Mass. Residents Will See Little Change Under National Health Plan

The national health care bill passed by the House on Sunday night is modeled on Massachusetts' 2006 reforms — a fact that makes the architects of the state's law feel proud.

"The most striking thing at the end of the day is how much the new federal program resembles what was done in Massachusetts," said John McDonough, a former director for the advocacy group, Health Care for All, who also worked with the late Sen. Edward M. Kennedy on health care policy.

"There is absolutely no doubt Massachusetts was the overwhelming conceptual structure for this federal program," McDonough said.

Like Massachusetts' reforms, the federal proposal requires every resident to have health insurance and penalizes those who do not. It also prohibits insurance companies from rejecting patients based on pre-existing medical conditions.

Because of these similarities, most residents here will see little change in how they receive health insurance and treatment, said Stuart Altman, a professor of health policy at the Heller School at Brandeis University.

"Federal reform is more generous than what we’ve been able to do at the state level."-- Amy Whitcomb Slemmer, executive director of Health Care for All

"In spite of the rhetoric, this does not fundamentally change the health care delivery system and it will have minimal impact on most people in Massachusetts or the United States on how they get care," Altman said.

Beyond the individual experience, the state benefits from national legislation in several ways. Federal reform delivers more money to the state for health care. Most importantly, Massachusetts will receive $2 billion in Medicaid assistance over 10 years.

Until now, Massachusetts has needed to frequently go begging to the federal government, said Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority — the agency that oversees the state's mandated health insurance.

"We will not have to continue to go hat-in-hand to Washington every three years to get special permission from them for the matching federal support that we have for some of the programs that national health reform will begin to fund in 2014," Kingsdale said.

Under the federal plan, more low-income residents will qualify for insurance subsidies and the federal government will pay for health insurance for legal immigrants. The state currently does that on its own. And small businesses will get more tax breaks to offer coverage to employees.

That's because "federal reform is more generous than what we’ve been able to do at the state level," said Amy Whitcomb Slemmer, the executive director of Health Care for All. "Small businesses will qualify for a 35 percent rebate on the insurance premiums that they pay. We know that will make a tremendous difference."

Also, more than 80,000 senior citizens in Massachusetts will get help from the federal government to pay for prescription drugs, according to AARP.

"This is a huge victory for seniors," said Nora Super, AARP's director of federal government relations. "What happens in the doughnut hole is people have to pay premiums and get nothing in return after they reach a certain dollar limit."

That so-called doughnut hole, or prescription drugs coverage gap in Medicare Part D, will be eliminated by 2020.

The federal plan does have some drawbacks for certain Massachusetts residents.  About 8,600 residents who have expensive health care plans will see a 40 percent federal tax on them. These are mostly people in government or union jobs.

Also nearly 200,000 seniors will lose the extra benefits they currently get from Medicare Advantage because they'll have to switch to regular Medicare.

But overall, the national health reform bill means that Massachusetts is no longer running an "experiment" in universal coverage. The experiment has proven successful enough to become the national model for a system that will bring more funding for health care coverage in Massachusetts and across the country.