This educational brief describes the key elements of the Affordable Care Act (ACA) and provides an overview of California v. Texas, a case currently before the U.S. Supreme Court that seeks to overturn the ACA. Also included in this brief is a discussion of recent relevant case history and how the arguments in California v. Texas build upon prior legal challenges to the ACA.
The Blue Cross Blue Shield of Massachusetts Foundation released a report today – on the eve of arguments before the U.S. Supreme Court to decide the fate of the Affordable Care Act – that forecasts severe consequences for health coverage and funding for Massachusetts if the ACA is overturned in its entirety.
The report, a collaboration between the Foundation and its research partner, Urban Institute, estimates that as many as 422,000 Massachusetts residents would lose health insurance coverage, more than doubling the number of uninsured people, if the California v. Texas case overturns the historic health care law that was passed in 2010. The report also anticipates Massachusetts would lose $3.3 billion in federal health care spending that supports the state’s Medicaid program along with tax credits that help individuals afford insurance coverage.
“A Supreme Court decision that overturns the ACA would be a devastating setback in Massachusetts, which was a pioneer in achieving near-universal coverage and served as the model for the groundbreaking national health care law,” said Audrey Shelto, president of the Blue Cross Blue Shield of Massachusetts Foundation.
Massachusetts passed its health care reform law in 2006, securing federal funding to support the development of a subsidized coverage program that helped the Commonwealth achieve the nation’s highest health insurance rate in just a few years. Today, only 4.4 percent of Massachusetts residents under age 65 lack health insurance, according to the report. If the Supreme Court overturns the Affordable Care Act, the report’s analysis shows 12 percent of Commonwealth residents under age 65 could lack coverage – an even higher rate than before the state passed its landmark 2006 law.
“Since Massachusetts was a trailblazer in expanding health care coverage, people may be under the false impression that our gains would withstand the repeal of the Affordable Care Act,” Shelto said. “Our findings demonstrate how the California v. Texas case has the potential to undermine over a decade’s worth of progress.”
The full report can be found online at: https://bluecrossmafoundation.org/publication/impacts-aca-repeal
The mission of the Blue Cross Blue Shield of Massachusetts Foundation is to expand access to health care for low-income and vulnerable individuals and families in the Commonwealth. The Foundation was founded in 2001 with an initial endowment from Blue Cross Blue Shield of Massachusetts. It operates separately from the company and is governed by its own Board of Directors.
The nonprofit Urban Institute is a leading research organization dedicated to developing evidence-based insights that improve people’s lives and strengthen communities. For 50 years, Urban has been the trusted source for rigorous analysis of complex social and economic issues; strategic advice to policymakers, philanthropists, and practitioners; and new, promising ideas that expand opportunities for all. Urban’s work inspires effective decisions that advance fairness and enhance the well-being of people and places.
California v. Texas, a case currently before the U.S. Supreme Court, seeks to overturn the Affordable Care Act (ACA). The court is expected to begin hearing arguments on this case on November 10, 2020. A final ruling that overturns the ACA would have widespread implications, affecting every state in the nation.
This brief and companion infographic describe what’s at stake for Massachusetts if the court were to overturn the ACA — focusing on what it could mean for the state’s health insurance coverage rates and federal funding. This analysis is based on two scenarios: 1) where the ACA is overturned in its entirety and the state is not able to reestablish the subsidized coverage programs created by the state’s 2006 health reform and 2) where the ACA is overturned, but the state is able to reestablish its 2006 coverage programs.
The estimates described in this brief are generated from a model developed by the Urban Institute, which was used for a similar analysis released by the Foundation in December 2019. This new analysis uses state-level 2019 and 2020 cost and coverage data from MassHealth, the Health Connector, and the Center for Health Information and Analysis. The updated data used for this analysis captures many of the changes to the health insurance coverage landscape in Massachusetts as a result of COVID-19 and the associated economic downturn.
The Foundation's Massachusetts Medicaid Policy Institute (MMPI) hosted a webinar with chart pack authors Rachel Gershon and Lissette Victoriano from the Commonwealth Medicine Division at the University of Massachusetts Medical School. The goal of the webinar was to provide participants with basic background information about MassHealth, including what benefits MassHealth covers, who it serves, program spending and cost drivers, and a status update on the state's delivery reform efforts.
