Notes from Massachusetts

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It’s always dangerous to visit other states – you are reminded of how far Connecticut has to go. I spent yesterday in Boxborough, MA at Health Care For All’s fifth annual policy & organizing conference. The prevailing climate was of advocates, providers and state administration very comfortable working together toward a common goal – getting every MA resident affordable coverage and high quality services. There was a friendliness and mutual respect between stakeholders that was refreshing. I didn’t just rely on speakers but quizzed everyone I sat next to.

They have a great deal to be proud of – over 300,000 state residents now have insurance who didn’t before — about the total number of CT’s uninsured. They are addressing health disparities, reining in costs, and how to fund the higher than expected demand for coverage. As one speaker put it, they are victims of their own success. They recognize the big challenges ahead and already have an ambitious agenda for cost control.

The individual mandate compromise still has an edge for many advocates, but everyone is trying to work through it and respect the final agreement. The state has hired an army of lawyers and other counselors to help people navigate the very confusing process and to hear appeals. First year penalties for consumers who do not purchase coverage are coming due with tax returns in the next few weeks. There are still no numbers on how many will have to pay 2007 penalties ($219 for individuals). For 2008 penalties will go up to 50% of the least costly health insurance available. There are plenty of details, questions and forms, including the new Schedule HC to be filed with every tax return, but there is lots of help. One big question is how much this is costing to administer.

In response to a question, Nancy Turnbull, a member of the Connector Authority Board and a lecturer at Harvard, gave this list of lessons learned to share with other states.
1 – Get as much federal money as possible
2 – Defer hard decisions to the implementation stage – you need real world experiences to make informed choices, and any decisions made earlier would have been behind closed doors, which never contributes to good policy making
3 — Be ready for big buy-in costs – e.g. significant funding for providers, very modest employer contributions
4 – “What you can get business to agree to is not much”
5 – It was the right strategy to get coverage first and wait to control costs – one thing at a time
6 – Reform can’t happen without a broad based consumer advocacy coalition

One speaker thought the reason that reform worked in MA and other states are struggling is that others are letting the perfect be the enemy of the good – not true here in CT.
Ellen Andrews