September 2006

Health Care & You!
Understanding how health care reform impacts the individual, the employer and the government

How Health Care Reform Impacts Employers:

Employers with 11 or more employees who do not “offer to contribute toward, or arrange for the purchase of health insurance” may be assessed a “free rider” surcharge, if their employees collectively access free care a total of five times per year, or one individual accesses free care more than 3 times a year. The employer may also be assessed a “free rider” surcharge if the Division of Health Care Finance and Policy assesses a surcharge, which will be between 10-100% of the costs to the state of that free care, with the first $50,000 of the costs exempted.

Employers who don’t make a “fair and reasonable” contribution will be required to make a per- worker “fair share” contribution that does not exceed $295 per full-time-equivalent employee, per year. This contribution reflects the approximate cost of free care used by employees of non-contributing employers. Businesses with 10 or fewer employees will not be subject to the contribution, and businesses with temporary or seasonal employees will pay a pro-rated assessment as long as their employees work a minimum of 30 days.

How Health Care Reform Impacts Your Tax Dollars & Government:

Your federal and state taxes are traditionally spent on a variety of programs and initiatives. This health care reform secures additional aid from the federal government in Medicaid funding to Massachusetts, and uses an additional $125 Million dollars of Massachusetts’ general fund toward health care coverage for the uninsured. The difference in this coverage is that it reallocates money that is traditionally spent in a very reactive way – through the uncompensated care pool, toward proactive and in many ways preventative health care coverage for over 95% of Massachusetts residents. The additional money spent through the general fund is enhanced through some federal matching of state spending.

How Health Care Reform Impacts You:

This health care reform requires an individual to have health insurance, and make an individual investment in their coverage. This requirement is an exciting aspect of this health care plan because in order to insist upon such a contribution from individuals, health care must be affordable to people at every income level – this reform does just that. Right now, every taxpayer pays for the care of those who are uninsured and need emergency care, that way, through employer contributions and additional state investment, we can reduce the cost to the individual to ensure that rather than using emergency care only, he or she is able to afford his or her own care by already having health insurance, this reducing reliance on the uncompensated care pool that consumes $600 Million of taxpayer money annually. This will impact ever individual differently, and health care plans will be tailored to the individual. Whether you are one of the 550,000 currently uninsured residents, or someone already with coverage this health care reform will impact every business and resident of Massachusetts in different ways.

How Health Care Reform Impacts the Long- Term:

One interesting aspect of this health care reform is that it includes provisions that allow it to grow and evolve with the Massachusetts individual, particularly at studying and reducing racial and ethnic disparities in care. Some of these provisions are:
• Requiring hospitals to collect and report on health care data related to race, ethnicity and language.
• Medicaid “paid for performance” measures include reducing racial and ethnic disparities.
• A study to develop a sustainable Community Health Outreach Worker Program to help eliminate health disparities and remove linguistic barriers to care.
• Creates a Health Disparities Council, to continue the work of the Special Commission on Racial and Ethical health Disparities.

For more information about Health Care Reform click here.