ANSWERS to "A Quiz on Health Reform" by Nancy Turnbull

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(OK readers - here's a view of the law no one else has packaged for you. Are there surprises? What stands out? Martha)

If You Build It, Will They Come?

Which health plan has the most Commonwealth Care members?

Answer: Boston Medical Center HealthNet Plan

What percent of the people who have enrolled in Commonwealth Care so far are required to pay a premium?

Answer: 17%

• What percent of the estimated number of uninsured people with incomes less the poverty level have enrolled in Commonwealth Care?

Answer: Based on most recent public data I can find, enrolled = 64,000; eligible = ~57,000: 112%

• How much funding for health reform outreach and enrollment is included in the FY08 budget?

Answer: $3.5 million explicitly in the budget (and much more if you count what will be spent for MassHealth outreach and by the Connector).

• How many other states have passed comprehensive health coverage reform laws since Chapter 58 was enacted in April 2006?

Answer: One--Vermont

Shared Responsibility

• How much in total Medicaid rate increases are providers scheduled to receive in fiscal years 2007-2009 under the provisions of Chapter 58?

Answer: $540 million (plus community health centers received increases in the annual budgets for FY07 and FY08)

• How much money does that state estimate it will collect in FY 2007 from employers that did not make a “fair and reasonable” contribution to health insurance?

Answer: $0

• If every adult who was uninsured in Massachusetts when Chapter 58 was enacted were to become insured year-round, at a monthly premium of $175 per month, approximately how much additional revenue would health insurers receive annually?

Answer: Somewhere between $688 million and $1.1 billion

Low: Using the 2006 state survey: 328,000 adults $175 times 12 = $688.8 million

High: Using 2006 CDC estimate: 524,000 times $175 times 12 = $1.1 billion

• If every person who is eligible for Commonwealth Care were to enroll, approximately how much money will be left in the Health Safety Net Trust Fund?

Answer: Not very much (the exact amount will depend on the number of eligibles and the rate of premium increase for Commonwealth Care).

• Why is June 30, 2008 a critical date for Massachusetts health reform?

Answer: It’s the date the state’s federal 1115 demonstration waiver expires. Much of the financing for reform comes through this waiver and the state needs continuing financial support from the federal government to sustain coverage expansions.

Coverage and Costs

• Suppose you are a resident of Boston (who’s older than 26), you aren’t eligible for employer-sponsored health insurance, Medicaid or Commonwealth Care, and you’re looking for health insurance to comply with the individual mandate. If you consider only products sold by four health insurers (Blue Cross Blue Shield, Harvard Pilgrim, Neighborhood Health Plan and Tufts Health Plan), how many different products would you need to review to ensure that you’ve exercised fully your newly-granted right of greater choice?

Answer: More than 70 products :

If you look to buy through the Connector: 20 products (5 per health insurer)

If you go directly to the health insurers: More than 50 products

• If you live in Boston and get a job working for the Commonwealth of Massachusetts, how many different health insurance options will you have?

Answer: 7 or 8 (whether you are eligible for one of the products offered by Fallon Community Health Plan through the Group Insurance Commission will depend on where specifically you live).

• What’s the approximate average monthly premium contribution in dollars paid by a worker in Massachusetts who has employer-based health insurance?

Answer: The median contribution for an individual policy is $80 according to the most recent state employer survey by DHCFP.

• What’s the lowest monthly premium available to a 27-year-old hospital worker in Massachusetts who lives in Boston and buys a Commonwealth Choice product?

Answer: $162 per month

• Assume this person is not eligible for Medicaid, Commonwealth Care or employer-sponsored insurance, and does have to comply with the individual mandate. If there is no increase in Commonwealth Choice premiums in 2008, what penalty will this person have to pay if he or she does not purchase insurance in 2008?

Answer: One half of the premium for each month without insurance= One half of $162= $81 times 12 = $972

• What would the penalty be for this person if he or she were 60-years old instead of 27?

Answer: The lowest premium available for a 60-year-old is $324 per month. So, unless the state decides to deal with this issue differently through its regulations, or there is a statutory change, the penalty would be twice as great: Half of $324 times 12 = $1,944


• What is the annual permissible limit on covered medical expenses in a Young Adult Policy?

Answer: $50,000

• Suppose you are a young adult living in Boston who purchases the least expensive Young Adult plan sold through the Connector. You have a bad car accident and incur hospital costs of $70,000. How much more will your out-of pocket expenses be than if you had purchased the most comprehensive policy available to you?

