Young and
Uninsured
Academy Health
National 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 Law
First “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:
Age 18-26:
$72/month, or $912/year.
$56/month, or $672/year.
The Mass. Health Reform Law
The 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-olds
Dependent coverage for 2 years following
the loss of dependent status on taxes, up
to age 26.
New “carve-out” – Young Adult Plans for 1926 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 Facts
Uninsured 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)
1,771
4%
290
1%
Up to 100% FPL
13,481
29%
100.1 - 200%
200.1 - 300% (lower premium)
200.1 - 300% (higher premium)
30,923
66%
CommCare growth: 19-26 year-olds
(November 2006 – January 2008)
60,000
4
0
9,
4
6,
99
4
50,000
65
3
16
87
4
2,
08
5
9,
50
6
6,
43
3
3,
2
64
4
9,
93
3
2,
1
1
26
5
7,
1
29
20,000
56
4
8,
0
5,
3
2
2
2
30,000
6
9,
3
3
40,000
2
3,
48
6
,8
10,000
7
5
1
,2
1
6
0
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)
122
3%
245
6%
1,163
27%
211
5%
123
3%
Gold
Silver
Bronze with Rx
Bronze without Rx
YAP with Rx
YAP without Rx
2,368
56%
CommChoice growth: 19-26 year-olds
(July 2007 – January 2008)
4500
4232
3907
4000
3500
3000
2 56 1
2500
2021
2000
173 9
15 0 0
1153
10 0 0
555
500
0
J ul y 0 7
A ug. 0 7
S e pt . 0 7
Oc t . 0 7
N ov . 0 7
Dec. 07
J a n. 0 8
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).