Share on Facebook Share on Twitter Email
Answers.com

Massachusetts health care reform

 
Wikipedia: Massachusetts health care reform
Home > Library > Miscellaneous > Wikipedia
Commonwealth Health Insurance Connector Authority
Connectorroundlogo.png
Connector Logo
Agency overview
Formed April 12, 2006
Headquarters Boston , Massachusetts
Agency executive Jon Kingsdale, Executive Director
Website
www.mahealthconnector.org
Health care in the United States
Public health care
Private health coverage
Health care law
State/municipal level reform
This box: view • talk • edit

The Massachusetts health care reform law was enacted in 2006. It requires nearly every resident of Massachusetts to obtain health insurance coverage. Through the law, Massachusetts provides free health care for residents earning less than 150% of the Federal Poverty Level (FPL)[1], and partially subsidized health care for those earning up to 300% of the FPL, depending on an income-based sliding scale. The law is credited with covering an additional 439,000 Massachusetts residents as of April 1, 2008.[2]

The law established an independent public authority, the Commonwealth Health Insurance Connector Authority, also known as the Health Connector, which offers the subsidized coverage and facilitates the selection and purchase of private insurance plans by individuals and small businesses.[3][4] Incentives for residents to obtain health insurance coverage include tax penalties for failing to obtain an insurance plan. In 2007, Massachusetts tax filers who failed to enroll in a health insurance plan that was deemed affordable for them lost the $219 personal exemption on their income tax. In 2008, penalties increase by monthly increments, and are based on half of the cost of a health insurance plan.[5][6]

The reform law was enacted as Chapter 58 of the Acts of 2006 of the Massachusetts General Court, entitled An Act Providing Access to Affordable, Quality, Accountable Health Care. In October 2006, January 2007, and November 2007, bills were enacted that amended and made technical corrections to the statute (Chapters 324 and 450 of the Acts of 2006, and chapter 205 of the Acts of 2007).[7]

Contents

Background

Estimates of the number of Massachusetts residents who were uninsured in 2006 range from 395,000[8] to 653,000.[9] Due to their lack of health insurance coverage, uninsured residents commonly utilize emergency rooms as a source of primary care.[10]

The United States Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986. EMTALA requires hospitals and ambulance services to provide care to anyone needing emergency treatment regardless of citizenship, legal status or ability to pay. EMTALA applies to virtually all hospitals in the U.S but includes no provisions for reimbursement. The law is therefore considered an "unfunded safety net program" for patients seeking care at the nation's emergency rooms.[11][12] As a result of the 1986 EMTALA legislation, hospitals across the country faced unpaid bills and mounting expenses to care for the uninsured.[13]

In Massachusetts, a fund of approximately $700 million, known as the Uncompensated Care Pool (or "free care pool"), was used to partially reimburse hospitals and health centers for these expenses and the expenses of non-residents.[14] The fund was raised through an annual assessment on insurance providers and hospitals, plus contributions of state and federal tax revenue. It was anticipated that implementation of the Massachusetts health reform law would result in a decrease in expenses incurred in providing services to the uninsured, as the number of covered Massachusetts residents increased. In 2006, MIT professor Jonathan Gruber (economist) predicted that the amount of money in the "free care pool" would be sufficient to pay for reform legislation without requiring additional funding or taxes.[15]

Reform coalitions

In November 2004, political leaders began advocating for major reforms of the Massachusetts health care system to expand coverage. First, the Senate President Robert Travaglini called for a plan to reduce the number of uninsured by half. A few days later, the Governor, Mitt Romney, announced that he would propose a plan to cover virtually all of the uninsured.

At the same time, the ACT (Affordable Care Today) Coalition introduced a bill that expanded MassHealth (Medicaid and SCHIP) coverage and increased health coverage subsidy programs and required employers to either provide coverage or pay an assessment to the state. The coalition began gathering signatures to place their proposal on the ballot in November 2006 if the legislature did not enact comprehensive health care reform, resulting in the collection of over 75,000 signatures on the MassACT ballot proposal. The Blue Cross Blue Shield Foundation also sponsored a study, "Roadmap to Coverage," to expand coverage to everyone in the Commonwealth.[16]

Attention focused on the House when Massachusetts House Speaker Salvatore DiMasi, speaking at a Blue Cross Blue Shield Foundation Roadmap To Coverage forum in October 2005, pledged to pass a bill through the House by the end of the session. At the forum, the Foundation issued a series of reports on reform options, all of which included an individual mandate. At the end of the month, the Joint Committee on Health Care Financing approved a reform proposal crafted by House Speaker DiMasi, Committee co-chair Patricia Walrath and other House members.[17]

Massachusetts also faced pressure from the federal government to make changes to the federal waiver that allows the state to operate an expanded Medicaid program. Under the existing waiver, the state was receiving $385 million in federal funds to reimburse hospitals for services provided to the uninsured. The free care pool had to be restructured so that individuals, rather than institutions, received the funding.[18]

Legislation

In fall 2005 as the House and Senate each passed health care reform bills.

