BOSTON — Lawmakers are moving forward with the biggest expansion of state-subsidized health insurance in years under a pilot program that would extend coverage to tens of thousands of residents who are not currently not eligible.
A proposal included in the $52.7 billion state budget, which was sent to Governor Charlie Baker’s office on Monday, calls for a two-year pilot project expanding eligibility for ConnectorCare, the insurance program state-subsidized disease.
Under the plan, coverage would be available to individuals and families earning up to 500% of the federal poverty level, or about $139,000 for a family of four. The current level is 300% of the poverty line.
Advocacy group Healthcare for All said the move would make an additional 37,000 residents eligible for more affordable coverage.
“It would be really essential support for these people and their families,” said Alex Sheff, the group’s director of policy and government relations. “It would help tens of thousands of residents afford the care they need, which is often too far away.”
Massachusetts law requires people to have health coverage, and the state has one of the highest insurance coverage rates in the country. But Sheff said studies have shown that at least a quarter of residents have “unmet health care needs” due to high costs, and more than half face difficulty obtaining care.
“We hear daily on our helpline from hard-working individuals and families who can’t make ends meet and are forced to choose between paying rent and going to the doctor or picking up their prescription,” Sheff said. “In many cases, these are people who barely exceed this eligibility threshold.”
He said the expansion targets middle-income individuals and households who earn too much money to be eligible for coverage from MassHealth, the state’s Medicaid program, but who still struggle to afford the cost of private health plans.
The move would cost between $140 million and $150 million over a two-year period, according to the advocacy group. But Sheff said the state has accrued savings from enhanced federal health insurance subsidies provided during the pandemic, which will more than cover the cost of the pilot program.
“We believe this is the best way for the state to reinvest the money it saves from these enhanced federal grants,” Sheff said.
This decision is supported by the Massachusetts Medical Society, which represents doctors. Dr. Theodore Calianos, president of the company, said the changes “will allow more of our patients to have high-quality insurance while reducing out-of-pocket costs at a time when so many individuals and families need of help”.
“We believe that everyone has the right to the highest possible standard of health and healthcare and this program is an essential part of ensuring that this becomes a reality,” he said.
The ConnectorCare program, which was created as part of the landmark 2006 state health care act, offers low-premium plans with no deductible and limited cost sharing to approximately 150,000 members.
If the proposed changes survive Baker’s veto, it would be the biggest expansion of state-subsidized coverage since the implementation of the federal Affordable Care Act in 2014, advocates say.
But critics of the plan say it would create a ‘cliff’ when the two-year pilot expires, forcing the state to either find funds to continue subsidies or drop coverage for tens of thousands of people who received it as part of the expansion.
Josh Archambault, director of health care policy at the Pioneer Institute, said the move would be a “blank cheque” for the insurance industry and “crowd out” employer coverage as more and more people migrate to state-subsidized schemes.
The Health Care Act 2006, signed by the then government. Mitt Romney, included an “anti-crowding” provision that barred workers whose private employers offered insurance from accessing taxpayer subsidies. But that was eliminated under the ACA and changes to state health care law.
Archambault said expanding taxpayer health care subsidies would “add fuel to the fire,” causing more private employers to drop coverage.
“Instead of addressing why health insurance is so expensive across the board, they’re going to put a band aid on it by asking taxpayers to fund a subset of the middle class,” he said. he declares. “We’re just flooding taxpayers’ money, in an incredibly inefficient way, without making sure we’re getting better results.”