December 5, 2006 |
2006-R-0704 | |
HEALTH CARE REFORM IN THE STATES | ||
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By: Robin K. Cohen, Principal Analyst | ||
You asked for a side-by-side comparison of states that have enacted comprehensive laws to reduce the number of uninsured residents. Table 1 provides this comparison among the four states that we believe have adopted the most comprehensive reforms. Massachusetts appears to have the most comprehensive plan, while Rhode Island's law is fairly limited in scope. Table 2 shows common elements among the plans.
Table 1: States with Universal Health Care Reforms
Maine |
Massachusetts |
Rhode Island |
Vermont | |
Plan Name |
Dirigo Health |
Commonwealth Care |
Health Care Affordability Act (package of bills) |
Catamount Health |
Year Passed/Start Date |
2003/October 1, 2004 |
2006/various—Medicaid eligibility expansion 7/1/06; employer surcharge 10/1/06; Connector plans 4/1/07; individual mandate 7/1/07 |
2006 |
2006/October 1, 2007 |
Target group |
Uninsured residents, especially small employers and self-employed |
Uninsured residents, with adult coverage mandate |
Uninsured residents, with specific reforms for small business, high risk |
Uninsured residents |
Income threshold for subsidized care |
300% of FPL |
300% of FPL |
NA |
300% of FPL |
Ability for higher-income individuals to buy into program |
Yes |
Yes |
NA |
Yes |
Table 1: -Continued-
Maine |
Massachusetts |
Rhode Island |
Vermont | |
Administrative structure |
Independent, executive branch agency (Dirigo Health) |
Independent, quasi-public agency |
NA |
Commission to monitor health care reform activities |
Insurance purchase function |
Yes |
Yes |
NA |
Yes |
Medicaid expansion |
Yes |
Yes |
No |
No |
Crowd out (cannot drop coverage to qualify for subsidized care) |
12 months |
Six months |
NA |
12 months |
Small Group Market Reforms |
Yes |
Yes |
Yes |
No |
Financing |
One-time federal payment (Medicaid), additional Medicaid matching funds, insurance company “offset” payments, premiums (employer and employee) |
Employer surcharge, general and federal funds, premiums |
NA |
Premiums, employer assessment, increase in tobacco tax, matching federal funds |
Chronic disease management |
Yes, Dirigo Health charged with promoting quality improvement, disease prevention, disease management |
No |
No |
Available to every resident |
Medicaid provider rate hikes |
Yes |
Yes, for physicians and hospitals. At least 15% of increase must go for physician fees. |
No |
Yes |
Healthy behavior and wellness |
Cash incentives when enrollee chooses and meets with primary care physician |
Yes, including Medicaid tobacco use cessation treatment |
New wellness benefit plan for small employers and individuals; mandate for 8. 5 hours of insurance coverage for tobacco cessation |
Healthy lifestyle insurance discounts; law's principles call for residents to pursue healthy lifestyles, with focus on preventive care and wellness; increase in cigarette tax |
Health care quality and transparency |
Yes, Maine Quality Forum |
Creates councils to establish health care quality improvements and cost containment goals; performance-based Medicaid hospital rate increases |
Reporting of quality indicators in community-based health care |
Yes, in law's guidelines |
Table 2: Common Elements of State Health Insurance Reforms
Element/State |
Maine |
Massachusetts |
Rhode Island |
Vermont |
Income threshold for subsidies |
ü |
ü |
ü | |
Crowd out |
ü |
ü |
ü | |
Medicaid expansion |
ü |
ü |
||
Employer assessment |
ü |
ü | ||
Wellness [1] |
ü |
ü |
ü |
ü |
Small group market reforms |
ü |
ü |
ü |
[1] This category includes general wellness programs and specific initiatives, such as smoking cessation.
For additional information about these states' reforms, please go to www. cgalites/olr/universalhealth. asp and click onto various OLR reports. For a complete listing of states that are considering universal coverage, including those requiring feasibility studies, go to http: //www. ncsl. org/programs/health/universalhealth2006/htm
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