Massachusetts

Status of reform effort: The state is currently implementing provisions of the 2006 health care reform law, including the individual mandate, which required all adult residents to have health insurance by December 31, 2007. As of March 2008, over 350,000 previously uninsured individuals had obtained health insurance.

On April 12, 2006, Massachusetts enacted legislation, Chapter 58 of the Acts of 2006, which would provide near universal coverage for state residents. 

The components of the legislation included:

• The Commonwealth Care program to provide subsidized coverage for individuals with incomes up to 300 percent of the federal poverty level;
• The Commonwealth Health Insurance Connector to “connect” individuals to insurance by offering affordable, quality insurance products;
• MassHealth (Medicaid program) expansion to children up to 300 percent of the federal poverty level.
• An individual mandate that requires all adults in the state to purchase health insurance by December 31, 2007;
• A requirement that employers with 11 or more employees provide health insurance coverage or pay a “fair share” contribution of up to $295 annually per employee; 

The Board of the Commonwealth Connector was charged with implementing several aspects of the reform plan not specified in the legislation.  In May, the Board approved plans offered by seven of the state’s health insurers that provide a range of coverage options, including a specially designed lower-cost product for 19-26 year olds.  In June, the Board defined minimum creditable coverage to include “preventive and primary care, emergency services, hospitalization benefits, ambulatory patient services, mental health services and prescription drug coverage.”  The coverage standards cap deductibles at $2,000 for individuals and $4,000 for families and limits out-of-pocket spending to $5,000 for individuals and $10,000 for families. 

The Board was also charged with setting the affordability standards to determine the subsidy levels for individuals enrolled in Commonwealth Care and the premium amounts for families with incomes above 300 percent of the federal poverty level (FPL).  Individuals with incomes below 150 percent FPL do not have to pay a premium, while premium amounts are $39 for individuals with incomes between 150 percent and 200 percent FPL, $77 for individuals with incomes between 200 percent and 250 percent FPL, and $116 for individuals with incomes between 250 percent and 300 percent FPL.

As of March 2008, over 350,000 of the estimated 600,000 uninsured individuals in the state had obtained health care coverage.  State residents had until December 31, 2007 to comply with the mandate to purchase health insurance.*