults in Mississippi now have insurance which is included in 3.1 million young people nationwide. The health care law includes Medicare prescription drug coverage benefits which have made prescriptions more affordable. In 2010, a $250 rebate was given to 34,604 people with Medicare in Mississippi who had hit the prescription drug donut hole. In 2011, they began receiving a 50 percent discount on covered brand-name drugs and a discount on generic drugs (U.S. Department of Health & Human Services, 2012). Since the law was enacted, residents with Medicare in Mississippi have saved a total of $41,809,338 on their prescription drugs. As a result of the discounts people are saving $591 per year and a total savings of $11,732,360 in Mississippi in 2012. It is projected by 2020; the law will close the donut hole. Massachusetts’ Healthcare Reform Act Essay

Last year (2011) 330,017 people with Medicare in Mississippi received free preventive services or a free annual wellness visit with their doctor (U.S. Department of Health & Human Services, 2012). Approximately 47 million women, including 381,704 in Mississippi now have guaranteed access to additional preventive services without cost-sharing. Under the new health care law, insurance companies must provide consumers greater value by spending generally at least 80 percent of premium dollars on health care and quality improvements or they must provide consumers a rebate or reduce premiums. This means that 51,744 Mississippi residents with private insurance coverage will benefit from $10,122,532 in rebates from insurance companies this year which will average to $329 for the 30,800 families in Mississippi covered by a policy. Under the new law Mississippi has received $4,783,208 to help fight arbitrary premium increases. As of August 2012, 317 previously uninsured residents of Mississippi who were locked out of the coverage system because of a pre-existing condition are now insured through a new Pre-Existing Condition Insurance Plan that was created under the new health reform law (U.S. Department of Health & Human Services, 2012). Massachusetts’ Healthcare Reform Act Essay

Mississippi has received $21,143,618 in grants for research, planning, information technology development, and implementation of Affordable Insurance Exchanges. Since 2010, Mississippi has received $5,200,000 in grants from the Prevention and Public Health Fund created by the Affordable Care Act. This new fund was created to support effective policies in Mississippi, its communities, and nationwide so that all Americans can lead longer, more productive lives (U.S. Department of Health & Human Services, 2012). In Mississippi, there are 21 health centers providing preventive and primary health care services to 324,046 people from183 different sites. These health centers have received $49,784,983 under the Affordable Care Act to support the operations and establishments of new health center sites. Mississippi was granted $4,100,000 for school-based health centers, to help clinics expand and provide more health care services such as screenings to students and $3,100,000 for Maternal, Infant, and Early Childhood Home Visiting Programs. These programs bring health professionals to meet with at-risk families in their homes and connect families to the kinds of help that can make a real difference in a child’s health, development, and ability to learn – such as health care, early education, parenting skills, child abuse prevention, and nutrition (U.S. Department of Health & Human Services, 2012). Massachusetts’ Healthcare Reform Act Essay

The Patient Protection and affordable care Act (PPACA) will be implemented in a span of the next four years. The law includes an increase of the number of persons who are eligible to Medicaid; the government will reward discount of insurance premiums, for businesses providing health insurance. Insurance companies will no longer be able to deny coverage or claims because of the health history of any person. With the Patient Protection and affordable care Act all Americans will have the security of knowing that they don’t have to worry about losing coverage if they’re laid off or change jobs. Insurance companies now have to cover preventive care like mammograms and other cancer screenings. The new law also makes a momentous investment in State and community-based efforts that promote public health prevent disease and protect against public health emergencies. Massachusetts’ Healthcare Reform Act Essay

Although this healthcare plan comes with its own costs, they will be covered by the taxes that will be imposed on the wealthy. Individuals who choose not to have insurance will be penalized with a tax fee as a way of encouraging every member in society to have insurance and this will be as a source of income to offset the plan’s cost. This was a great step towards ensuring a good healthcare for all the people of the US regardless of whether they are insured or not. There are several classes of people living in the US, who do not have access to insurance. These people range from illegal immigrants to others who see insurance as very expensive and can’t afford to pay for insurance. The number of uninsured Americans is estimated to be 32 million today but after the PPACA was signed in to law the number is expected to decline considerably to about 23 million. Most of the uninsured people are drawn from illegal immigrants because they are not eligible to obtain insurance while they are residing in the US. Poor and middle class persons and their families also tend to go without insurance. (Institute of Medicine of the National Academies 2010 available online) Massachusetts’ Healthcare Reform Act Essay

The Affordable Care Act was specifically designed to give States the resources and flexibility they need to tailor their approach to their distinctive needs and to help families across the country gain access to quality, affordable health care. The Affordable Care Act ensures hard-working, middle class families will get the health care they deserve by keeping health care costs low, encouraging prevention, and making insurance companies accountable. Massachusetts’ Healthcare Reform Act Essay