For more resources on the MassHealth program, visit our MMPI page.
Behavioral health urgent care services are a critical component of the broader behavioral health care delivery system. Developing and sustaining a robust set of behavioral health urgent care services across community-based settings will provide adults with more options for timely access to care and offer alternatives to emergency departments for treatment. This brief proposes a vision and framework for behavioral health urgent care and outlines a series of policy and programmatic recommendations to address workforce, clinical, payment, and administrative barriers to implementing behavioral health urgent care. Addressing these barriers will advance access to and availability of behavioral health urgent care services for adults in Massachusetts.
This brief complements the Foundation’s Behavioral Health Urgent Care grant program, through which the Foundation is supporting Emergency Services Programs (ESPs) to bolster their capacity to deliver behavioral health urgent care services in Massachusetts. The work of the ESP grant partners and insights from other key stakeholders informed the proposed vision and key elements of the behavioral health urgent care framework as well as the recommendations outlined in this brief.
This UPDATED (October 2020) edition of the MassHealth: The Basics chart pack provides new data on MassHealth enrollment and spending from the most recent state fiscal years available, as well as a high-level overview and status update on the state’s delivery system reform efforts. The 2020 chart pack features a summary of the many temporary policy and programmatic changes that MassHealth quickly implemented in response to the COVID-19 pandemic.
The chart pack provides comprehensive yet accessible data points and updates on the complex MassHealth program that will be useful to policymakers and administrators, as well as advocates and academics. It is made available in PDF and PowerPoint formats to facilitate its use in presentations.
The Blue Cross Blue Shield of Massachusetts Foundation today released a new analysis of the revised “public charge” admissibility rule, finding that the federal policy will likely prompt thousands of Massachusetts residents to forgo or disenroll from health care and nutrition benefits. This occurs as the COVID-19 pandemic’s public health and economic crisis is leading to a greater need with more than a million Massachusetts residents losing their jobs. At the same time, up to $457 million in hospital spending is at risk, due to people avoiding health coverage and provider care.
The revised public charge rule makes it harder for certain immigrants to obtain green cards or visas if they have applied for or enrolled in public benefits such as MassHealth (Medicaid and the Children’s Health Insurance Program) or SNAP (Supplemental Nutritional Assistance Program). The rule took effect in Massachusetts in February and, while applying to a relatively narrow subset of the population, it is having a chilling effect on many more lower income individuals who could receive public benefits for health, nutrition and housing without consequence, but may decline to claim such federal assistance out of concern it will affect their immigration status.
The report, a collaboration between the Foundation’s Massachusetts Medicaid Policy Institute and UMass Medical School’s Commonwealth Medicine, estimates that 55,000 to 129,000 Massachusetts residents will likely avoid enrolling in, or disenroll from, MassHealth; and 27,000 to 63,000 residents will be in households that avoid enrolling in, or disenroll from, SNAP. These individuals and families are likely to experience worse health outcomes and a lower quality of life without public benefits for health and nutrition.
Despite this reduction, MassHealth overall enrollment is still expected to rise given the economic hardship created by the pandemic. Also, these estimates are based on national studies and do not account for strategies that are taking place within Massachusetts to try to mitigate the impact of public charge on enrollment in MassHealth – including intensive outreach and education in immigrant communities.
“Leaders within immigrant communities and health care providers who serve those communities were worried as soon as it became clear that the federal administration was thinking of making public charge stricter than the previous rule,” said Audrey Shelto, president of the Blue Cross Blue Shield of Massachusetts Foundation. “They knew that it would harm vulnerable people and many have already reported that people are deciding not to continue services. This analysis demonstrates that many more people to whom this policy change does not apply will be harmed as well, given their fear that it might apply to them, and the result will be poorer health, more food insecurity and greater stress for many in the Commonwealth.”
