***NCOIL LEGISLATIVE ALERT***
MASSACHUSETTS PASSES MANDATORY HEALTH CARE BILL
Date:
April 7, 2006
To:
NCOIL Legislators
From:
Susan Nolan, NCOIL Executive Director
Re:
Massachusetts Passes Landmark Health Care Reform, Would Mandate
Coverage
On April 4, the Massachusetts legislature passed conference bill H.B. 4850, which would
mandate health insurance coverage for all residents in the state.
Attached, please find:
 an April 4 article in the Boston Globe entitled Mass. bill requires health insurance
 an April 6 article in the New York Times entitled On Health Care, Massachusetts
Leaders Invoke Action, Not Talk
BILL STATUS
The Massachusetts legislature passed Conference Committee on Health Care Access and
Affordability report H.B. 4850 after compromising on H.B. 4479 and S.B. 2282. On April 4, the
Senate voted 37 to 0, and the House voted 154 to 2, to send the bill to the Governor Mitt
Romney. Romney is expected to sign the legislation after making minor modifications.
BILL PROVISIONS:
MARKET REFORMS
 As of July 2007, the non- and small-group markets will merge.
 The bill does not allow new health insurance mandated benefits before 2009.
 The age of dependency will be the earlier of two years past the loss of dependent
status, or a person’s 25th birthday.
COMMONWEALTH HEALTH INSURANCE CONNECTOR
 The Connector would be created as an authority within the Massachusetts
Department of Administration and Finance.
 The Connector would review and certify what it deems to be good-value health
products that could be offered to eligible consumers.
 The Connector would operate the Commonwealth Care Health Insurance program
to provide subsidized health insurance to those with fewer financial means.
 Individuals and businesses with 50 or fewer employees would be eligible to acquire
insurance through the Connector. Employed individuals could purchase insurance
using pre-tax dollars.
 The Connector would permit insurance portability and allow multiple employers to
contribute towards a worker’s premium.
HOW THE BILL IMPACTS:
INDIVIDUALS
 As of July 1, 2007, all residents would be required to obtain health insurance
coverage.
 The first-year penalty for those without insurance would be a loss of the personal
exemption for tax year 2007. Financial penalties would increase to part of what an
individual would have paid toward an affordable premium.
 Young adults would be eligible for specially tailored, low-cost, health programs
through the Connector.
LOW-INCOME RESIDENTS
 Individuals ineligible for Medicaid who earn less than 300 percent of the Federal
Poverty Level (FPL) could apply for subsidized coverage.
 Low-income plans would have no deductibles, and premiums would be set on a
sliding scale based on household income.
 Individuals who earn less than 100 percent FPL would pay no premiums.
EMPLOYERS
 A “Fair Share Contribution” would be paid by an employer who does not provide, or
contribute to, employee health insurance. The contribution is estimated to be $295
per employee per year.
 A “Free Rider Surcharge” would be paid by employers who do not provide health
insurance and whose employees often use free care. Ten (10) to 100 percent of the
state’s costs for serving the uninsured employee would be charged to the employer.
 Employers would have to offer Section 125 plans, or “cafeteria plans,” that would
allow employees to purchase health insurance on a pre-tax basis.
 The Contribution, Surcharge, and cafeteria plans would apply to employers with 11
or more employees.
MEDICAID RECIPIENTS
 Eligibility for children would be expanded.
 Community-based outreach programs would be expanded.
 Dental and vision services cut in 2002 would be restored.
 Federal money would shift from supporting individual hospitals to funding health
insurance for the uninsured.
NCOIL will report on the status and significant implications of the Massachusetts legislation
during the July 20 through 23 NCOIL Summer Meeting in Boston, Massachusetts.