Massachusetts has been a clear leader when it comes to health care coverage, and as a result, outpaces other states in health care outcomes. But it has taken a village of health care policymakers, economists, practitioners, community leaders, and legislators to create an insurance coverage system that not only works, but that also rises above partisan acrimony.
How did the state manage to be almost radically bipartisan when it comes to health care, or at least sensibly pragmatic? Another ingredient in the successful overhaul, according to John E. McDonough, professor of public health practice at the Harvard T.
What does the evidence tell us? About 22 percent of adults in Massachusetts have trouble paying medical bills, according to a new report by Washington-based consultancy Altarum, with many complaining that high-deductible health plans come with steep out-of-pocket costs. Expanding coverage was just the first step, Blumberg says.
And then from there, you can talk about where we can create efficiencies in the health care delivery systems and reduce costs. Both laws also require guarantee issue, meaning consumers cannot be denied coverage due to pre-existing health conditions. Subsidies for lower-income households — While the amount of individual subsides vary, and the income levels for eligibility differ, both laws provide financial assistance to lower-income households so that health insurance is affordable.
Massachusetts subsidizes private health coverage for families and individuals with incomes up to percent of the Federal Poverty Level FPL.
The individual and business mandates — Both laws require that individuals who can afford insurance to purchase insurance or face a financial penalty.
This provision was repealed in July in anticipation of the ACA business mandate. The ACA business mandate takes effect January 1, How are the laws different Size and scope — The Massachusetts law applies to the 6.
The ACA covers more than million people spread across 50 diverse states. Massachusetts began its reform with a rate of uninsured that was half that of the nation as a whole, and it was written to meet the unique needs of state residents. Guaranteed issue would do little to help sicker or older individuals if insurance companies could still charge those consumers exorbitant rates that they could not afford.
The premiums paid by healthy people who spend less on health care subsidize the cost of insuring sicker, higher-cost people in the pool. The Affordable Care Act also includes a number of additional market reforms and protections for patients.
First, the law prohibits insurance companies from placing annual or lifetime limits on benefits. Because Romneycare and Obamacare prohibit insurers from denying coverage to older or sick individuals and limit their ability to charge these consumers higher premiums, some people might decide to wait until they are sick to purchase insurance. This is problematic for several reasons. Without a sizable number of healthy individuals to spread the risk to insurers of covering older, sicker consumers, the average cost of insuring people in the market will rise, which in turn will raise premiums for everyone else.
Both Romneycare and Obamacare have the same solution to this problem: Requiring every uninsured person who can afford insurance to make a choice to either purchase coverage or pay a penalty, with certain limited exceptions. In Massachusetts this approach has led to nearly universal coverage and the Affordable Care Act should have a similar effect when it is fully operable. Individuals have a responsibility to purchase insurance if they can afford to do so.
Both Romneycare and Obamacare also recognize that caring for the uninsured exacts a high cost on society. Uncompensated care is paid for by taxpayers through public programs, by health care providers through lost profits, and by providers shifting costs to private insurers. Private insurers may then increase premiums for the rest of their customers.
The choice between purchasing health insurance and paying a penalty helps combat this cost shift. The penalties in Massachusetts are generally comparable in scope and magnitude to those under the Affordable Care Act.
Because of these differences in design, fewer people with incomes below percent of the federal poverty level will be exempt under the federal mandate. Moreover, the federal penalties will be higher for people with incomes below percent of the federal poverty level. Both Romneycare and Obamacare make shopping for insurance easier and purchasing insurance more affordable.
Both create new, virtual marketplaces for uninsured individuals and small businesses to shop for health insurance products. These marketplaces—called exchanges—provide both individuals and small businesses with one-stop, streamlined shopping for health insurance, where individuals and small businesses can compare insurance plans.
Both laws also help low- and middle-income individuals afford the cost of insurance, but when compared to Romneycare, the federal law gives even more middle-class individuals and families significant tax relief. The Affordable Care Act includes tax breaks for millions of middle-class individuals and families. It provides various levels of financial assistance in the form of premium tax credits and cost-sharing reductions. The distribution of this assistance varies, however.
Overall, the subsidies under the Affordable Care Act are smaller than those offered in Massachusetts. Middle-class individuals with incomes between percent and percent of the federal poverty level will receive significant financial assistance under the Affordable Care Act. To protect this source of coverage, both laws require larger employers to provide insurance to their employees. But there are differences in which businesses must meet these requirements and the penalties for not complying.
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