1. Lessons from Massachusetts for Implementing National Health Care Reform Jon Kingsdale, Ph.D. Executive Director Mass. Health Connector Families USA January 28, 2010

2. 2 Overview 1.Key elements of reform 2.Progress report on Massachusetts 3.The challenge of implementing 4.Selling insuranceoutreach, allies and exchanges

3. 3 Mass. Model for National Reform 1.Medicaid Eligibility Expansion 2.Shared Responsibility -Individual mandate -Employer contribution -Public subsidies 3.Insurance Market Reform 4.Insurance Exchange

4. 4 Progress Report on Mass. 1. 2.7% uninsured after 3 years 2. Of newly insured, 35% private pay 3. 98% compliance (taxpayer filings) 4. 59% - 75% voter approval rating 5. Net new state costs ~ $350 million

5. 5 Theres More to the Story If I didnt have health insurance, I would never have made an appointment with my doctor because of the cost. The cancer would have spread and I would not be alive today to tell you my story. - Jaclyn Michalos, 27

6. 6 Theres More to the Story Before moving to Mass in 2007, she was told by an insurance agent in her home state: Youll never get insurance, so dont waste your time. After discovering Commonwealth Choice: I did the whole thing online and got a very good plan. I was just thrilled! Abbie von Schlegell, Commonwealth Choice member

7. 7 Strong Voter Support Source: Kaiser Family Foundation/Harvard School of Public Health/BCBS of Mass Foundation Surveys, 2006-2008; Harvard School of Public Health/Boston Globe Massachusetts Health Reform Poll (conducted September 14-16, 2009)

8. 8 Implementation Challenge for U.S. All the challenges of Mass., plus… Federal vs. state systems, e.g. eligibility determination Timelines for a law that is perhaps 15 times more ambitious Massive, organized opposition

9. 9 Its a campaign! - Tom ONeill 1.Coordinate government agencies 2.Communicate like crazy 3.Build and sustain coalitions, across the health care sector 4.Make progress monthly 5.Manage expectations

10. 10 Countless moving parts Strong centralized coordination needed to track progress and share information Secretary of Health and Human Services convened weekly cross agency meetings HCR project leaders from each agency reported progress and challenges Coordinate Agencies

11. 11 One front door for subsidized health programs (MassHealth, Commonwealth Care, and the Health Safety Net) Medicaid program has the staffing and systems required to determine income eligibility Adding CommCare rules to the existing eligibility system ensured maximum benefits for applicants & notice of eligibility for all family members Used Existing MassHealth Infrastructure

12. 12 These programs can be applied for online using the Virtual Gateway: 1.MassHealth, including: –Children's Medical Security Plan –Healthy Start –Health Safety Net –CommCare 2.Child Care 3.Food Stamps 4.Women Infants Children (WIC) 5.Womens Health Network 6.Department of Mental Retardation services 7.Mass. Rehabilitation Commission services 8.Elder services 9.Mass. Commission for the Blind Services 10. Commission for the Deaf/Hard of Hearing services 11. Veterans Services/Chelsea Soldiers Homes Virtual Gateway – Front Door for Many Programs

13. 13 Communicate Like Crazy Launch an aggressive public education campaign to: Provide information about the new law and raise awareness Promote the availability of new plans all certified by the state for quality and value Promote the Connectors ability to offer unprecedented choice

14. 14 Connectors Public Information Unit (November 06) Created to focus on calls regarding Health Care Reform law and business questions Alleviated pressure on two call centers for enrollment Handled up to 2,500 calls/e-mails a week.

15. 15 Connect to Health Campaign Launched May 07

16. 16 Elements of the Campaign Media Outreach Direct Mail Seminars & forums (over 150 presentations) Grassroots Outreach Paid Advertising Public Information Unit Grants to Community Organizations Coalitions of corporate and civic organizations: –health care community- employer assns –consumer advocacy groups- businesses –faith communities - sports teams - unions

17. 17 Health Care Reform Coalition

18. 18 Coalition Partners Other State Agencies Greater Boston Interfaith Organization –Developed train the trainer materials –Educational workshops following weekend services –Went door to door –Helped at grassroots outreach events CVS –Window Signage, info at pharmacy counters, overhead radio announcements Shaws and Star Market Supermarkets –Messaging in circulars, messages on store receipts

19. 19 Coalition Partners Associated Industries of Massachusetts, (AIM) –Partnered with key business associations to co-sponsor 16, three-hour sessions across the state. Retailers Association, NFIB, Bank of America –helped with business outreach IBEW –Messaging on lighted billboard on Expressway Comcast –pro bono advertising Zip Car –website link Massachusetts Health Plans –MMCOs and commercial plans advertised

20. 20 Other State Agencies Department of Revenue –Postcards to tax filers (3.1 million), letters to employers ( 193,000) and uninsured MassHealth (Office of Medicaid) –EOHHS Outreach and Enrollment Grants Division of Insurance & Division of Health Care Finance and Policy –Presentations Registry of Motor Vehicles –Notices to new Mass. residents via new license process Division of Unemployment Assistance –Inserts in resident mailings MBTA –Advertising on subway cars and buses

21. 21 Grassroots Outreach 20 community-based enrollment events during Fall & Winter 2007 Partnered with: –Legislators –Mayors/City Councilors –Local Hospitals –Community Health Centers –Community Groups –Health Plans –MMCOs –School systems

22. 22 Advertising Television, including N.E. Sports Network Radio Print, including community, ethnic and college newspapers Internet Transit Targeted to all geographies

23. 23 Our Message There's a new law - you need health insurance Unprecedented choice of plans Easy comparison of plans and prices through our website State Seal of Approval for quality and value

24. 24

25. 25 Spike in visits to web site around major promotional efforts (6 & 11/07)

26. 26 Rapid Expansion of Coverage 1.July 1, 2006: eligibility for MassHealth expanded 2.October 1, 2006: CommCare enrollment begins for uninsured below 100% FPL 3.January 1, 2007: enrollment expands to eligible individuals who contribute toward monthly premiums (101%-300% FPL).

27. 27 Rapid Ramp-Up

28. 28 Over 300,000 newly insured December 5, 2007 Massachusetts State House World Series Trophy helps us celebrate HCR Milestone!

29. 29 Manage Expectations: Exchanges Easy shopping Value: select networks & premier brands Trust/consumer protection Administrative simplification