The state was also the first to require individuals who could afford it to purchase health insurance. Building on the existing system, the state expanded its Medicaid program, created a new subsidized program through a health insurance exchange, instituted insurance market reforms to make insurance more available and affordable, and required employers not offering insurance to contribute a modest amount of money to help finance government subsidies. ![]() Massachusetts launched its health reform initiative in 2006 based on the principle of shared responsibility among individuals, government, and business. This is followed by an assessment of current health insurance coverage and broader policy lessons from the Massachusetts experience. Next, we systematically analyze how affordability was defined, how minimum insurance benefits packages were established, how insurance market regulations were changed, and how the mandate has been enforced. Who would be required to obtain coverage? What coverage would be required? How would mandates for individuals to obtain coverage or employers to provide coverage be enforced? And how could the required coverage be made affordable?įirst, we provide an overview of health reform in Massachusetts and background on the efforts that led to its implementation. Even so, seeking coverage expansions in a multipayer context (individual and employer-based coverage plus public programs) posed a set of policymaking challenges. Massachusetts had several advantages as it approached reform, including a relatively high percentage of the population that already had coverage, an uncompensated care pool that could be converted to dollars for coverage, and the ability of a Republican governor and Democratic legislature to work constructively together. ![]() This article describes the substance and the politics of the steps that were taken to achieve this level of coverage. Data show that only 2.6 percent of the state's population was uninsured in 2008 ( Long, Cook, and Stockley 2008). The experience of the 2006 health reform in Massachusetts suggests that in combination, these tools can be helpful. With a single-payer option off the table, as it was in the 2009 federal health reform debate, requirements, incentives, and regulations now are the tools available to reformers who seek universal health insurance coverage. Implementation entailed trade-offs between the comprehensiveness of benefits and premium costs, the subsidy levels and affordability, and among the level of mandate penalties, public support, and coverage gains.Ĭonclusions: National lessons from the Massachusetts experience come not only from the specific decisions made but also from the process of decision making, the need to keep stakeholders engaged, the relationship of decisions to existing programs and regulations, and the interactions among program components. ![]() Methods: The data in this article are based on a case study of Massachusetts, including interviews with key stakeholders, state government, and Commonwealth Health Insurance Connector Authority officials during the first three years of the program and a detailed analysis of primary and secondary documents.įindings: Coverage expansion and an individual mandate led Massachusetts to define affordability standards, establish a minimum level of insurance coverage, adopt insurance market reforms, and institute incentives and penalties to encourage coverage. ![]() While achieving political consensus on reform is difficult, implementation can be equally or even more challenging. Context: Much can be learned from Massachusetts's experience implementing health insurance coverage expansions and an individual health insurance mandate.
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