The report also warned that the public charge rule may hamper the Commonwealth’s longstanding public policy priorities of controlling health care costs, maintaining the lowest uninsured rate in the nation, and addressing the social determinants of health such as housing and food security. Lower enrollment in public benefits results in less federal revenue flowing into Massachusetts, including matching dollars for MassHealth and federal housing subsidies, and as much as $85 million per year in SNAP benefits used by individuals and families to buy food at Massachusetts retail stores.
“Access to food, housing, and health care are essential parts of individual and societal well-being,” said Lisa Colombo, executive vice chancellor at UMass Medical School. “Policies that reduce access to basic services can have far-reaching consequences that may take years to fully realize.”
The report was developed prior to the onset of the coronavirus pandemic. While the report does not factor the COVID-19 public health crisis into the MassHealth and SNAP enrollment estimates, the researchers state that the impacts of the revised public charge rule are likely to be magnified. For example, residents without health care coverage are more vulnerable to COVID-19 due to a lack of access to care and testing. In addition, food insecurity has become more prevalent and severe during the pandemic due to higher unemployment.
The full report, “The Final Public Charge Admissibility Rule: Implications for Massachusetts,” is available online at: https://bluecrossmafoundation.org/publication/final-public-charge-admissibility-rule-implications-massachusetts
The mission of the Blue Cross Blue Shield of Massachusetts Foundation is to expand access to health care for low-income and vulnerable individuals and families in the Commonwealth. The Foundation was created in 2001 with an initial endowment from Blue Cross Blue Shield of Massachusetts. It operates separately from the company and is governed by its own Board of Directors.
The Massachusetts Medicaid Policy Institute (MMPI) – a program of the Blue Cross Blue Shield of Massachusetts Foundation – is an independent and nonpartisan source of information and analysis about the Massachusetts Medicaid program, MassHealth. MMPI’s mission is to promote the development of effective Medicaid policy solutions through research and policy analysis.
Commonwealth Medicine (CWM) is the health care consulting and operations division of the University of Massachusetts Medical School. It draws on the academic knowledge and public health service expertise of Massachusetts’ only public medical school to provide comprehensive, innovative health care and policy solutions to MassHealth and other human services agencies. Commonwealth Medicine provides state and federal agencies with the tools they need to develop and administer entire programs serving vulnerable populations. Today CWM’s work has expanded to more than 20 states, as well as a number of countries.
The revised federal public charge rule – which was finalized in August 2019 and took effect in Massachusetts in February 2020 – makes it harder for certain low- and moderate-income immigrants to obtain green cards or visas if they have applied for or enrolled in public benefits such as MassHealth or the Supplemental Nutritional Assistance Program (SNAP). This report describes the expected effects of the revised federal public charge rule on MassHealth and SNAP enrollment, and its downstream effects on the health of Massachusetts residents, health care providers, and the state’s economy.
This report updates and builds upon a November 2018 publication, The Proposed Public Charge Rule: An Overview and Implications in Massachusetts, which featured a similar analysis based on the proposed public charge rule. This current report analyzes the impact of the final rule, uses more recent data as the basis for its estimates, and updates the methodology based on new information. The estimates in this report do not account for strategies that are taking place within Massachusetts to try to mitigate the impact of public charge on enrollment in MassHealth - including intensive outreach and education in immigrant communities.
At the onset of the COVID-19 public health emergency, Massachusetts led the nation in rapidly deploying progressive policies to temporarily expand access to telehealth. These changes have enabled significant increases in adoption of telehealth, including telebehavioral health, for providers and consumers in a short period of time. Prior to COVID-19, utilization of telebehavioral health had not gained widespread spread traction in Massachusetts despite its potential as a means to dramatically improve access to behavioral health care services, particularly for vulnerable populations.
This report provides policymakers and other behavioral health stakeholders with an overview of the state’s current telebehavioral health landscape; a description of the attributes of an optimal telebehavioral health care delivery model; and a summary of the common barriers to provider and consumer adoption of telebehavioral health services in Massachusetts. It also outlines a series of policy and programmatic recommendations – including maintaining many of the temporary policy advances made during the COVID-19 pandemic – that will better enable the delivery of telebehavioral health care and support increased consumer engagement with and use of telebehavioral health services.
Authorizes the Connector to administer the Commonwealth Care health insurance program beginning October 1, 2006.