The legislature made a number of changes to Governor Romney's original proposal, including expanding MassHealth (Medicaid and SCHIP) coverage to low-income children and restoring funding for public health programs. The most controversial change was the addition of a provision which requires firms with 11 or more workers that do not provide "fair and reasonable" health coverage to their workers to pay an annual penalty. This contribution, initially $295 annually per worker, is intended to equalize the free care pool charges imposed on employers who do and do not cover their workers. The legislature also rejected Governor Romney's proposal to permit even higher-deductible, lower benefit health plans.[citation needed]

On April 12, 2006 Governor Mitt Romney signed the health legislation.[19] He vetoed 8 sections of the health care legislation, including the controversial employer assessment.[20][21] Romney also vetoed provisions providing dental benefits to poor residents on the Medicaid program, and providing health coverage to senior and disabled legal immigrants not eligible for federal Medicaid.[22][23] The legislature promptly overrode six of the eight gubernatorial section vetoes, on May 4, 2006, and by mid-June 2006 had overridden the remaining two.[24]

Statute

The enacted statute, chapter 58 of the acts of 2006, established a system to require individuals, with a few exceptions, to obtain health insurance.[25] Chapter 58 has several key provisions: the creation of the Health Connector; the establishment of the subsidized Commonwealth Care Health Insurance Program; the employer Fair Share Contribution and Free Rider Surcharge; and a requirement that each individual must show evidence of coverage on their income tax return or face a tax penalty, unless coverage was deemed unaffordable by the Health Connector.[25] The statute also expands MassHealth (Medicaid and SCHIP) coverage for children of low income parents and restores MassHealth benefits like dental care and eyeglasses. A merger of the individual (non-group) insurance market into the small group market will allow individuals to get lower group insurance rates. Payment rates are increased to hospitals and physicians, and a new "Health Care Quality and Cost Council" will issue quality standards and publicize provider performance.[26] Chapter 58 also sets up a Disparities Council, funds automated prescription ordering in hospitals, and implements changes to the public health council, state insurance laws, mandated benefit requirements, and other health-related programs.

On October 26, 2006, the Commonwealth enacted chapter 324 of the acts of 2006, legislation making adjustments and technical corrections to chapter 58. The statute contains 82 sections and includes sections amending effective dates for many of the private insurance provisions of chapter 58. Another technical corrections bill, chapter 450 of the acts of 2006, was enacted on January 3, 2007. The statute includes more adjustments to effective dates. A third technical corrections statute was enacted on November 29, 2007, as chapter 205 of the acts of 2007.

Commonwealth Health Insurance Connector Authority

The Health Connector is designed as a clearinghouse for insurance plans and payments. It performs the following functions:

  • It administers the Commonwealth Care program for low-income residents (up to 300% of the FPL) who do not qualify for MassHealth[27] and who meet certain eligibility guidelines.
  • It offers for purchase health insurance plans for individuals who:
    • are not working
    • are employed by a small business (less than 50 employees) that uses the Connector to offer health insurance. These residents will purchase insurance with pre-tax income.[28]
    • are not qualified under their large employer plan
    • are self-employed, part-time workers, or work for multiple employers
  • It sets premium subsidy levels for Commonwealth Care.
  • It defines "affordability" for purposes of the individual mandate

The Health Connector is run by the Commonwealth Health Insurance Connector Authority, an independent agency with a 10-member board. The Health Connector will make health insurance portable by allowing employees to keep the same plan even if they leave an employer. The Health Connector will also allow employees to aggregate the contributions of multiple employers, e.g. if they are part-time workers or work for multiple employers, and apply them to one insurance plan.[27] The Health Connector is currently managed by former Tufts Associated Health Plans executive Jon Kingsdale, who serves as its executive director.[29]