Answer: At least $17,600 and likely more.

Cheapest Young Adult Plan is $122 per month, or $1464 per year.

Out of pocket expenses from accident: $2,000 deductible, plus 20% coinsurance for next $62,500 of hospital bill ($12,500) plus amounts beyond the $50,000 annual maximum. Total costs of hospitalization =$20,000.
Plus you will have exhausted your coverage and have no benefits for any follow-up care (like physical therapy, medications, etc)
Cheapest Gold plan is $316 per month or $3,792. No deductible, no benefit limits and limited copayments.

Who Said It?

• “I don’t like calling it [the Massachusetts reform law] universal coverage. That smacks of Hillarycare.” Mitt Romney
• “Half-jokingly” refers to insurers as ‘sleazeballs and bloodsuckers’." Celia Wcislo
• “My status symbol is my brown felt hat from Botswana.” Jon Kingsdale
• “Section 125 is not sexy.” Jon Gruber
• “The real measure of success is not just access to health insurance. It’s not even access to health care. What we want is improved health.” Gov. Patrick

Not Just Health Coverage

• How many state entities were affected or created by Chapter 58?

Answer: 19

• Name three specific goals proposed for FY 2008 by the Health Care Quality and Cost Council.

Ensure Patient Safety and Effectiveness of Care:
• Reduce hospital-associated infections (HAI) during FY08. Eliminate hospital-associated infections by 2012.
• Eliminate “Never Events” as defined by the National Quality Forum. Eliminate events that should never happen in hospitals, such as wrong surgery, wrong site, or wrong patient.
Improve screening for and management of chronic illnesses in the community:
• Improve chronic and preventive care. Improve care of chronic diseases, such as congestive heart failure, diabetes and asthma.
• Reduce disease complication rates, readmission rates and avoidable hospitalizations.
Develop and provide useful measurements of health care quality in areas of health care for which current data are inadequate:
• Develop processes and measures to improve adherence to patients’ wishes in providing care at the end of life.
Ensure that health care providers ask about and follow patients’ wishes with respect to invasive treatments, do not resuscitate orders, hospice and palliative care, and other treatments at the end of life.
Eliminate racial and ethnic disparities in health and in access to and utilization of health care; health indicators will be consistent and consistently improving across all racial and ethnic groups:
• Reduce disparities in health care-associated infections.
• Eliminate disparities in “Never Events.”
• Reduce, and ultimately eliminate, disparities in disease complication rates, readmission rates, and avoidable hospitalizations.
• Reduce disparities in screening and management of chronic illnesses.
Promote quality improvement through transparency:
• Promote quality improvement through development of a website and other materials providing comparative quality information.

• What company is coordinating the statewide infection prevention and control program?

Answer: JSI, or John Snow, Inc.

What was the overall Massachusetts ranking in the recent Commonwealth Fund “State Scorecard on Health Systems Performance”?

Answer: Number 8

Extra credit: Where did Massachusetts rank on “Avoidable Hospital Use and Costs”?

Answer: Number 35

Pot Pourri

• Name 5 of the top 20 employers in Massachusetts that have 50 or more employees using public health assistance programs.



• Approximately what percent of non-US citizens living in Massachusetts have no health insurance?

Answer: Depending on which estimate you use, somewhere between 20-26%.

• Which Red Sox players are featured in the Connector’s “I’ve Got It” TV ad?


None. The people in the Red Sox uniforms are Red Sox ambassadors not Red Sox players.

• Name two of the tag lines in the health reform advertising series “Because…”


Because a sore throat doesn’t ask to see an insurance card

Because diabetes doesn’t ask how old you are.

Because a broken arm can happen when you’re between jobs

Because every body should have a physical every year.

Because a mammogram wasn’t invented for just certain women.

Because ignoring a problem has never made it go away.

• What WBUR Commonhealth blog entry has generated the most reader comments?


At the time the quiz was written: Elmer Freeman’s April 21, 2007 post: “Sanjaya Sings”, which had 33 comments.

As of this writing, it’s Barbara Andersons’ July 10 post, “Does the Health Care Law Impose an Unconstitutional Tax?’

Nancy Turnbull
Harvard School of Public Health

This program aired on August 17, 2007. The audio for this program is not available.