Healthcare reform has been a national issue for some time and the ability to afford citizens the opportunity to adequate healthcare services is an interesting debate with many ideas and arguments both for and against the practice. To help understand the finer meanings of what health care reform laws can impact on a region it is necessary to examine the impact of such reforms on a selection of states.
The purpose of this essay is to compare and contrast the varying health care reform laws of three differing states. This essay will examine Maine, Vermont and Massachusetts transformations in healthcare laws to help contextualize the law and demonstrate its feasibility, or lack of feasibility within the real world
The impetus for the attention given to health care reform has no doubt started due to the efforts of the Federal Government's involvement in regulating medical treatment through policy and law. On March 23, by executive order, President Obama signed the Affordable Care Act into law. This law introduced a series of steps and sequences that would eventually bring the law into full fruition.
The intentions behind this procedure were many and varying and there appears to be benefits and negative aspects depending on who you are and where you live and what your relationship to the medical establishment is. According to Drew (2010) "The Patient Protection and Affordable Care Act will ensure that all Americans have access to quality, affordable health care and will create the transformation within the health care system necessary to contain costs. The Congressional Budget Office (CBO) has determined that the Patient Protection and Affordable Care Act is fully paid for, ensures that more than 94% of Americans have health insurance, bends the health care cost curve, and reduces the deficit by $118 billion over the next ten years and even more in the following decade."
These economic benefits have yet to be realized and are even doubted by many. Tully (2009) suggested that there were many risks involved before the bill was passed and that many surprises may be in store to manage such a large scale operation. He wrote "If you prize choosing your own cardiologist or urologist under your company's Preferred Provider Organization plan (PPO), if your employer rewards your non-smoking, healthy lifestyle with reduced premiums, if you love the bargain Health Savings Account (HSA) that insures you just for the essentials, or if you simply take comfort in the freedom to spend your own money for a policy that covers the newest drugs and diagnostic tests -- you may be shocked to learn that you could lose all of those good things under the rules proposed in the two bills that herald a health-care revolution."
In reality, many of the federal issues with this plan are still being worked out and debated about and there are no clear answers as to how the success of this program will be measured, or even how it will be measured. The federal issues dealing with this issue suggest that the states may be best in handling their own systems and not relying so much on the influences from the federal forces at work. To best understand this, it is necessary to examine the three aforementioned states and investigate their involvement within the movement and determine the applicability, feasibility and efficiency of the recent laws and policies.
The State of Maine
The first state to be examined is the state of Maine. The Affordable Care Act (ACA) has indeed brought substantial and immediately alterations to this state's government's system of operation dealing with medicine and healthcare. In general many of the provisions that are applied nationally are also applied locally in this case. These include the following requirements:
The ACA requires individuals to have insurance coverage by March 31, 2014,or pay a tax penalty.
Any Maine resident not eligible for Medicare can buy an individual health insurance policy. (Individuals who need to pay for Medicare Part A can also buy an individual policy).
For insurance issued on or after January 1, 2014, plans cannot exclude coverage for pre-existing conditions.
Added Benefits for the Citizens of Maine
The ACA also presented some mandated benefits that put the state of Maine responsible for implementing new rules that must be applied. Federally approved health insurance plans must be updated to include new services that may have not been included before. These include such things as emergency service, mental health services, preventative and wellness services and chronic disease management; and pediatric services, including dental and vision care.
A reorganization of health insurance plans was also mandated and a new rating system was created to help citizens compare and contrast their varying options within the new rules. One such matrix is the metal levels that showed how each plan was cost effective and what it offered.
Actuarial Value* (This is the estimated % of total costs your plan will pay)
Your Expected Cost Share
20%, up to maximum OOP
30%, up to maximum OOP
40%, up to maximum OOP
To help with this problem, major insurance carriers catered to these demands and offered programs that were suitable to the customer.
Plans By Metal Level Offered By Each Carrier
Anthem Blue Cross Blue Shield
Guided Access HMO (South)
Guided Access POS (North)
Maine Community Health Options
Harvard Pilgrim Health Care
MEGA Life & Health Ins. Co.
Vermont Health Care Reform Laws
Like many states who have burdened by the ACA and all of its new demands and complexities, Vermont is experiencing the very same problem. According to Vermont State Senator Tim Ashe, "Explaining Vermont's proposed roadmap for health care reform is much more difficult than explaining why we need reform in the first place. In just the last decade, Vermont's total health care spending has climbed from $2 billion to $5 billion a year. This is already unsustainable, yet some believe the total bill is likely to double to a stunning $10 billion/year in the next decade. We clearly need reform."
Vermont's Leadership on Health Care Reform Law
In 2011, the state government of Vermont created a new government entity to help manage this problem. The Green Mountain Care Board (GMCB) was created to be responsible for overseeing the Vermont hospital budgets and health insurance plans. Vermont has appeared to be way ahead of other states by creating such an entity and has demonstrated that this approach may be effective in its application.
Grubb (2013) suggested that Vermont's ability to implement change has been a model for other states. Additionally, the lessons learned in the past few years have provided key lessons to be learned and assimilated in other regions of the country. He wrote "Policymakers and stakeholders in other states can learn some lessons from Vermont regarding ACA reform. First, engaging stakeholders while providing transparency at each stage of reform builds support for transition efforts. Second, the adage "work smarter, not harder" applies to the enormous task of implementing health care reforms: a central board can coordinate all implementation efforts, reduce redundancy and bureaucracy, and improve transparency. Third, the development of a health insurance exchange presents opportunities for state-specific health care innovation. And finally, instead of resisting the inevitable federal reforms in the name of federalism, states may capitalize on federal financing opportunities to build new state health programs and realize cost savings."
Massachusetts Health Care Reform Laws
The state of Massachusetts has been significantly ahead of the rest of the country in terms of implementing health care reform laws. In 2006 the Massachusetts Health Care Reform Act was passed in that state which required that all state residents to have health insurance if it was within their economic means. If not a tax penalty would be applied to that person. For those without sufficient income could become eligible for other programs such as MassHealth or Commonwealth Care, Medicare, Tircare, VA care or a Student Health Insurance Plan (SHIP). The Massachusetts Health Care Reform Law required employers with 11 or more full-time employees to offer a group health plan to their employees (and pay a fair share of the monthly premiums), or else pay an Employer Fair Share Contribution. The Employer Fair Share Contribution was $295 per employee paid into the Health Safety Net Trust Fund.
The following chart demonstrates the tax penalty rate in this state:
Health Insurance Tax Penalty Income Categories - Tax Year 2013
(based on Federal Poverty Guidelines effective January 2013)