Commonwealth Care Health Insurance Program

Commonwealth Care is one of the newest subsidized health insurance programs offered by the Commonwealth, and is a key part of Health Care Reform in Massachusetts. It is designed primarily for income-eligible Massachusetts adult residents who are not otherwise eligible for MassHealth, who either do not work or who work for employers that do not offer health insurance. Specifically, it allows eligible residents access to certain subsidized private insurance health plans – currently a choice of four plans – for individuals without health insurance who make below 300% of the federal poverty level.[26] There are no deductibles. For individuals below 150% of the federal poverty level, no premiums will be charged; for those below the poverty level, dental insurance is also provided. For those above 150% of the federal poverty level, a sliding scale premium schedule based on income is used to determine the amount of money a person contributes to their policy.[26] Commonwealth Care for those below poverty has been available through the Connector since October 1, 2006. Plans for those between 100% and 300% of the poverty line have been available since January 1, 2007. As of Dec. 1, 2007, over 158,000 people have enrolled in Commonwealth Care. The five Massachusetts health plans currently contracted with the state to serve the Commonwealth Care population include: Boston Medical Center HealthNet Plan, Celtic Care, Fallon Community Health Plan, Neighborhood Health Plan, and Network Health.

Employer taxes

Employers with more than ten employees must provide a "fair and reasonable contribution" to the premium of health insurance for employees.[30] Employers who do not will be assessed an annual fair share contribution that will not exceed $295 per employee per year.[30] The fair share contribution will be paid into the Commonwealth Care Trust Fund to fund Commonwealth Care and other health reform programs.[26] The Division of Health Care Finance and Policy defined by regulation what contribution level meets the "fair and reasonable" test in the statute. The regulation imposes two tests. First, employers are deemed to have offered "fair and reasonable" coverage if at least 25% of their full-time workers are enrolled in the firm's health plan. Alternatively, a company meets the standard if it offers to pay at least 33% of the premium cost of an individual health plan.

There is an additional Free Rider Surcharge that can be assessed to the employer.[31] This surcharge is different from the fair share contribution. The surcharge is applied when an employer does not arrange for a pre-tax payroll deduction system for health insurance, and has employees who receive care that is paid from the uncompensated care pool, renamed in October 2007 as the Health Safety Net.[27] If an employee receives free care more than three times or all of an employer's employees use free care a total of five times, then the employer must pay a portion of the health care costs.[27]

Individual taxes

Residents of Massachusetts must have health insurance coverage under Chapter 58.[32] Residents must indicate on their tax forms for the 2007 tax year if they had insurance on December 31, 2007, have a waiver for religious reasons, or have a waiver from the Connector. The Connector waiver can be obtained if the resident demonstrates that there is no available coverage that is defined by the Connector as affordable.[26] In March 2007, the Connector adopted an affordability schedule that allows residents to seek a waiver. If a resident does not have coverage and does not have a waiver, the Department of Revenue will enforce the insurance requirement by imposing a penalty. In 2007, the penalty was the loss of the personal exemption. Beginning in 2008, the penalty will be up to half the cost of the lowest available yearly premium which will be enforced as an assessed addition to the individual's income tax, up to $912 a year.[33]

Young adult coverage

Starting January 1, 2007, insurers' family coverage plans are required to cover young adults up to age 25 or for up to two years past the young adult's loss of dependent status. Beginning in July 2007, the Connector offers reduced benefit plans for young adults up to age 26 who do not have access to employer-based coverage.[34]

Implementation

The implementation of chapter 58 began in June, 2006, with the appointment of members of the Connector board, and the naming of Jon Kingsdale, a Tufts Health Plan official, as executive director of the Connector. The Board started meeting biweekly. On July 1, MassHealth began covering dental care and other benefits, and began enrolling children between 200% and 300% of the poverty level.

The federal Centers for Medicare and Medicaid Services approved the state's waiver application on July 26, 2006, allowing the state to begin enrolling 10,500 people from the waitlist for the MassHealth Essential program, which provides Medicaid coverage to long-term unemployed adults below the poverty line.[35]

In September, 2006, the Division of Health Care Finance and Policy issued regulations defining "fair and reasonable" for the fair share assessment. The regulations provide that companies with 11 or more full-time equivalent employees will meet the “fair and reasonable” test if at least 25 percent of those employees are enrolled in that firm’s health plan and the company is making a contribution toward it. A business that fails that test may still be deemed to offer a “fair and reasonable” contribution if the company offers to pay at least 33 percent of an individual’s health insurance premium.[36]

