A healthy direction
IT HAS BEEN six months since Governor Mitt Romney signed health reform into law, and Massachusetts is engaged in an unprecedented experiment to expand affordable health insurance coverage. Thousands have realized new benefits, much progress has been made, and difficult issues remain unresolved. It's a work in progress and residents should take pride in accomplishments to date.
For example, in July, MassHealth, the state's Medicaid program, restored key benefits to 615,000 poor adults, including dental services, dentures, and eyeglasses. Eligibility was expanded to include more than 20,000 children, and enrollment caps on certain vulnerable adults were lifted. As a result, MassHealth enrollment has grown by 35,000 since January.
On Oct. 2, eligibility opened for a new insurance program called Commonwealth Care. More than 50,000 working adults with annual incomes below the federal poverty line ($9,800) will receive coverage beginning Nov. 1 with no premiums, no deductibles, and reasonable copayments.
This past week, Health Care For All's free Helpline (1-800-272-4232) began assisting newly eligible people. Many have a hard time believing this coverage is real.
In January, Commonwealth Care will open for adults with incomes up to three times the federal poverty line ($29,400). As many as 150,000 people will be eligible for this broad coverage with income-based, sliding-scale premiums, no deductibles, and reasonable copayments.
Commonwealth Care was created by the board and staff of the Commonwealth Health Insurance Connector Authority, a new quasi-public agency with a small, dedicated staff. Its next challenge is to work with insurers to create new and more affordable products for small employers and for uninsured people not eligible for Commonwealth Care. These new plans are scheduled to launch in July.
Covering this higher-income group will be tricky. Two important components of our health insurance market -- individual (nongroup) coverage for 55,000 people and small group coverage for 760,000 workers in small firms -- will be merged into one market -- a change estimated to reduce individual premiums by as much as 25 percent. The impact on small group premiums is now under study.
Also looming is implementation of the so-called ``individual mandate" requiring individuals 18 and over to purchase coverage beginning July 2007. Penalties will be assessed on those who don't buy insurance and for whom the purchase of coverage is deemed ``affordable," the definition of which will be established by the Connector Board in 2007.
Other aspects of the law are just unfolding. A Quality and Cost Council began meeting in late summer. A committee studying the merger of the individual and small-group markets will report in December. A MassHealth payment review commission is holding its first meeting this month. A council on racial and ethnic health disparities will form next year.
Often, public involvement plummets once a new law is enacted. Yet many citizens and organizations involved in lobbying for passage of this law have remained engaged. While public awareness of the law is limited, those involved in implementation are pleased with the coverage expansions now unfolding.
There have been disagreements. Romney, through his vetoes, made clear his opposition to the law's $295 assessment on employers who do not cover their workers. His regulations interpreting this requirement undermine legislative intent and permit many employers to escape this minimal responsibility. Also, Commonwealth Care premiums will be too high for many people with incomes between 100 and 300 percent of poverty.
These disagreements are part of a robust conversation about how best to implement the law. They do not signify an undermining of support for the essential work of health reform implementation.
Other states have invited Massachusetts leaders to discuss the relevance of our efforts to them. As legislatures assemble in January, there will be a new wave of state reforms. The innovations will vary and many will not resemble the Massachusetts healthcare law. Still, our achievements have enabled them to consider far more ambitious reform efforts.
A large share of the enormous national attention paid to the law relates to Romney's presidential ambitions. This is only helpful. His presence as a potential candidate for the 2008 Republican nomination guarantees a more ambitious national conversation about 46 million uninsured Americans during the next presidential sweepstakes. Massachusetts has helped provoke a new and encouraging health reform conversation across the nation.
John E. McDonough is executive director at Health Care For All. 
