Late-in-the-game proposals from Charlie Baker’s administration attempted to rein in state budget costs by reducing MassHealth enrollment eligibility. In a June 20 letter to the legislature, whose budget was due about a week and a half later, the Baker administration outlined a package of proposed changes to the state’s health insurance system for low-income, disabled and elderly people. Health care advocates said they appreciated the tricky financial situation but noted that the moves have serious implications on people’s well-being and called for robust, public discussion.
“The governor seems committed to universal coverage and we’re pleased that he continues to do that but we think there’s a better way to do universal coverage than what he’s doing in this package,” Brian Rossman, research director for Health Care for All, told the Banner.
The package came in response to legislators’ request that the administration find ways to control current and future MassHealth spending. MassHealth represents about 40 percent of the state budget, with the vast majority of the cost increases due to enrollment growth, according to the state.
On Friday July 7, state lawmakers voted against the proposals reducing MassHealth eligibility for many families (as well as a proposal that would establish a new dental provider type), but supported a fee on employers to help pay for state health care costs. Some legislators said they rejected the proposals because they were not given sufficient time for evaluation or public debate. The budget now goes to Gov. Baker to sign or send back.
If the proposals had passed, about 140,000 low-income adults without disabilities would be transitioned off of MassHealth and onto commercial plans available through the state Health Connector. Non-disabled adults with access to employer-sponsored plans regarded as affordable would be unable to opt for MassHealth. These and other pieces of the policy proposals appeared to be part of a thrust to make employers — and not the state — pick up more responsibility for employee coverage. Other changes were intended to take advantage of federal subsidies.
In her June letter, Kristen Lepore, state secretary of administration and finance, strongly advised passing all the reforms together instead of picking and choosing, in order to achieve a balance budget and sustainable system. According to the state, the reforms generate fiscal year 2018 savings of about $114.6 million, with an additional $200 million gained in revenue, and about $88.3 million in savings in FY2019, when some of the provisions would go into effect. Several measures require legislative or federal approval.
After the legislature released its budget vote, a group of businesses including Massachusetts Taxpayers, the Massachusetts Business Roundtable, The Retailers Association of Massachusetts and others released a letter calling for the full package of proposals to be passed saying it was needed to redress underlying cost issues.
Eligibility rollback
Under now-rejected policies outlined by Lepore, non-disabled adult members of two-person households with incomes over 100 percent of the federal poverty level (incomes between $16,240 and $21,600, according to The Boston Globe) no longer would qualify for MassHealth. This pool includes about 140,000 people, of which an estimated 100,000 are parents. They would have to use ConnectorCare commercial plans, with higher costs and less expansive coverage, advocates say.
In the switch to ConnectorCare programs, the affected individuals would lose coverage for some services such as dental care. They also would experience higher out-of-pocket costs such as co-pays and deductibles, and may have to start paying premiums, said Health Care For All’s Rosman.
“The worst impact applies to low-income parents,” said Rosman. “For these low-income families, having to pay out of pocket will really hurt their ability to get the health care they need.”
According to the state, this transition would allow for maximum use of federal subsidies, and reduce instances of individuals cycling between MassHealth and ConnectorCare as their income fluctuates.
Another suggested measure shifts about 230,000 parents and caretakers with incomes less than 100 percent of the federal poverty level from the standard MassHealth program to CarePlus. According to Rosman, the problem is that the latter program is intended for childless adults and has fewer benefits.
There also is the risk that individuals may be switched into programs that will cease to exist. Should the Congress eliminate or repeal the Affordable Care Act, ConnectorCare and CarePlus could be eliminated, Rosman said. That could throw these customers’ coverage into uncertainty.
Other measures would deny MassHealth eligiblity to low-income adults who have the option of an employer-sponsored plan. Lepore noted that since 2011, commercial coverage enrollee counts have declined, while MassHealth enrollment numbers have grown.
Optional benefits
Bill Henning, co-chair of Disability Advocates Advancing Our Healthcare Right at the Boston Center for Independent Living, and Rosman separately told the Banner that they are concerned over a proposal allowing the state to remove certain optional benefits from MassHealth coverage.
In MassHealth, the state has elected to include certain benefits beyond the basic Medicaid program requirements, such as dental care, prescription drugs, and personal care services for people with disabilities. Henning said that maintaining such benefits is essential to many who currently are covered.
“These are categorized as ‘optional’ benefits under Medicaid, but no one would think they were optional for low-income folks, which includes many people with disabilities and seniors,” Henning said. “The benefits package is great at MassHealth and it serves a lot of poor people who may not get like coverage in private insurance.”
Rosman also expressed concern about allowing such changes to be conducted outside of the legislature.
“The pattern in Massachusetts has been to require legislative approval for those changes and we think giving unconditional approval to the state to make those changes could lead to interruptions in care,” Rosman said.
Employers and dental therapists
Some advocates — and, ultimately, the state legislature — found attractive a temporary measure that would increase employer’s participation in health care coverage for a two-year period. During that period, Employer Medical Assistance Contributions, which help subsidize state healthcare for low-income residents, would increase. Additionally, employers would pay extra for each of their non-disabled workers on state-supported healthcare, i.e. MassHealth or ConnectorCare, during those two years. The latter is not a new idea and it earned praise from some advocates. Both of the temporary employer assessment increases were passed by legislators.
Rosman also spoke in support of a proposal, later rejected by the legislature, that would have created a health care provider class for so-called dental therapists — that is, dental health practitioners who are of a lower level than a traditional dentists and may be more willing to accept MassHealth. Rosman said this measure could bring dental care access to many low-income people.
More deliberation
Speaking last Thursday, Rosman, Henning and Matt Selig, executive director of the Health Care Law Advocates, said they respected the financial pressures behind the proposals but hoped for thorough discussion of possibilities before such a significant changes be approved.
“We [HLA] are hoping that this proposal is a starting point and we’re ready to work with the administration and the legislature and other advocates and business groups and providers and carriers and consumers who we represent… to try to find an alignment of the programs going forward that we think is satisfactory to everybody,” Selig said.