Also in September, the Connector Board set premium levels and copayments for the state subsidized Commonwealth Care plans. Premiums will vary from $18 per month, for individuals with incomes 100%-150% of the poverty line, to $106 per month for individuals with incomes 250%-300% of poverty. The Connector approved two copayment schemes for plans for people 200%-300% of poverty. One plan will have higher premiums and lower copayments, while a second choice will have lower premiums and higher copayments.[37] Four managed care plans began offering Commonwealth Care on November 1, 2006. Coverage for people above 100% of poverty up to 300% of poverty began on February 1, 2007. As of December 1, 2007, around 158,000 people were enrolled in Commonwealth Care plans.

Ambox outdated serious.svg
 This article may need to be updated. Please update this article to reflect recent events or newly available information, and remove this template when finished. Please see the talk page for more information.

Initial bids received by the Connector showed a likely cost for the minimum insurance plan of about $380 per month. The Connector rejected those bids, and asked insurers to propose less expensive plans. New bids were announced on March 3, 2007. The Governor announced that "the average uninsured Massachusetts resident will be able to purchase health insurance for $175 per month."[38] But plan costs will vary greatly depending on the plan selected, age and geographic location, ranging from just over $100 per month for plans for young adults with high copayments and deductibles to nearly $900 per month for comprehensive plans for older adults with low deductibles and copayments. Copayments, deductibles and out-of-pocket contributions may vary among plans. The proposed minimum creditable coverage plan would have a deductible no higher than $2,000 per individual, $4,000 per family, and would limit out-of-pocket expenses to a $5,000 maximum for an individual and $7,500 for a family. Before the deductible applies, the proposed plan includes preventive office visits with higher copayments, but would not include emergency room visits if the person was not admitted.[39]

Outcomes

Composition of Newly Covered as of 1/1/08
Drop in Uninsurance Significant Across Income Strata
Detail of Uninsured Taxpayers

From fall 2006, the number of uninsured Massachusetts residents dropped to 5.4%-5.7% in fall 2007, depending on the methodology used.[40] Approximately 3% of taxpayers were determined by the Commonwealth to have access to affordable insurance but paid an income tax penalty instead. Approximately 2% were determined not to have access to affordable insurance, and a small number opted for a religious exemption to the mandate.[41] As of June 30, 2008, the estimated number of uninsured had dropped to 2.6%.[41] Comparing the first half of 2007 to the first half of 2008, spending from the Health Safety Net Fund dropped 38% as more people became insured.[41] The Fund (which replaced the Uncompensated Care Pool or Free Care) pays for medically necessary health care for those who do not have access to health insurance, and the underinsured.[42]

In February 2008 the Boston Globe reported that Commonwealth Care covered 169,000 people and had a projected cost of $618 million for the fiscal year. By June 2011 enrollment is projected to grow to 342,000 people at an annual expense of $1.35 billion. The original projections were for the program to ultimately cover approximately 215,000 people at a cost of $725 million.[43] Enrollment in the Commonwealth Care Health Insurance Program reached approximately 170,000 by April 1 of 2008. Enrollment in the Commonwealth Choice Plans, offered through the Commonwealth Health Insurance Connector, was almost 18,000 by the same date. Enrollment in the Commonwealth's Medicaid program, MassHealth, was up by 50,000 by January 2008. Data from the Massachusetts Association of Health plans suggest that enrollment in employer-sponsored health insurance was up by 85,000, but the number of people with individual coverage increased by less than 10,000.[44]

Ambox outdated serious.svg
 This article may need to be updated. Please update this article to reflect recent events or newly available information, and remove this template when finished. Please see the talk page for more information.

In March 2008 the Boston Globe reported that some "safety-net" hospitals serving low-income individuals in urban areas were facing budget shortfalls due to the combination of reduced "free-care" payments from the state and low enrollment in Commonwealth Care. The reduced state payments anticipated that by reducing the number of uninsured people Commonwealth Care would reduce the amount of charity care provided by hospitals.[45] In a subsequent story that same month the Globe reported that Commonwealth Care faced a short-term funding gap of $100 million and the need to obtain a new three-year funding commitment from the federal government of $1.5 billion. The Globe reported that a number of alternatives were under consideration for raising additional funding, including a $1 per pack increase in the state's cigarette tax. Health care costs in the state were rising at an annual rate of 10 percent, and the state budget deficit was $1.3 billion.[46]

In April 2008, a preliminary study analyzing the impact of Massachusetts approach to health financing reform, insurance mandates, on the rate of new business starts was completed.[47] The study found that new business starts were reduced in Massachusetts by 16%, and that this reduction included displacement of new firm starts across the state line into New Hampshire. In addition, the study found some evidence that this effect did not vary based on the size of the firm, but may have had a more negative effect on new businesses owned by women. The study's author suggested that were this approach to become a model of national health finance reform, that it would have an especially profound impact on physically small states such as those in New England where jurisdictional arbitrage is potentially a practical consideration for entrepreneurs.

