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Massachusetts health care — wonky, with a healthy dose of reality

"Blueprint for Coverage" Outlined for New York

"Blueprint for Coverage" Outlined for New York

December 20, 2006

The United Hospital Fund and the Commonwealth Fund in New York have collaborated on a universal coverage plan for the Empire State, called a "Blueprint for Coverage." They used John Holahan and colleagues from the Urban Institute for the analytical work -- John was centrally involved in the "Roadmap to Coverage" plans advanced by the Blue Cross Blue Shield Foundation of Massachusetts in our health reform process. This new outline resembles the MA health reform framework in striking ways. Key features:

Public Programs. Simplification and expansion of existing public programs with three components:

Simplification of public program rules to ease enrollment and renewal in order to increase participation rates among eligible but uninsured persons;
Expansion of Family Health Plus eligibility for childless adults to 150 percent of the federal poverty level (FPL);
Subsidized buy-in to FHP so that affordable coverage is available to more moderate-income New Yorkers (up to 300 percent FPL);

Insurance Exchange. Implementation of a new purchasing entity for individual purchase of coverage at pooled group rates;

Employer Requirements. Two variations of assessments on employers with 10 or more employees that do not offer health insurance:

A modest employer assessment of $400 per worker per year;
An employer "pay-or-play" assessment of 8 percent of payroll or a credit toward this assessment for coverage offered (on average, the assessment would be $3,200 per worker);

Individual Mandate. A requirement that all residents purchase health insurance coverage, with income-related premium assistance.

Head of the UHF is Jim Tallon, former majority leader in the New York Assembly and a genuine advocate for universal coverage for many years. He has called the MA health reform a "demonstration project" for this New York initiative.

Add New York to the list of states using MA health reform as a significant source of inspiration.