This brief describes the potential impact in Massachusetts of a proposed rule, released by the Department of Homeland Security in October 2018, to change the process by which it determines whether an immigrant is inadmissible to the United States or unable to adjust status because the person is likely to become a “public charge.” The proposed Public Charge Rule would mark a significant shift from current policy by defining a “public charge” as a noncitizen who receives one or more public benefits. This brief also provides an estimate of the scope of immigrants in Massachusetts who may be impacted by the proposed rule and what effect that could subsequently have, both directly and as a result of the “chilling effect,” on enrollment in particular benefit programs, including MassHeath and the Children’s Health Insurance Program (CHIP).

This brief frames the key issues and potential impacts to Massachusetts consumers that may result from implementation of the federal proposed rule to expand the availability of Association Health Plans (AHPs). This brief:

• Describes the ways in which allowing AHPs to operate according to the proposed rule could impact the scope of benefits, provider networks, and consumer protections available to consumers in plans covered through this arrangement;
• Explains technical topics such as risk segmentation and rating rules and why they are important in considering the impacts of the proposed AHP rule on consumer access to health coverage; and
• Provides policymakers with options the Commonwealth could consider to protect consumers in response to the federal AHP proposal.

This brief provides an overview of the steps that Massachusetts has taken to establish a functioning insurance market that provides consumers with meaningful access to health coverage. It includes a review of statutory and regulatory provisions in place today, and provides context for key health reform initiatives that have occurred over the past 30+ years. This brief is structured around four key components of a functioning market for health coverage:

1. Encouraging or requiring coverage of a comprehensive set of benefits and services;
2. Ensuring fair competition among insurance carriers;
3. Providing access to coverage, particularly for low- and middle-income residents; and
4. Instituting mechanisms to protect consumers.

The policies and provisions described in this brief have played an important role in the evolution of the Massachusetts market, helping the state achieve near-universal coverage, enabling most Massachusetts employers to offer comprehensive coverage to their employees, establishing a competitive market for health coverage, and protecting consumers.

Federal authorization for the Children’s Health Insurance Program (CHIP) expired on September 30, 2017. Senators Orrin Hatch (R-UT) and Ron Wyden (D-OR) have filed a bill to extend CHIP for five years, but Congress did not act quickly enough to prevent the current authorization from expiring. Unspent federal CHIP funds may be carried over into the next fiscal year and Massachusetts’s current allotment of federal CHIP funds should allow the state to continue to use CHIP funds for benefits until early 2018. However, we have now entered a policy limbo in which states are hopeful for reauthorization but must also determine other coverage options for children if funds run out.

As follow up to the Foundation’s June report, The Importance of CHIP Reauthorization for Massachusetts, this brief provides an update on the status of federal reauthorization for CHIP and a summary of its potential impact on the program in Massachusetts.

This chart pack provides an overview of the Senate-proposed Better Care Reconciliation Act of 2017, highlighting some of its key provisions, particularly as they relate to Medicaid. Developed by Manatt Health, this chart pack was commissioned by the Blue Cross Blue Shield of Massachusetts Foundation for the Massachusetts Coalition for Coverage and Care.

This report describes the Children’s Health Insurance Program (CHIP) in Massachusetts and its role as part of MassHealth. Though there is no expiration date for CHIP in federal law, Congress has authorized funding of the program through September 30, 2017. Without Congressional action, a majority of states, including Massachusetts, will exhaust their current federal CHIP allocation by March 2018. This report discusses the importance of CHIP and the broader health policy debate, including reauthorization, now taking place in Washington.

The Blue Cross Blue Shield of Massachusetts Foundation, on behalf of the Massachusetts Coalition for Coverage and Care, funded a state-level analysis on the impact of the American Health Care Act (AHCA) on Massachusetts focused on 2022, when the law would be fully phased in.

Created by the Urban Institute’s Health Policy Center, this analysis uses state-level cost and coverage data from MassHealth (the state’s Medicaid program), the Massachusetts Health Connector Authority, and the Center for Health Information and Analysis. It is believed to be the first published study of the bill’s impact on an individual state.

Using data from the 2011-2015 five-year file of the American Community Survey, this brief and set of detailed tables provide estimates of local uninsurance rates in Massachusetts. The appendices provide data on the estimates of the number and rate of uninsurance by the following categories: all persons, males, females, children (ages 0-17), non-elderly adults (ages 18-64), and elderly (ages 65+). Each appendix provides these results for a different geographic unit, including large areas such as congressional districts and smaller areas such as school districts.

This chart pack provides an overview of proposals to cap federal Medicaid funding and the considerations for Massachusetts.

This issue brief describes the key elements of the most recent MassHealth 1115 waiver extension, including the shift to a delivery system centered on Accountable Care Organizations and Community Partners, a Delivery System Reform Incentive Program, the redesigned Safety Net Care Pool, and the expansion of services for treatment of substance use disorders. It concludes with a discussion of implications of the new system for major stakeholder groups.