Massachusetts' problem of overcrowded waiting rooms and overworked primary-care physicians (who were already in short supply) has been exacerbated by the influx of patients now covered.One criticism of the program is that it has done nothing to realign incentives for MDs to provide primary care.[48].[49]

As of September 2009, Massachusetts has the lowest number of non-insured residents at 4.1%.[citation needed]

Possible legal challenges

A legal challenge to the law may arise under the presumption that it is an attempt to preempt the federal Employee Retirement Income Security Act (ERISA).[50] A somewhat similar law with respect to employer spending on health insurance in Maryland was struck down by a federal judge on July 19, 2006.[50] The law in question had required employers with more than 10,000 employees to spend no less than 8% of their payroll on health insurance benefits.[50] The ruling effectively delineated that states cannot interfere in the administration of employer provided benefits to their employees and such interference was a violation of federal law.[50] However, some policy analysts argue that the Massachusetts reform differs in that it does not mandate business to change coverage, but rather, simply imposes a tax – one of the states' rights guaranteed by the 10th amendment of the United States Constitution.[51]

Challenges can also be mounted for a violation of the 14th Amendment[52] requirement for "due process" prior to a deprivation of property as well as for a violation of Article 12[53] of the Massachusetts Bill of Rights which requires that one be formally charged for any offense against the law. Another possible challenge would be for a violation of the 13th Amendment prohibition against "involuntary servitude"[54]. A person works to earn money to satisfy his "needs", "wants" and "desires". If he is then compelled to use his after tax money to satisfy the "needs", "wants" and "desires" of the government, at that point the government has more say in the use of his property then he does. At that point, he is arguably nothing but a slave.

Legal challenges

A legal challenge, Fountas v. Dormitzer Docket No. 2008-121, was filed in Essex Superior Court contesting the fine imposed for a failure to get health insurance as well as the fine imposed for a failure to provide information on a tax return as to whether one has health insurance. Both fines are detailed within MGL CH 111M Section 2 [55]

The method of collecting the fines was contested as a Bill of Attainder[56] as the fines are collected through the income tax return without any charges ever being filed and the law does not provide for a trial in a court of law to determine guilt. Bills of Attainder are prohibited to the states by Article 1 Section 10 of the US Constitution[57]

The method of collection, though the income tax return, was also contested as a violation of separation of powers, as only the judicial branch has the power to determine guilt or innocence and the punishment for guilt. Separation of powers in enforced by Article 30 of the Massachusetts Bill of Rights [58]

The fine for a failure to provide information was further contested as contrary to the right to remain silent as protected by the 5th Amendment and Article 14 of the Massachusetts Bill of Rights. The fine for a failure to provide information was listed as such a compelling. The 5th Amendment extends to proceeding involving "fines, penalties and forfeitures" [59] as such are "criminal proceedings" within the meaning of the 5th Amendment [60]. The right to remain silent as protected by the Massachusetts Bill of Rights does not include a limiting "incrimination" clause as does the 5th Amendment and extends to civil cases. Article 14 states "No subject shall .... be compelled to accuse, or furnish evidence against himself."

Both fines for the 2007 tax year were the forfeiture of the personal tax exemption, worth about $220, and the fines for that year were contested as a breach of the Massachusetts Constitutional requirement for "proportional taxation". By taking the personal tax exemption away from some but not all taxpayers, the tax code becomes non-proportional. Massachusetts is a flat tax state, and a number of Constitutional amendments allowed a graduated income tax have been repeatedly rejected by Massachusetts voters.

