An Interview with Brian Rosman, Research Director of Health Care For All in Massachusetts.
The success Massachusetts had in creating affordable, accessible, quality health coverage options for all residents of the Commonwealth has helped lead the way for national health reform. Now that we’re getting beyond the larger conceptual phase of health reform and getting into the nitty-gritty details, we thought it would be helpful to check back in with someone in Massachusetts to enlighten us on how the Commonwealth was able to get over some of the stumbling blocks on the road to success. We tracked down Brian Rosman, research director of Health Care For All, to help us better understand how health reform worked in Massachusetts.
Cathy: How were you able to make health coverage affordable to families through the exchange?
Brian: An often-overlooked part of Massachusetts’s health reform is the important role that Medicaid and CHIP played in providing affordable coverage options for children and families. We built on the strong base of underlying Medicaid coverage. The Commonwealth Care program filled in the gaps in coverage and a CHIP expansion for kids (up to 300% of the poverty level) allowed thousands of kids to get affordable coverage. The exchange, called the Health Connector in Massachusetts, offers subsidized coverage to adults only, through a program called Commonwealth Care. Under a reform instituted under Governor Patrick, who took over from Mitt Romney in 2007, CHIP premiums for children are waived if the parents are enrolled in Commonwealth Care. Medicaid, CHIP and subsidized coverage through the Health Connector have made coverage much more affordable for families.
Cathy: It’s interesting that you mentioned CHIP as there’s some disagreement in Washington about whether or not to eliminate CHIP and move children into the “Exchange” immediately. One reason to move CHIP eligible children into the “Exchange” immediately is to simplify the enrollment process for families. How has MassHealth managed to integrate CHIP and Medicaid with the Exchange?
Brian: Mass Health is what our state calls the combined Medicaid and CHIP programs. It operates as a unified program, and enrollees often don’t know if they are in CHIP or in the Medicaid waiver program. It’s all called MassHealth, and the program is consolidated. The Connector, which administers the Commonwealth Care program, uses the same application as MassHealth, and the MassHealth system processes the enrollment applications, as well as renewals and other systems. So it’s seamless for enrollees, regardless of what program they are in.
Also, all of the MassHealth managed care plans are also available under Commonwealth Care, so families can be in the same health plan even if they are technically in different coverage programs.
Cathy: It sounds kind of complicated to integrate all those programs. How does it work for families?
Brian: Families aren’t required to figure out the sometimes-complicated rules about program eligibility. They can file one application for everyone in the family, and the state’s combined eligibility system will place each member of the family in the best program he or she is eligible for. For the most part, the family experiences seamless unified coverage.
Cathy: Another interesting aspect of Massachusetts’ health reform plan is that it didn’t mandate coverage for children but did mandate coverage for adults.What was the thinking behind that policy?
Brian:When Massachusetts passed its health reform legislation in 2006, we already had a very low uninsurance rate for children – just a few percent. The problem we had was growing uninsurance among low-income working adults. Since no state had ever required coverage before, there was reluctance to extend the mandate to children.
Cathy: How has it worked?
Brian:Since passage of the legislation, our child uninsured rate has dropped, even though kids were not included in the mandate. Parents have responded to the increased availability of affordable coverage, even without a mandate.
Cathy: Another hot topic in Washington these days surrounds the level of subsidy necessary to make insurance affordable.A family of three earning about $32,000 (or 175 percent of the poverty line) would have to pay about $1,738 per year under the bill currently being considered on the floor of the Senate.The family would pay about $1,360 under the House-passed bill. What would health coverage cost for a similar family under Massachusetts health reform?
Brian: For the two parents, the combined Commonwealth Care premiums would be $936 for the year. The parents would have a choice of up to 5 managed care plans. The plans have comprehensive benefits, no deductibles, and modest co-pays. The children would get MassHealth without any premiums.
Cathy: Do you think MassHealth would be as successful as it is at reaching so many families if it did not provide coverage at that rate?
Brian: The high premiums required of low-income families under the Senate bill concerns us greatly. We know many low-income families are stretching to survive, with higher fuel and utility costs eating into their tight budgets. The board of the Massachusetts Connector set the premium subsidies after we provided them with overwhelming evidence of the deep financial distress of many families in this income range. I worry that Congress is placing a burden on families that will not work.
Cathy: Finally, what will happen to the Massachusetts Connector if health reform passes?
Brian: The Connector is working to make sure that we don’t lose the gains we have achieved. There is still some uncertainty, but we’re hopeful that we’ll be allowed to continue the programs that are working so well for kids and parents.
Cathy: Thanks Brian.I also want to put in a plug for A Healthy Blog that was created by Brian’s organization and is a great resource on what’s happening with health coverage in Massachusetts. Another helpful resources is the recently released Robert Wood Johnson Foundation’s SHARE program report The Secrets of Massachusetts’ Success: Why 97% of State Residents Have Health Coverage.
