September 2016

September 15, 2016

Our friend Vicky Pulos, attorney and advocate at the Massachusetts Law Reform Institute, has a blistering letter in today's Boston Globe, objecting to the reasoning used by the Connector in suddenly raising subsidized ConnectorCare premiums (see our post for background).

Here it is:

A safety net frays as Mass. health plan premiums spike

THE MASSACHUSETTS Health Connector’s decision to raise most premiums for subsidized insurance in 2017 represents a change in its longstanding policy of protecting the poorest of the poor from the full effects of premium increases (“Subsidized health plan raises rates 21%,” Page A1, Sept. 9). For the lowest-income ConnectorCare enrollees, including the destitute and the homeless, the cost of remaining with their current plan may increase by as much as $165 per month.

Massachusetts’ 2006 health reform law prohibited premium contributions for those living below the poverty level. Until last week’s board meeting, the Connector had honored the spirit of state health reform by fully subsidizing all plan choices for the very poor.

Several board members objected to this practice of what they called “cross-subsidization.” However, the Connector is not a private insurance company. It has no profitable or unprofitable product lines. It’s a public authority, and ConnectorCare is a public program. The fiscal constraints driving the Connector have more to do with declining state tax revenue, and the need to transfer funds back to the general fund to support other state spending, than with any other cause. Now that’s cross-subsidization.

Victoria Pulos
Senior health law attorney
Massachusetts Law Reform Institute

We agree. The Connector is a public entity, tasked with administering a public insurance program, for the benefit of the low-income people in the Commonwealth. We urge the Connector to re-examine its decision.

Thanks, Vicky, for a great letter.

                                                                                                                     -- Brian Rosman

September 13, 2016

We're number oneToday the federal Census Bureau released its annual statiscal report on “Income, Poverty and Health Insurance Coverage in the United States: 2015” (link). This is their annual survey based on the Current Population Survey and the American Community Survey.

And so, it's time for our annual blog post (e.g, 2014, 2010, and 2009) on the continuing progress Massachusetts in making in expanding health coverage.

First, the encouraging national headlines:

  • Fewer uninsured: The percentage of people without health insurance coverage for the entire 2015 calendar year was 9.1 percent, down from 10.4 percent in 2014. The number of people without health insurance declined to 29.0 million from 33.0 million over the period.
  • Both private and public coverage: Between 2014 and 2015, the increase in the percentage of the population covered by health insurance was due to an increase in the rates of both private and government coverage. The rate of private coverage increased by 1.2 percentage points to 67.2 percent in 2015, and the government coverage rate increased by 0.6 percentage points to 37.1 percent.
  • Kids better, too: In 2015, the uninsured rate for children younger than age 19 was 5.3 percent, down from 6.2 percent in 2014.

The Massachusetts headlines: (based on this state table)

  • We’re number one: The 2015 uninsurance rate in Massachusetts went down to 2.8% - again, the best in the country. (second best is a tie between DC and VT, each at 3.8%). So our coverage rate is 97.2%
  • Continuing Improvement: The uninsurance rate continues to decline - it was 3.3% in 2014, and 3.7% in 2013, and 3.9% in 2012

More analysis (including great charts) are available from the Mass Budget and Policy Center.

We cannot be complacent about the continuing progress. Our state's success relies on the aggressive outreach and enrollment efforts, which should not be curtailed. We do hear frequent reports of considerable churn in enrollment, as people shift between various programs and private coverage. And there is a big challenge coming in next year, as MassHealth (which covers 1.8 million in the state), begins rolling out ACO options for most of its members.

                                                                                                                                                                         -- Brian Rosman



September 12, 2016

On Thursday, the Health Connector Board met to award the final Seal of Approval (SoA) for plans to be sold through the Health Connector in 2017. This included a review of premium changes in the ConnectorCare program and plans for member communication and outreach for open enrollment. The meeting sparked big headlines, including the lead story in the Boston Globe (see below). Materials from the meeting can be found here.

Boston Globe: Subsidized Health Plan raises rates 21%

Due to an increase in rates offered by some health plans, the Health Connector reported that many members will have higher premiums upon their 2017 plan renewal. This will particularly impact individuals enrolled in Harvard Pilgrim HealthCare, Neighborhood Health Plan, and Health New England. Members receiving only premium tax credits or no subsidies will see a 19% premium increase.

That’s going to have a big impact on people. There’s going to be a lot of shifting and a lot of disruption.’Until now, the Health Connector “smoothed” the difference in premiums between the lowest and highest cost plans in the ConnectorCare program. After considering budget constraints and alternative solutions, the Health Connector has decided to discontinue most premium smoothing in the ConnectorCare program beginning in plan year 2017. However, the Connector will continue to “smooth” plans offering premium rates less than $35 different from the lowest cost plan for 2017 only.   Continuing smoothing as it has been implemented would cost $51 million ($35 million after federal reimbursement). The significantly reduced premium smoothing in 2017 will cost $4.2 million ($2.1 million net).  

The impact this decision has on the most vulnerable members of the Commonwealth is apparent. The starkest change if for “Plan Type I” ConnectorCare members, whose incomes put them below the poverty level (about $11,800/year in income for an individual). In previous years, these members could choose any ConnectorCare plan and not pay a premium. Starting in 2017, they will pay anywhere from $0 to $165 in premiums, depending on their choice of plans.  

While the Connector has other insurance plans that are less expensive and have comparable benefits, the individuals who choose to switch their plans will likely need to switch physicians and providers. The Connector Board stated that these changes are necessary in order to adhere to their goal of giving individuals options in light of their heavy budget restrictions.

The next Connector Board meeting is scheduled for Thursday, October 13th, 9am, at 1 Ashburton Place, 21st floor, Boston.

                                                                                                                                        -- Chelsea Canedy

September 4, 2016

MassHealth has pending before CMS - the federal Centers for Medicare & Medicaid Services - its proposal for a major redesign of its care delivery system. MassHealth is the state's Medicaid program, and covers nearly 1.9 million Bay Staters. 

The proposal (read the submission and supporting materials here) calls for creating Accountable Care Organizations (ACOs) as a new choice for MassHealth members. An ACO is made up of primary care providers who team up to provide integrated, coordinated care, with the goal of both treating patients when they are sick, and keeping members healthy. They will work with community organizations to assist members with social needs that keep us healthy, like nutrition or housing.

MassHealth is asking CMS for a $1.8 billion up-front investment over five years to support transition toward ACO models, including direct funding for community-based providers of behavioral health and long-term services, as well as funding for safety net programs.

HCFA coordinated the submission of 5 sets of comments to CMS on the proposal, from various coalitions that we coordinate. All together, 96 different organziations signed on to one or more of the comments that we coordinated. The comments reflect each coalition's particular concerns. The final set of comments below is from over 30 consumer groups, such as the Greater Boston Food Bank, Alliance of Massachusetts YMCAs, Easter Seals Massachusetts and the Massachusetts Association of Community Health Workers. Click the links below to see the submitted comments.