Health Care Experts Discuss Massachusetts Health Insurance Law Two Years After Implementation

Massachusetts has made "reasonably good progress" in implementing its universal health coverage law, Jon Kingsdale, executive director for the Massachusetts Health Insurance Connector Authority, said Monday at a forum sponsored by the Alliance for Health Reform and the Kaiser Family Foundation, CQ HealthBeat reports. However, health care experts at the forum acknowledged that legal, cost and regulatory challenges remain, according to CQ HealthBeat. Under the law, Massachusetts residents ages 18 and older are required to obtain health insurance, if affordable coverage is available, or pay a tax penalty. The state offers subsidized coverage for low-income residents, and employers also must contribute to the cost of workers' coverage or pay into a fund.

Kingsdale said that two-thirds of the 340,000 newly insured state residents have enrolled in the subsidized program, while the remaining one-third have purchased private coverage. Kingsdale said that, as a result of the law, premiums for residents who purchase private coverage have declined by nearly half. Meanwhile, costs for the Commonwealth Care subsidized program are increasing by 6.5% per beneficiary, Kingsdale said. The increase "is below budget," but "we've got a lot of challenges," Kingsdale said, adding that "this is a huge financial venture." Commonwealth Care spending is expected to reach $647 million this fiscal year and $869 million in FY 2009. Lawmakers are considering an increase in the state tobacco tax to offset the unexpected cost.

Grace-Marie Turner of the Galen Institute said that costs to taxpayers are increasing because of the law. She said that the cost of the program in FY 2009 "could be closer to $1.1 billion." Turner said, "The fines I think are going to be an issue particularly as they go up." According to Turner, other challenges the law faces include a 12% insurance rate for FY 2009 approved for next year and the possibility of "crowd out" of private coverage. In addition, Turner said the state's federal Medicaid waiver expires soon, raising questions about whether the law is "still going to be legal under Medicaid law" (Reichard, CQ HealthBeat, 5/19).

A webcast of the forum is available online at kaisernetwork.org.