In the United States of America, health care is provided by a number of different entities. One such entity is the state of Massachusetts with its much publicized Health care Plan, which underwent some reforms in 2006 and has repeatedly been lauded as the model for other states to follow. There are four key components or provisions of the health plan that differ from the federal health plan. One of the key components is the point of individual ‘mandate’. Federal law provides that all patients who visit hospitals should be treated even if they cannot afford to pay.
Thus, there are those who could take advantage of the emergency services and avoid paying hence leaving a huge bill for the taxpayer to clear. However, under the Massachusetts health plan, the residents of the state are expected to either purchase insurance or pay a fine. The financial penalty will be carried out through tax filings. Through this plan, access to health care coverage has been made easy even for those who earn very little income as they are given a subsidy to aid them buy insurance. This is almost the same as the same as the federal health tax credits.
Those who cannot afford insurance coverage can apply to be exempted from the mandate. At least 2% of Massachusetts state residents are exempted from the mandate since it has been established that they cannot afford it (Moffit; Kaiser Family foundation 1). The second component is the new employer mandate. For many years, Massachusetts employers who bought their employees coverage had to pay a health insurance premium tax to the uncompensated care pool of the state. However, employers who did not provide coverage were not subject to the tax.
Thus under the Massachusetts health plan, the legislature included a provision that companies that do not have any insurance provisions pay a levy to the uncompensated care pool of the state. This applied to employers who had eleven employees or more. This levy is set at a maximum of $295 per annum for each employer. This contribution is termed as the “fair share”. Furthermore, employers were also required to provide their employees with a plan that allows them to buy health care using pre-tax dollars (Moffit; Kaiser Family foundation 1).
The third component is the regulation of health insurance. The state of Massachusetts is among health care markets in the United States that are highly regulated. An insurer working in the individual Health Insurance market of the state has to give an all-inclusive standardized benefit package that has minimal flexibility. Through the Massachusetts health plan, small businesses as well as individuals can purchase insurance policies through the “connector” thus be able to expand their options of coverage particularly for those within the individual market.
The connector can be referred to as a sort of market where people can buy the health coverage from a wide range of competing health insurers. Health care providers can also contract with the insurance plans that are provided through the connector thus relieving them of the requirements of “any willing provider”, which are very costly. This hinders plans from getting patients to providers offering best value.
Insurers can also offer plans to individuals between 19-26 years of age subject to fewer pricey state mandates and places two year freeze on any fresh insurance mandates while the state carries out an evaluation of all mandated benefits (Moffit). The Massachusetts health care plan is aimed at making health coverage to be mandatory as well as universal. Universal coverage was to be achieved by enrolling anyone who was eligible for Medicaid when they presented themselves for care since it appeared that a significant number of people, approximately 100,000, qualified for Medicaid but who had not enrolled themselves.
The newly insured gained coverage primarily through four processes; one of them is the Mass health expansion which is an extension of the Medicaid program provided for by the state to include children from families with incomes of up to 300 percent FPL. The other processes include employer based coverage, an increase in individual coverage through the merging of the individual insurance market with the small group insurance market, the commonwealth care health insurance program and commonwealth choice plans (Kaiser family foundation 2).