Notes from Today’s Connector Board Meeting

Health reform took an important step forward today as the Connector Board adopted a draft affordability schedule. The product of a careful compromise reminiscent of Chapter 58′s passage, Board members pointed out that while no one obtained the precise result they sought, everyone can support the result. The schedule is intended to bring the vast majority of the uninsured into coverage, while preventing the most vulnerable from being penalized for not buying unaffordable coverage. After the meeting, the Connector, GBIO and ACT!! celebrated this important step.

Health Plan Contracts
General Counsel Jamie Katz told the Board his staff has finalized contracts with (now) six health plans that will sell Commonwealth Choice policies. The Connector could not reach agreement with ConnectiCare and decided not to force negotiations, since there are three other options available for potential ConnectiCare enrollees. The Board quickly approved the contracts.

Affordability Schedule
Before introducing the draft affordability schedule, ChairLeslie Kirwan applauded the collaborative approach that the Connector staff took in incorporating a wide range of suggestions. Executive Director Jon Kingsdale emphasized that achieving nearly universal coverage is important because it improves quality of care, gives people the protection of coverage, and reduces adverse selection, lowering costs for everyone.

Kingsdale highlighted the principles behind the schedule:
– flexible enforcement to account for variations in individual circumstances;
– required participation of eligible persons in Commonwealth Care;
– an easy to understand schedule for everyone.
He said that the appeals process would be an important part of a flexible system and laid out criteria for appeals: conventional hardships, lack of availability of Section 125 plan, lack of availability of employer sponsored insurance (ESI) or ESI that meets minimum creditable coverage (MCC), and when the employer’s open enrollment period occurs.

To justify requiring enrollment in Commonwealth Care, Kingsdale proposed adjustments to the enrollee premium contributions as follows:

Although people with incomes between 101% and 150% of fpl will pay no premiums, they will still be in Plan Type II, which does not include dental coverage and has higher copays than Plan Type I. Additionally, the Patrick Administration has agreed that parents enrolled in CommCare will not have to pay premiums for their children’s MassHealth coverage.

CommCare enrollee contribution rates will define affordability for people with incomes below 300% fpl. For people with incomes above 300% fpl ($30,630), the affordability schedule will be extended as follows:

Separate schedules in Connector materials show the maximum affordable premiums for couples and families.

Connector staff estimate the affordability schedule will require 99% of the state’s population to purchase insurance – and predicts that many of those who are exempted from the penalty will still purchase coverage. The Board unanimously approved the changes in Commonwealth Care premiums and the draft affordability regs. The Connector will hold hearings across the state in May to get input on the affordability schedule. The changes will then take effect July 1.

Thoughts from the Board
Celia Wcislo said common ground was reached because people kept coming back, listening and learning from each other until they found a compromise. She expressed hope that this progress achieved will spur the rest of the nation to act.

As someone who has dedicated his life to helping poor folks get health care, Chip Joffe Halpern said he has lived for this moment. He said there is a lot of work left to do, but this is an historic moment – an entire socioeconomic group moving from being healthcare beggars to being healthcare participants.

Dolores Mitchell marveled at how quickly this group has learned to work with and trust each other. She congratulated advocates for taking such a thoughtful and rational approach to the reforms.

Jon Gruber and Rick Lord applauded Kingsdale and his staff for their hard work while Bruce Butler praised the Connector’s process of establishing principles and translating them into reality. Lou Malzone expressed his trust in the process that produced today’s compromise, and noted that stakeholders must be kept involved in the work left to do.

Kirwan highlighted the top roles health reform and the state budget play in her job. She reiterated the Governor’s commitment to health reform’s success.

Operations Report
Rosemarie Day told the board that, like Madeleine Albright, she is “an optimist who worries.” She believes they will have essential elements of Commonwealth Choice up and running for May 1st, but some website features may not work right away. Importantly, she noted small group enrollment in Commonwealth Choice will be delayed by as much as several months. During this time small employers can obtain plans—including the same plans that are offered through the Connector—outside the Connector.

While discussing marketing for section 125 plans, Jon Gruber said “section 125 is not sexy” and urged the Connector to focus on the tax benefits. Wcislo commented that providing a website and phone number asks people to contact the Connector, but what enrollees need is for the Connector to contact them. She suggested that community organizations need adequate outreach grants to contact potential enrollees.

Birthday Party/Press Briefing
The meeting ended with a celebration of the one year anniversary of Chapter 58′s signing – with cake. While answering press questions, Kirwan emphasized the importance of a flexible, humane approach to health reform implementation. She highlighted that achieving 99% coverage is better than the coverage in any other state. She stressed that while the state hopes exempted people will still be able to buy insurance, they shouldn’t be penalized for not being able to. Kingsdale said once the state achieves 99% coverage, it can focus on the last 1%. Sitting next to her was GBIO president, Rev. Hurmon Hamilton, who praised the plan and pledged continued work on implementation.

GBIO press conference
Following the meeting and official press briefing, GBIO, which had engaged in extensive lobbying around affordability, held its own celebration and press conference to address the Board’s decision. Kirwan, who stayed for GBIO’s event, thanked the group for its passion and commitment to health reform. She said the Board took a major step forward today, and there is much more to do. She is counting on stakeholder groups like GBIO to help with outreach and enrollment. GBIO leaders spoke about how the changes will help protect the vulnerable, and said that the changes were a major victory for GBIO and for people across the state.

Joffe-Halpern said “Massachusetts is a model of political maturity” which has found ways to reach compromises other states had missed. Wcislo spoke about the importance of how the stakeholders in reform sought to help entire community, not just their own groups. She also spoke of channeling power of people through the Board and raised a larger, nationwide challenge saying “It’s time for healthcare in America.”
Eric Benson