Massachusetts's Health Care

Massachusetts’s health care

The Massachusetts health care insurance reform law, enacted in 2006, mandates that nearly every resident of Massachusetts obtain a state-government-regulated minimum level of healthcare insurance coverage and provides free health care insurance for residents earning less than 150% of the federal poverty level (FPL) who are not eligible for Mass Health (Medicaid). The law also partially subsidizes health care insurance for those earning up to 300% of the FPL. These subsidies and FPL-related calculations affect very few of the over 6,000,000 people (see Massachusetts Department of Healthcare Finance and Policy quarterly Key Indicators report) that had healthcare insurance prior to the enactment of the law.

The law established an independent public authority, the Commonwealth Health Insurance Connector Authority, also known as the Health Connector. Among other roles, the Connector acts as an insurance broker to offer private insurance plans to residents. The reform legislation also included tax penalties for failing to obtain an insurance plan. Massachusetts tax filers who failed to enroll in a health insurance plan, which was deemed affordable for them lost the $219 personal exemption on their income tax. Beginning in 2008, penalties increased by monthly increments.

The healthcare insurance reform law was enacted 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, and Accountable Health Care. In October 2006, January 2007, and November 2007, bills were enacted that amended and made technical corrections to the statute (Chapters 324 and 450 of the Acts of 2006, and chapter 205 of the Acts of 2007).

Allegedly because of their lack of health insurance, uninsured Massachusetts’s residents commonly utilize emergency rooms as a source of primary care. The United States Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986. EMTALA requires hospitals and ambulance services to provide care to anyone needing emergency treatment regardless of citizenship, legal status or ability to pay. EMTALA applies to virtually all hospitals in the U.S but includes no provisions for reimbursement. EMTALA is therefore considered an "unfunded safety net program" for patients seeking care at the nation's emergency rooms. As a result of the 1986 EMTALA legislation, hospitals across the country faced unpaid bills and mounting expenses to care for the uninsured. Data following enactment of mandatory insurance show total emergency visits and spending continued to increase, and low-severity emergency visits decreased less than 2%; researchers concluded, "To the extent that policymakers expected a substantial decrease in overall and low-severity ED visits, this study does not support those expectations."

In Massachusetts, a fund of approximately $700 million, known as the Uncompensated Care Pool (or "free care pool"), was used to partially reimburse hospitals and health centers for these expenses and the expenses of non-residents. The fund was created through an annual assessment on insurance providers and hospitals, plus state and federal contributions. It was predicted that implementation of the Massachusetts health reform law would result in a decrease in expenses incurred in providing services to the uninsured, as the number of covered Massachusetts residents increased. In 2006, an MIT economics professor Jonathan Gruber predicted that the amount

...