10 Questions About ACA/Obamacare Implementation in Massachusetts That Need to be Answered

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1.      Why is Massachusetts giving the federal government a free pass to overtake the states right to regulate our insurance marketplace?

For an example, see the ongoing saga over rating factors changes, under which 60% of small companies will experience premium increases.

Bob Dylan singing  The Times They Are a-Changin’

2.      Why is Massachusetts letting the federal government push 100,000 low-income individuals out of the Connector and onto the flawed MassHealth (Medicaid) program?

Arkansas has obtained approval from the federal government for a different approach that Massachusetts should learn from.

When the ACA is fully implemented roughly 25 percent of our total state population will be on Medicaid. The MassHealth budget is scheduled to balloon well over 10 percent next year, and the governor requested a 33 percent increase in operations funding to hire dozens of new state workers to enroll people onto the public program.

If the Connector has done such a good job providing coverage for these individuals for the last 6 six years, why place them in a program that fails to even verify if the beneficiaries live in the state, and is rife with waste, fraud, and abuse?

3.      Why is Massachusetts not considering unmerging the small group and nongroup marketplaces?

The impact of the forced rating factor changes would be more moderate. (The Division of Insurance has not publically released their analysis on this option.)

4. Why is Massachusetts opting to spend additional money for a “state wrap” to subsidize more generous insurance plans in the Connector than what is required under the ACA? (Sections 76-79)

This optional additional spending will cost state taxpayers $119 million every year. It is supplemental subsidies for those between 200-300% FPL. Instead of subsidizing a Honda version of health insurance, the state continues to want to subsidize Cadillac-care. Implementing the law will be costly enough, as state officials have acknowledged “extreme premium increases” for some small companies, but this is self-inflicted. As an illustration, the current “bronze” tiered plans offered on the Connector are all considered “platinum” or “gold” level under the ACA.

5.      Should Massachusetts take advantage of the less restrictive rating bands that are allowed by the ACA?

In other words, older individuals at the top of their earning potential nearing the end of their careers would pay more money for their insurance (better reflecting their likelihood of needing medical care), instead of forcing younger workers at their lowest earning potential to subsidize the insurance premiums of older members of society. This is a matter of fairness, and in this case also better for the aggregate.

6.      Why are Connector contractors being granted preferential treatment under ACA implementation? (Sections 2,3,4)

7. How many individuals will qualify, and what will be the cost of the MassHealth demonstration project that grants premium assistance for employer sponsored health insurance for individuals up to 300% FPL, who are uninsured at the time of application and not eligible for Medicaid or purchase a qualified health plan because they have access to employer sponsored insurance? (Section 20)

8. Why is the state opening the flood gates to collect and share any of our personal data that is deemed “reasonably necessary” for ACA implementation?

Which includes but is not limited to what would be found on the federal application for insurance:

  • Social Security Number
  • Name
  • Address
  • E-mail
  • Telephone number
  • Marital Status
  • Information about your Children
  • Income
  • Birth date
  • Citizenship status
  • Disability Status
  • Medical Status
  • Education
  • Race
  • Foster Care Information
  • Other Assets

Will any of this information be shared with unlicensed and uninsured Navigators, who will help with enrollment for the Connector?

How much of this information will be shared with the department of revenue, the executive office of health and human services, the department of public health, the executive office of labor and workforce development, the registry of motor vehicles, the  department of correction, the center for health information and analysis and any such other state agencies, departments, divisions, commissions, authorities or political subdivisions?  (Sections 1, 94)

9.      Why is the state eliminating the requirement that carriers limit the effect of small group rating adjustment factors on annual premium increases? (Section 97)

When this was put on the books a couple years ago, it was to smooth out increases for small business, have we lost the need for this?

 10.  Why has the state neutered the coop concept for small business by forcing the same rates inside and out? (Section 53)

 Section 53: Any rates offered by a carrier to a certified group purchasing cooperative under this section shall be based on those group base premium rates that apply to individuals and small employer groups enrolling outside the group purchasing cooperative.

If the answer is the federal government is forcing the state to change, then return to question 1.

Find me on twitter: @josharchambault