Despite the near-universal health insurance coverage that the state has maintained for nearly a decade, pockets of high uninsurance remain for both adults and children in communities across Massachusetts. This brief, prepared by the Urban Institute, explores the relationship between community characteristics and the uninsured rate for people of all ages in Massachusetts and highlights the geographic and community context of the remaining uninsured. It also provides data to better target outreach and enrollment activities.

Massachusetts currently has the lowest uninsurance rate in the nation, and as part of the individual mandate to carry health insurance coverage, the state collects detailed information through its tax filing process about the health insurance status of over four million residents. This report analyzes 2011 and 2012 state tax filer data and provides new information about Massachusetts residents that are prone to remaining uninsured over consecutive years. The findings can help inform stakeholders who want to maintain the state’s low uninsurance rate and who strive to lower the number of individuals without health insurance coverage.

Prepared by Michael Chin of the University of Massachusetts Medical School and Audrey Gasteier of the Commonwealth Health Insurance Connector Authority, the analyses in this report represent the first time that tax filer data is being used to quantify the state’s uninsured population over a period of two consecutive calendar years. No other state has such detailed information on its residents’ insurance status.

Since 2001, the Blue Cross Blue Shield of Massachusetts Foundation (the Foundation) has supported community-based organizations, federally qualified health centers, and public agencies through its Connecting Consumers with Care grant program. During the October 2013 through September 2015 grant cycle, 16 organizations across Massachusetts received awards to help low-income and vulnerable consumers enroll in and maintain access to publicly subsidized health insurance coverage, and to help consumers navigate systems of coverage and care with increasing independence. This period coincided with the state’s implementation of key components of the Patient Protection and Affordable Care Act (ACA).

This report includes findings from the evaluation of the 2013-2015 Connecting Consumers with Care grant program. The goals of the evaluation were to 1) assess progress made on select outreach and enrollment measures, 2) describe the practices grantees adopted to reach and enroll consumers in health insurance, and 3) characterize efforts and challenges in defining, promoting, and evaluating consumer self-sufficiency. 

Chapter 58 of the Acts of 2006—“An Act Providing Access To Affordable, Quality, Accountable Health Care”—was signed into law by Governor Mitt Romney on April 12, 2006. The groundbreaking law sought near-universal health care coverage for the residents of Massachusetts by expanding Medicaid, creating a new program of subsidized insurance, enacting changes to the health insurance market, and requiring adults to have health insurance unless an affordable option was not available.

As we mark the occasion of the 10th anniversary of Chapter 58’s enactment, this fact sheet, prepared by Kelly Love and Robert Seifert of the Center for Health Law and Economics at the University of Massachusetts Medical School, presents a summary of the law’s effects, as reported in the many studies that have focused on Massachusetts’ reform. This high-level review summarizes the findings in various categories, including insurance coverage, access to care, health care utilization, and affordability for consumers. The authors also developed a full bibliography as a companion to the fact sheet.

This collection of reports and chart packs is the latest in a series by the Urban Institute analyzing the results of the Massachusetts Health Reform Survey (MHRS) which has been conducted most years since 2006, the year that Commonwealth enacted comprehensive health care reform. The 2015 MHRS, conducted  in the fall of 2015, provides an assessment of the state's efforts to improve the affordability of care and reduce health care spending through the cost containment legislation titled “An Act Improving the Quality of Health Care and Reducing Costs Through Increased Transparency, Efficiency and Innovation” (Chapter 224 of the Acts of 2012). It also assesses the impact of the federal Affordable Care Act (ACA) that began in January 2014.

The 2015 MHRS highlights sustained gains in health insurance coverage since the passage of Massachusetts’ 2006 health care reform law, as well as persistent gaps in health care access and affordability for many of those with insurance coverage. Low-income adults and those with health problems tend to be disproportionately impacted by these gaps. The survey findings are a reminder that the goals of health care reform are not fully achieved by simply reducing the number of people who are uninsured. New strategies are needed to improve access to care and reduce the burden of health care costs for Massachusetts families with insurance coverage, particularly for those made more vulnerable by limited resources and high health care needs.

This year’s results are presented in a variety of publications including:

• Summary
• Full narrative report
• Chart pack
• Infographic

In an effort to expand opportunities for researchers to understand the experience of Massachusetts consumers with accessing and affording health care, the Blue Cross Blue Shield of Massachusetts Foundation will be making available a public use file of the 2015 survey as they did with the previous years’ surveys (i.e., 2006 – 2010, 2012-2013). The 2015 public use files will be available through the Inter-University Consortium for Political and Social Research.

On Tuesday, April 19th, the Foundation hosted a webinar to review key findings from the 2015 Massachusetts Health Reform Survey with author Sharon Long of the Urban Institute. Click here to access the webinar slides.