Only Available In Massachusetts

A clear majority of the Massachusetts electorate voted on January 19 to send the 41^st Republican to the Senate, effectively killing the health reform compromise that was close to passage in the U.S. Congress.

At stake in the election were increases in healthy care coverage for most of the uninsured, requirements for both individuals and employers to purchase health insurance, and a comprehensive exchange program to allow all individuals to purchase health insurance in a fair and open market.

All of which Massachusetts citizens already have and are satisfied with in large part. So let’s take a brief look at health reform in Massachusetts, which the voters there get to keep but were unwilling to let the rest of the nation have a crack at.

Between the fall of 2006 and the fall of 2008, the percentage of working-age adults without health insurance in Massachusetts dropped from 13% to 4%, according to a September 2009 report from Blue Cross and Blue Shield of Massachusetts, the Commonwealth Fund, and the Robert Wood Johnson Foundation. This compares with a national uninsurance rate of 19.7% for nonelderly adults. The report, Health Reform in Massachusetts: An Update on Insurance Coverage and Support for Reform, found the uninsurance rate was down to 7.6% among lower-income adults and 1.4% among higher-income adults. The remaining uninsured adults in Massachusetts are disproportionately young, male, single, and/or healthy (54.5%). The report noted that these groups can be difficult to convince about the need for insurance.

The report also found that employer-sponsored coverage remains strong under the health care reform law in Massachusetts. Employer-sponsored coverage rose from 66.5% to 71.4% among all adults, and from 37.4% to 43.5% for lower-income adults. The report noted that "with [employer-sponsored insurance] coverage higher under health reform, there continues to be no evidence that any expansion in public insurance coverage under health reform is 'crowding out' or replacing [employer-sponsored insurance] coverage, as is often the case in reform efforts that focus on public expansions.”

A new poll by the Harvard School of Public Health and The Boston Globe finds 59% of Massachusetts residents who are aware of the state's health reform legislation, which was enacted in 2006, support it. A little more than one in four oppose it (28%), and 13% are not sure. The level of public support for the law has declined somewhat in the last year, from 69% saying they support the law in 2008 to 59% in the current poll. The current number is similar to the 61% found in 2006. Support for the law varied by party affiliation, with 76% of Democrats, 56% of Independents, and just 35% of Republicans saying they support the legislation.

Here are some key elements of health reform in Massachusetts (from the state’s health reform website):

• Provides for legal residents who are not eligible for other public or employer-sponsored health insurance:

• Completely subsidized, comprehensive health insurance to adults earning up to 150% of the federal poverty level (fpl).


• Substantial premium subsidies to people earning above 150% and up to 300% of fpl.


• Completely subsidized comprehensive coverage to children of parents earning up to 300% of fpl.

• Reforms the non-group and small-group health insurance markets to effectively lower the price and offer more choices for individuals purchasing unsubsidized products on their own.

• Requires adults in Massachusetts who can obtain affordable health insurance to do so.

• Requires employers of 11+ full-time equivalent employees in Massachusetts to make a fair and reasonable contribution toward coverage for full-time employees, or pay a Fair Share Assessment, and to offer both full-time and part-time employees a pre-tax IRC Sec. 125 plan) for their own health insurance premium payments.