- Massachusetts inaugurated its experiment with broad based health care in 2006 with passage of Chapter 58 of the Acts of 2006, “An Act Providing Access to Affordable, Quality, Accountable Health Care.” (Salient provisions of the law can be found in Chapter 111M of the Massachusetts General Laws. Mass.Gen. Laws ch. 111M).
- One of the goals of the Act was to spread out risk by pooling together the healthy—and thus less likely to seek health care—and those with medical problems, Health Care Access and Affordability Conference Committee Report (PDF). The Act does this by requiring almost all the state’s citizens to obtain affordable health care coverage. Mass. Gen. Laws ch. 111m § 2.
- A unique feature of the Massachusetts law is the Department of Administration and Finance, Commonwealth Health Insurance Connector (the "Connector") (external link). Composed of both private and public representatives, the Connector reviews and certifies “health insurance products” for cost and quality and “connects” them with individuals and small businesses. class="external" target="_blank"HealthConnector: Find Insurance: Individuals & Families (external link).
- The drafters of the Act also sought to achieve cost savings by merging individual and group markets, allowing HMOs to link plans to Health Savings Accounts, allowing young persons to stay on their parents’ health care plans two years beyond their status as dependents. Health Care Access and Affordability Conference Committee Report.
Under the Act, state residents must obtain coverage that meets Minimum Creditable Coverage (MCC) requirements. MCC means a plan that offers:
- Coverage of certain medical services
- Preventative care doctor visits
- An annual deductible cap of $2,000 for individuals and $4,000 for a family
- A cap on “out-of-pocket spending for non-Rx health services” at $5,000 for a family and $10,000 for a family
- No cap on total benefits to cover an illness, Mass. Gen. Laws ch. 111M § 1 & 956 Mass. Code Regs. 5.01 - 5.05 (external link) (PDF).
- Employers who employ 11 or more full time equivalent employees and do not provide them with health insurance pay a “Fair Share Employer Contribution.” Mass. Gen. Laws ch. 149 § 188.
- Employers not paying the "Fair Share Employer Contribution" are required to pay a “Free Rider Surcharge” if they have 11 or more employees, are not providing health coverage to their employees, and those employees obtain free state coverage. Mass. Gen. Laws ch. 118G § 18b.
- Employers with 11 or more employees are required to offer cafeteria employee benefit plans that meet certain legal requirements. Mass. Gen. Laws ch.151F § 2.
- State residents over the age of 18 must obtain and maintain “creditable coverage.” Residents must designate on their tax returns what coverage they have in force. Mass. Gen. Laws ch.111M § 2.
- Commonwealth residents without coverage can be penalized by state retention of tax overpayment in the amount of up to “50 per cent of the minimum insurance premium for creditable coverage available through the commonwealth health insurance connector for which the individual would have qualified during the previous year.” Mass. Gen. Laws ch.111M § 2.
- Government subsidized plans are available to those who make below 300% of the federal poverty level. Mass. Gen. Laws ch.118H § 2.
- Residents with “sincerely held” religious beliefs that prevent them from having insurance are exempted from the health care requirements. Mass. Gen. Laws ch. 111M § 3.
- Residents who are unable to obtain affordable health care are also exempt from the Act’s requirements. The Connector publishes an affordability schedule that determines when affordable plans are not available and tax penalties are waived. Mass. Gen. Laws ch. 111M § 2(a) and Health Connector: Find Insurance: 2009 Affordability Schedule.
For more information on Massachusetts see:
Last Updated: 02/28/2014