Joint Committee on on Health Care Financing
The Massachusetts Health & Hospital Association (MHA), on behalf of our member hospitals, health systems, physician organizations and allied healthcare providers, appreciates the opportunity to submit comments in strong support of SB1685, An Act to ensure affordable Health Connector coverage.
The 2006 health reform law introduced a program called Commonwealth Care that, for the first time, helped low- and middle-income individuals that did not qualify for MassHealth be able to afford commercial health insurance in the state’s new health insurance exchange. This was accomplished with the help of state and federal subsidies to make premiums and out-of-pocket expenses more affordable for this population. More than a decade later, that model largely continues through a program called ConnectorCare that is supported by state subsidies and federal income tax credits provided by the Affordable Care Act (ACA). This subsidized insurance has consistently helped approximately 200,000 people annually afford health coverage. Maintaining adequate subsidies for this population has been vital to ensuring that the vast majority of this population has access to health insurance coverage they can afford.
Much of the commonwealth’s current focus in healthcare – including that of state government, healthcare providers, and insurers – is controlling the cost growth trend and improving care quality. This is being accomplished, in part, through innovations such as the creation and expansion of Accountable Care Organizations (ACOs), risk-sharing between providers and insurers, and increased provider accountability for the health of patients beyond their walls. The cost-and-quality focus is the correct one. However, any momentum in this area is only possible due to the fact that we have near-universal coverage. Without that foundation, it would be immensely challenging to manage a patient community containing a sizeable, uninsured portion.
That is why it is imperative to prioritize protection of the coverage expansions we have made as a commonwealth, which is the goal of SB1685. This legislation would put back into state statute a previous 2006 health reform protection that ensures that those individuals living below the federal poverty line always have access to affordable health insurance through the Connector. With the 2014 implementation of the Affordable Care Act, and subsequent retirement of the Commonwealth Care statute, this protection unfortunately got lost in the shuffle. Fortunately, the successor program – ConnectorCare – has maintained the same affordability goals. We appreciate the commitment to these subsidies by the legislature and Baker Administration, however, we believe that protection for the lowest level income group should not be subject to an annual decision-making process by the state’s Connector board and should be a protection that is afforded in statute – just like it was under Chapter 58.
SB1685 would require that at least two health plans be offered to this income group with no premium, and that co-payments be aligned with the MassHealth program. Each year, health plans seeking to serve as ConnectorCare plans effectively bid the cost of the premiums, and the lowest cost health plan can vary each year. If the Health Connector only allows one zero-premium plan, then an enrollee must switch to a different plan each year if the zero-premium plan’s carrier changes. In 2018, the second lowest health plan costs as much as $147 per month for an individual living below the poverty line. Currently in 2019, the Health Connector offers two-zero premium plans, a practice that would be codified by the passage of this legislation.
Patients switching plans every year and, even in some cases, patients changing healthcare providers due to health plan network differences, conflicts with the very approach we have all endorsed to improve care management. Supporting two zero-premium health plan choices for this low-income group provides the appropriate balance of health plan competition, consumer choice, and stability in provider and health plan management of patient care. This protection should be embedded in statute to ensure that the commonwealth’s poorest residents who do not qualify for MassHealth due to various eligibility circumstances always have an affordable coverage option.
Other aspects of SB1685 provide greater transparency and protections for the funding source of the state subsidies that support Connector coverage for low-income individuals. While the state has remained strongly committed to these subsidies, the funding sources and uses of the Commonwealth Care Trust Fund have not been transparent. In some years, funding has actually been transferred out of the trust fund to the General Fund for unknown purposes. Meanwhile, decisions on the level of subsidies are made, in part, based on this funding. SB1685 provides much needed transparency on the accounting of this important trust fund. It would also ensure that funding remains for the purpose of supporting low-income subsidized health insurance. For the Connector population, this trust fund is critical to maintaining affordable coverage, and increased transparency of the monies available to support state subsidies is an important component of that protection.
Thank you for your consideration of the concepts included in this bill which we believe support the commonwealth’s goal to maintain our coverage gains. If you have any questions or concerns or require further information, please contact Michael Sroczynski, MHA's Senior Vice President of Government Advocacy at (781) 262-6055 or msroczynski@mhalink.org