In addition, both fines were challenged by contesting the health insurance mandate as a "taking without compensation". The taking being of the "owners right to spend his money" resulting in the effective seizure of that money. If the government forces you, though the use of fines, to use your property (money) for a purpose you do not desire but which the government does, then the government has "for all practical purposes" taken your property and deprived you of the use of your money. The Massachusetts Constitution specifically states that money is property. [61]

Both fines were further challenged as "cruel and unusual". One because it was a fine for the legal exercise of the Constitutionally protected "right to remain silent", and the other because it was a fine for "being frugal". Article 18 of the Massachusetts Bil of Rights[62] states that the constant adherence to the principle of "frugality" within the laws of the Commonwealth is "absolutely necessary to preserve the advantages of liberty, and to maintain a free government." The observance of a principle that is "absolutely necessary to preserve the advantages of liberty, and to maintain a free government" simply cannot be the subject of fines and any law that authorizes fines for such action is contrary to that principle. Article 18 further gives the inhabitants the "right to require" that this principle be observed in the laws of the Commonwealth. [63]

Despite the fact that the case was a dispute over property, the fines themselves, and also the money one is forced to be used to pay for health insurance, and the fact that the plaintiff had chosen trial by jury as the means of dispute resolution, Judge Kathe M. Tuttman dismissed the case upon a Motion filed by Assistant Attorney General Amy Spector. A petition for a Writ of Mandamus, Docket No SJ-2009-0098, to the Massachusetts Supreme Court, ordering Essex Superior Court to vacate this dismissal on procedural grounds, the failure to provide trail by jury in a dispute over property as requested by the plaintiff, was denied. The right to trial by jury in a dispute over property is protected by the 7th Amendment to the US Constitution, Article 15 of the Massachusetts Bill of Rights[64], as well as Mass. Rules of Civil Procedure 38 and 39[65]. An Appeal was then filed with the Massachusetts Appeal Court and was given Docket No. 2009-P-0526. A later petition for a Writ of Mandamus, Docket No. SJ-2009-0146, with the Massachusetts Supreme Court, ordering the Appeals Court to vacate the dismissal on procedural grounds, as above, and to return the case to Essex Superior Court for trial by jury, was also denied.[66]

