Not Just Budget: Important Health Reform Bills Pending

In the past four years, health reform has expanded health care access to over 400,000 Massachusetts residents. At 97.4%, Massachusetts has the highest rate of insurance coverage in the nation. With increased access to health insurance, health outcomes are beginning to improve.

Two key legislative priorities of the ACT!! Coalition are currently before the Joint Committee on Health Care Financing. These bills would strengthen health reform’s success. We urge the Committee to report these bills favorably.

Despite Massachusetts health reform’s success, gaps in coverage still exist, affecting people’s ability to access critical health care services. An Act Strengthening Health Reform (S.873/H.4258) seeks to secure health care access and continuity of coverage for Massachusetts residents. One of the provisions in the bill – prohibiting lifetime caps in all health insurance plans – has been accomplished through national health reform.

The bill also would address gaps in coverage caused by current application and appeals processes. It would require Commonwealth Care enrollment to begin on the date of application (instead of the first of the next month) and provide retroactive coverage for wrongfully terminated members. This bill would also make Health Safety Net retroactive coverage consistent at 6 months for all eligible patients, in order to ensure providers get the reimbursement they need and patients not go into bad debt due to a timing difficulty.

Two provisions of An Act Strengthening Health Reform would strengthen our system with no cost to the state:

  • Give the Office of Medicaid the flexibility to provide cost-effective care to elderly and disabled legal immigrants: Without access to post-acute services, many MassHealth Essential members become “stuck” in the hospital for longer than necessary. This provision gives the Office of Medicaid the flexibility to authorize additional benefits – like home care and skilled nursing – when it is cost effective.
  • Codify and strengthen the MassHealth Outreach Grant program: The MassHealth Outreach Grant program is a critical part of health reform’s success. Without continued expert assistance over time, the gains of health reform will be lost as individuals are unnecessarily terminated from programs and lose access to primary and preventive care. This provision would make the MassHealth Outreach Grant program permanent.

The second ACT!! bill, An Act Relative to Health Care Affordability (S.549/H.1102), seeks to address cost on the individual and systematic levels by

  • Redefining affordability to include out-of-pocket costs; and
  • Creating a separate Division of Health Insurance to improve public accountability and transparency of health insurers.

The Affordability Schedule change will have the most immediate impact for health consumers, at no cost to the state. By reworking the Affordability Schedule to take into account all out of pocket costs, not just premiums, consumers will be better protected from unaffordable health coverage. We all know that the cost of health care doesn’t stop at premiums; most of us also have co-pays, and some have deductibles and co-insurance. So, why shouldn’t the Affordability Schedule also take these costs into account?

We ask the Joint Committee on Health Care Financing to look at these bills with an eye towards the impact they will have on Massachusetts residents’ ability to access affordable, quality health coverage.

If you have any questions about these bills, please contact Suzanne Curry at
-Suzanne Curry

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