Massachusetts Health Insurance

Massachusetts soon may come up with a new on how the health insurance companies will reimburse doctors and hospitals for their services. Government may want the health insurance providers to radically change the way they pay health care service providers.

Massachusetts' health insurance law will not be sustainable over the next five to 10 years unless the state takes significant steps to reduce health care spending growth, government and industry officials say, the New York Times reports. Architects of the 2006 law said that it would not have been feasible to include heavy cost control measures in the legislation. According to the Times, "Now those stakeholders and the state government have a huge investment to protect. But the task of cost-cutting remains difficult in a state with a long tradition of heavy spending on health care."

Modeling the U.S. health care system after Massachusetts' health insurance law would leave many residents without affordable health insurance coverage.

More than 44,000 Massachusetts seniors must pay larger prescription drug copayments as a result of an $11 million cut to the state Prescription Advantage program, which provides copay assistance for seniors who meet an income-eligibility requirement, the Boston Globe reports. The cut, which was part of Gov. Deval Patrick's (D) $1 billion state budget reduction in October 2008, could leave many seniors paying double or triple their copays, state officials said.

Massachusetts Gov. Deval Patrick (D) on Monday met with health care industry executives to request that they address rising health care costs or potentially face new government regulations, the Boston Globe reports. During the meeting, which came in response to recent articles by the Globe's Spotlight Team about the cost of medical care, Patrick said he is considering holding hearings on health insurance premiums and hospital charges to insurers for member care. Last week, Patrick said the state Division of Insurance has the power to reject hospital rates it finds excessive.

Massachusetts Gov. Deval Patrick (D) on Monday "accelerated his administration's efforts to control spiraling statewide health care costs," and said that officials are considering regulations to block excessive insurance premiums, the Boston Globe reports. A recent investigation by the Globe's Spotlight Team found that an agreement between the former CEOs of Partners HealthCare and Blue Cross and Blue Shield of Massachusetts helped drive up health costs in the state.

Enrollment in a Massachusetts program designed to help unemployed state residents pay health insurance premiums has increased by 73% in the past year, the Boston Globe reports. The state Medical Security Program, which is funded by a tax on employers, pays 80% of a laid-off worker's monthly insurance premium for up to 46 weeks. For people who cannot afford to retain their coverage, even with the assistance money, the program offers full basic coverage and charges a copayment of about $15 per doctor visit.

The Massachusetts Health Insurance Connector Authority Board on Saturday approved guidelines for contracts with managed care companies that include incentives for cutting costs and patient-protection provisions, the Boston Globe reports. The guidelines will apply to state-subsidized Commonwealth Care health plans, which cover 162,000 residents whose incomes are too high to qualify for Medicaid. The contracts will be sent out for bids in January 2009 and take effect on July 1.

It's the "floor" of benefits that adult tax filers need to be considered insured and avoid tax penalties in Massachusetts. Starting on January 1, 2009, specific benefits will be required under Minimum Creditable Coverage. Massachusetts-licensed health insurance companies must put an MCC-compliance notice on their plans to indicate if it does or does not meet MCC. Most do meet the MCC standards.

The Boston Globe on Friday examined how "[k]ey players in the debate over how to provide health care coverage for the nation's 47 million uninsured" residents believe that the Massachusetts health insurance law is "an important model for what Washington could do and how to get it done." The state system requires that residents obtain health coverage, with subsidies available for eligible residents. In addition, employers must either offer coverage or pay into a state insurance fund.