See also

References

  1. ^ Commonwealth Care Program Guide. Accessed October 6, 2009.
  2. ^ Lazar, Kay (August 20, 2008). "439,000 more get health coverage". Boston Globe: pp. 1. http://www.boston.com/news/local/articles/2008/08/20/439000_more_get_health_coverage/. Retrieved 2008-08-20. 
  3. ^ LeBlank, Steve; (Associated Press) (November 9, 2007). "Timing of health care law's penalties could pose risks for Romney". Boston Globe. http://www.boston.com/news/nation/articles/2007/11/09/timing_of_health_care_laws_penalties_could_pose_risks_for_romney/\. Retrieved 2007-11-18. 
  4. ^ Rainey, James (November 13, 2007). "Romney casts a cool eye on a former triumph". Los Angeles Times. http://www.latimes.com/features/health/la-na-romney13nov13,1,4228006,full.story. Retrieved 2007-11-18. 
  5. ^ "Find Insurance: Individuals & Families: Act Now". Commonwealth Health Insurance Connector. http://www.mahealthconnector.org/portal/site/connector/template.PAGE/menuitem.55b6e23ac6627f40dbef6f47d7468a0c/?javax.portlet.tpst=ab2ef98d75886742e902ac100ce08041&javax.portlet.prp_ab2ef98d75886742e902ac100ce08041_viewID=MY_PORTAL_VIEW&javax.portlet.begCacheTok=com.vignette.cachetoken&javax.portlet.endCacheTok=com.vignette.cachetoken. Retrieved 2007-11-15. 
  6. ^ Dembner, Alice (November 15, 2007). "Insurance deadlines – Nov. 20 and Dec. 31". Boston Globe. http://www.boston.com/news/health/blog/2007/11/insurance_deadl.html?p1=MEWell_Pos3. Retrieved 2007-11-18. 
  7. ^ For text of the laws, provided by The General Court of The Commonwealth of Massachusetts
    and subsequent amendments and technical corrections bills enacted in the same legislative session:
  8. ^ Massachusetts Division of Health Care Finance and Policy, June 2008
  9. ^ U.S. Census Bureau, August 2007
  10. ^ In Massachusetts, Health Care for All?
  11. ^ . American College of Emergency Physicians Survey of Emergency Department Directors, April 2006. http://www.acep.org/WorkArea/downloadasset.aspx?id=33266/. Retrieved 2009-07-21. 
  12. ^ Boston Public Health Commission - How To Access Health Care - Massachusetts Uncompensate (Free) Care Pool
  13. ^ NPR: Romney's Mission: Massachusetts Health Care
  14. ^ Uncompensated Care Pool PFY05 Utilization Report
  15. ^ The Wall Street Journal Online - Featured Article
  16. ^ Roadmap to Coverage - Research on providing health coverage for the uninsured in Massachusetts
  17. ^ ACT Health Care Reform Timeline
  18. ^ Health Care Reform in Massachusetts
  19. ^ http://news.yahoo.com/s/ap/massachusetts_health;_ylt=AkMg0NHWbbPPMpo5ese19mKs0NUE;_ylu=X3oDMTA2Z2szazkxBHNlYwN0bQ--
  20. ^ House approves healthcare overhaul - The Boston Globe
  21. ^ [1][dead link]
  22. ^ North Adams Transcript - Romney signs health care bill
  23. ^ http://news.bostonherald.com/localPolitics/view.bg?articleid=134877
  24. ^ See chapter 58 text for overrides. Chapter 58, Acts of 2006: The six prompt overrides were noted at the foot of the chapter: Approved (in part) April 12, 2006. Disapproved sections 5, 27, 29, 47, 112, 113, 134 and 137
    'Sections 5, 29, 47, 113, 134 and 137 overridden on May 4, 2006.
  25. ^ a b 2006 Mass. Acts Chp. 58
  26. ^ a b c d e Report from Massachusetts Secretary of Health and Human Services Timothy Murphy, to the Massachusetts General Court, "Chapter 58 Implementation Update" (June 12, 2006).
  27. ^ a b c d Massachusetts General Court, Committee on Health Care Financing, "Health Care FAQ" (April 4, 2006) PDF
  28. ^ Mitt Romney, "Health Care for Everyone?" Wall Street Journal (April 11, 2006)
  29. ^ Administration and Finance
  30. ^ a b 2006 Mass. Act Chp. 58, sec. 47
  31. ^ 2006 Mass. Acts Chp. 58, sec. 44
  32. ^ 2006 Mass. Acts Chp. 58, sec. 12
  33. ^ Health Care for All "Massachusetts's Health Care Reform Law Fact Sheet" PDF
  34. ^ http://bluecrossfoundation.org/foundationroot/en_US/documents/MassHCReformLawSummary.pdf
  35. ^ Press Release on waiver approval, July 28, 2006
  36. ^ Press Release on Fair Share regulations, September 8, 2006
  37. ^ Health Care For All's Commonwealth Care page
  38. ^ Press release on minimum creditable coverage plans, March 3, 2007
  39. ^ Dembner, Alice. Outline for new insurance plan proposed Boston Globe. January 19, 2007. Retrieved January 19, 2007.
  40. ^ http://www.mass.gov/Eeohhs2/docs/dhcfp/r/pubs/08/est_of_uninsur_rate.pdf
  41. ^ a b c http://www.mahealthconnector.org/portal/binary/com.epicentric.contentmanagement.servlet.ContentDeliveryServlet/About%2520Us/News%2520and%2520Updates/Current/Week%2520Beginning%2520March%25209%252C%25202008/Facts%2520and%2520Figures%25203%252008.doc
  42. ^ http://www.massresources.org/pages.cfm?contentID=50&pageID=13&Subpages=yes
  43. ^ Alice Dembner, "Subsidized care plan's cost to double: Enrollment is outstripping state's estimate," The Boston Globe, February 3, 2008
  44. ^ "Massachusetts Health Care Reform: Two Years Later," Kaiser Family Foundation, May 2008
  45. ^ Jeffrey Krasner, "Safety net hospitals strained by reform," The Boston Globe, March 18, 2008
  46. ^ Alice Dembner, "Healthcare cost increases dominate Mass. budget debate," The Boston Globe, March 26, 2008
  47. ^ Jackson, Scott [2] "Mulling Over Massachusetts: Health Insurance Mandates and Entrepreneurs"
  48. ^ Moore, Pamela "Voting for Healthcare Reform"|journal=Physicians Practice|volume=18|number=7|pages=26-40|year=2008|accessdate=2009-01-07
  49. ^ "Overcrowded ERs Lead To Deadly Mistakes", WBZ TV (website), 11-26-2008
  50. ^ a b c d USA Today July 19, 2006: Walmart Healthcare Litigation
