Young and Uninsured

Academy HealthNational Health Policy Conference

February 4, 2008

What I’ll cover

1. Summary of the Massachusetts Health Reform Law.

2. Focus on young adults.3. Enrollment so far.

The Mass. Health Reform Law

Became law on April 12, 2006. 6.4 to 10.7% of MA uninsured in 2005/06:

395,000 (MA Div. of Health Care Finance and Policy).532,000 (Urban Institute for BCBS of MA Foundation).618,000 (U.S. Census Bureau).

Expanded Medicaid. Created new subsidized and unsubsidized

health plan options.

The Mass. Health Reform LawFirst “individual mandate” in the U.S.7/1/07: Legal requirement to have insurance.

12/31/07: Must be insured on this date to avoid loss of MA personal exemption (worth $219).

1/1/08 - : New month-by-month penalties based on ½ the monthly premium of lowest-cost Health Connector option for the individual.

Sample penalties for those above 300% FPL:

Age 27 up: $72/month, or $912/year.

Age 18-26: $56/month, or $672/year.

The Mass. Health Reform LawThe Commonwealth Health Insurance

Connector Authority:Regulates. (What’s affordable? What should

health insurance cover…?)Subsidizes. Commonwealth Care

(“CommCare”) insurance for Mass. adults (19+) at or below 300% of FPL ($30,636 for an individual, $61,956 for family of 4, etc.).

Enterprises. Negotiates with carriers to offer new Commonwealth Choice (“CommChoice”) plans in the commercial market. Provides marketplace, tools and support for consumers.

The Mass. Health Reform Law

Employers of 11 or more FTE’s:Offer tax-free savings on premiums (Section

125 Plans) or risk surcharge when employees and/or dependents use Safety Net Care (a.k.a. “free care”).

“Fair and reasonable” health benefits or pay into Safety Net (care for uninsured).

And more…

How’s it going?300,000+ newly insured on or before 1/1/08.

70,000 new Medicaid enrollees. 169,000 in CommCare (Health Connector

subsidized plans). 16,000 in CommChoice (Health Connector

unsubsidized plans).47,000 people newly enrolled in private health

plans outside of CommChoice (and beyond ordinary growth projections) through 10/1/07.

The Law and 18-26 year-oldsDependent coverage for 2 years following

the loss of dependent status on taxes, up to age 26.

New “carve-out” – Young Adult Plans for 19-26 y-o* in the commercial marketplace:Rx not required.Purchase through the Health Connector

(Commonwealth Choice) only.Don’t have an employer-subsidized option.

*(Amended in 12/07 to include 18 year-olds)

Who said that it would be easy?

Mass. Young Adult FactsUninsured rate for 18-26 year-olds*: 25.4% (191,255) in 2004. 18.9% (142,312) in 2006.

Enrollment of people age 18-26 in Health Connector programs (as of 1/1/08):

46,465 in CommCare, or 29.4% of all enrollees. 4,232 in CommChoice, or 26.5% of all enrollees. Other sources…?

* Estimates calculated from Massachusetts Div. of Health Care Finance and Policy data.

19-26 year-olds in CommCare by Plan Type

(as of 1/1/08)1,7714%

30,92366%

2901%

13,48129%

Up to 100% FPL

100.1 - 200%

200.1 - 300% (lower premium)

200.1 - 300% (higher premium)

CommCare growth: 19-26 year-olds (November 2006 – January 2008)

23,39322,36419,426

17,52913,2486,875

26,643

49,09946,465

39,65638,41635,087

32,40829,550

1,2160

10,000

20,000

30,000

40,000

50,000

60,000

Nov.'06

Dec.'06

Jan.07

Feb.'07

Mar.'07

Apr.'07

May'07

June'07

July'07

Aug'07

Sep.'07

Oct.'07

Nov.07

Dec.07

Jan.'08

19-26 year-olds in CommChoice by Plan Type (as of 1/1/08)

1233%

2115%

2456%

1223%

2,36856%

1,16327%

GoldSilverBronze with RxBronze without RxYAP with RxYAP without Rx

CommChoice growth: 19-26 year-olds (July 2007 – January 2008)

42323907

2561

2021

1739

1153

555

0

500

1000

1500

2000

2500

3000

3500

4000

4500

J uly 07 Aug. 07 Sept. 07 Oct. 07 Nov. 07 Dec. 07 J an. 08

Young Adults: 2008 Outreach Plans

Research: focus groups, survey.

Partnerships: Red Sox, MBTA, Registry of Motor Vehicles, CVS, tax preparers, ZipCar, colleges and universities, more.

Ads/Media: TV, radio, print, and web (including social networking sites).