Massachusetts & The Affordable Care Act

What The Affordable Care Act Means For Massachusettsians
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For more information about the Affordable Care Act, visit CBSBoston.com/ACA.

In April 2006, then Massachusetts Governor Mitt Romney signed health care reform legislation creating the Massachusetts Health Connector health insurance exchange. The Massachusetts health reform law served as a model for the federal Patient Protection and Affordable Care Act (ACA), which President Obama signed into law in 2010. One goal of the Massachusetts reform was to provide near-universal health insurance coverage for its citizens. In 2011, 16 percent of Americans lacked health insurance. In Massachusetts, the uninsured rate that year was four percent, the lowest in the country. [1] The Massachusetts reform was not as successful in containing costs. Massachusetts had the ninth highest premium cost for family coverage in the nation in 2010.

The Massachusetts law requires all citizens age 18 and older have health insurance. Employers with 11 or more employees must offer a group plan and pay a “fair share” of the each employee’s premium. Tax penalties are assessed on individuals and businesses that fail to comply with these provisions, although individuals with incomes less than 150 percent of the Federal Poverty Level are not penalized. Low income and moderate income Massachusetts residents are eligible for free or low-cost health insurance under many programs including MassHealth (Medicaid and CHIP), Commonwealth Care, Health Safety Net, Commonwealth Choice, and the Children’s Medical Security. [2]

How does the Affordable Care Act affect Massachusetts residents?

The Affordable Care Act requires states provide access to an online marketplace where individuals and small businesses may compare, select and purchase private health insurance policies that offer a minimum level of coverage. States have the option of establishing their own exchange, operating an exchange in cooperation with the federal government, or turning all administration of the health care marketplace over to the federal government. Massachusetts will continue to operate its own exchange.

Under the ACA, all new policies, and in-force policies upon renewal, must cover a package of essential health benefits, including hospitalization, emergency services, and mental health treatments. Annual wellness check-ups and other preventative screenings must be covered with no co-payments or deductibles. Residents may not be denied health insurance for pre-existing health conditions, and insurers may not place a lifetime cap on benefits. Households with incomes at or below 400 percent of the Federal Poverty Level may be eligible for tax credits to offset premium costs. This represents an expansion of subsidies for Massachusetts residence. The state health law only provides subsidies for households with incomes up to 300 percent of the Federal Poverty Level. The MassHealth program will be expanded to allow eligibility for new categories of residents, and the Commonwealth Care program will be eliminated in 2014.

Massachusetts health insurance exchange

In December 2012, Massachusetts received conditional approval from the Department of Health and Human Services to operate its state-based exchange as required by the ACA. Massachusetts Health Connector is governed by an 11-member board of directors, and operates as an active purchaser, selecting plans and negotiating with insurers to ensure the best value for Massachusetts consumers. All plans will provide coverage of essential health benefits based on the Blue Cross and Blue Shield of Massachusetts HMO Blue 2000 Deductible plan.

Small Business Health Options Program (SHOP)

Under the ACA, small business employers with fewer than 50 full-time workers, or full-time equivalent workers, will not be required to offer health insurance to their employees. (Check here for a definition and calculator to determine who qualifies as a full-time worker.) However, the ACA encourages many small business employers to provide health insurance by offering small business health care tax credits.

Many small businesses were already offering health insurance packages to their employees before the ACA was passed and signed into law. These plans are accepted, or grandfathered in, under the ACA.

For small business owners who wish to change their coverage plans, or for those who did not offer health insurance before the new law, the ACA establishes the Small Business Health Options Program or SHOP. SHOP allows employers to compare and shop for quality insurance plans side by side for their employees. Massachusetts small business owners may access SHOP through Massachusetts’s health insurance exchange.

Massachusetts health centers

Resources for Massachusetts residents

See the full list of external resources from CBS Boston.

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[1] http://kff.org/other/state-indicator/total-population/
[2] http://www.massresources.org/health-care.html

Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on Examiner.com.

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