  51. ^ Butler, Patricia. "Fact Sheet: ERISA Implications for State Pay or Play Laws." California HealthCare Foundation. [3]
  52. ^ http://www.usconstitution.net/const.html nor shall any State deprive any person of life, liberty, or property, without due process of law
  53. ^ http://www.mass.gov/legis/const.htm Article XII. No subject shall be held to answer for any crimes or offence, until the same is fully and plainly, substantially and formally, described to him; or be compelled to accuse, or furnish evidence against himself. And every subject shall have a right to produce all proofs, that may be favorable to him; to meet the witnesses against him face to face, and to be fully heard in his defence by himself, or his council at his election. And no subject shall be arrested, imprisoned, despoiled, or deprived of his property, immunities, or privileges, put out of the protection of the law, exiled, or deprived of his life, liberty, or estate, but by the judgment of his peers, or the law of the land.
  54. ^ http://www.usconstitution.net/const.html Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction.
  55. ^ http://www.mass.gov/legis/laws/mgl/111m-2.htm
  56. ^ http://www.techlawjournal.com/glossary/legal/attainder.htm A bill of attainder was a legislative act that singled out one or more persons and imposed punishment on them, without benefit of trial. William H. Rehnquist
  57. ^ No state shall enter into any treaty, alliance, or confederation; grant letters of marque and reprisal; coin money; emit bills of credit; make anything but gold and silver coin a tender in payment of debts; pass any bill of attainder, ex post facto law, or law impairing the obligation of contracts, or grant any title of nobility.
  58. ^ http://www.mass.gov/legis/const.htm Article XXX. In the government of this commonwealth, the legislative department shall never exercise the executive and judicial powers, or either of them: the executive shall never exercise the legislative and judicial powers, or either of them: the judicial shall never exercise the legislative and executive powers, or either of them: to the end it may be a government of laws and not of men.
  59. ^ Counselman v Hitchcock http://supreme.justia.com/us/142/547/case.html It is an ancient principle of the law of evidence that a witness shall not be compelled, in any proceeding, to make disclosures or to give testimony which will tend to criminate him or subject him to fines, penalties, or forfeitures.
  60. ^ Boyd v US http://supreme.justia.com/us/116/616/case.html A proceeding to forfeit a person's goods for an offence against the laws, though civil in form, and whether in rem or in personam, is a "criminal case" within the meaning of that part of the Fifth Amendment which declares that no person "shall be compelled, in any criminal case, to be a witness against himself."
  61. ^ Chapter II, Section IV. Secretary, Treasurer, Commissary, etc. And that the citizens of this commonwealth may be assured, from time to time, that the moneys remaining in the public treasury, upon the settlement and liquidation of the public accounts, are their property,
  62. ^ http://www.mass.gov/legis/const.htm A frequent recurrence to the fundamental principles of the constitution, and a constant adherence to those of piety, justice, moderation, temperance, industry, and frugality, are absolutely necessary to preserve the advantages of liberty, and to maintain a free government. The people ought, consequently, to have a particular attention to all those principles, in the choice of their officers and representatives: and they have a right to require of their lawgivers and magistrates, an exact and constant observance of them, in the formation and execution of the laws necessary for the good administration of the commonwealth.
  63. ^ Massachusetts Bill of Rights Article XVIII. A frequent recurrence to the fundamental principles of the constitution, and a constant adherence to those of piety, justice, moderation, temperance, industry, and frugality, are absolutely necessary to preserve the advantages of liberty, and to maintain a free government. The people ought, consequently, to have a particular attention to all those principles, in the choice of their officers and representatives: and they have a right to require of their lawgivers and magistrates, an exact and constant observance of them, in the formation and execution of the laws necessary for the good administration of the commonwealth.
  64. ^ Article XV. In all controversies concerning property, and in all suits between two or more persons, except in cases in which it has heretofore been otherways used and practiced, the parties have a right to a trial by jury; and this method of procedure shall be held sacred, unless, in causes arising on the high seas, and such as relate to mariners' wages, the legislature shall hereafter find it necessary to alter it.
  65. ^ http://www.lawlib.state.ma.us/source/mass/rules/civil/index.html
  66. ^ http://www.ma-appellatecourts.org/search_party.php?pln=fountas&pfn=&dfy=&dsc=&ddt=&dtp=&sort=&get=Search

External links

Further reading


This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)

Search unanswered questions...

Enter a question here...
Search: All sources Community Q&A Reference topics

 
 

 

Copyrights:

Wikipedia. This article is licensed under the Creative Commons Attribution/Share-Alike License. It uses material from the Wikipedia article "Massachusetts health care reform".  Read more