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Q&A: Changes Ahead for Mass. Health Reform02:15

This article is more than 9 years old.

Starting in June, the quasi-state agency that oversees Massachusetts health reform will have a new leader. That agency is the Connector, which helps people without insurance sign up for coverage. To talk about what changes Massachusetts residents can expect, WBUR's health and science reporter, Sacha Pfeiffer, had this conversation with Morning Edition host Bob Oakes.

First, let's talk about why the Connector's current executive director, Jon Kingsdale, is leaving. He's headed the agency since it was created in 2006, right?

Right, and during that time the Connector has gotten more than 97 percent of all state residents insured. Its next big job is to integrate state health reform with the new national health reform law — and Kingsdale has said he thinks someone with fresh eyes and fresh energy would be better off tackling that tough work ahead.

What makes that work so tough, since the state already has health reform in place?

The way Kingsdale described it to me is that staying on was going to be like reenlisting. It's going to take several years to blend the state and federal plans, and that means reviewing all the reforms already in place in Massachusetts. Basically, Kingsdale just didn't want to commit to another tour of duty. He says somebody with a new perspective should have a turn.

And that somebody is Glen Shor, who now works on health care policy for Gov. Deval Patrick.

That's right.

So what will it take to get state health reform in line with national legislation? I ask because Massachusetts health reform was, in many ways, the model for the federal law. Are there that many differences to work out?

It's true the two laws are a lot alike. But even though the models are similar, the specifics are often different. Kingsdale has a great analogy. He says that while the other 49 states have to start from scratch doing health care reform — because, remember, only Massachusetts already has a health reform law — Massachusetts is basically doing a renovation.

What we're going to need to do in Massachusetts — it's like living in a building that you've built and rehabbing it while you're living there to federal specifications.

-- Jon Kingsdale, executive director, Commonwealth Health Insurance Connector Authority
So what are some of those rehabs the state has to do?

Kingsdale says there are about a half-dozen areas where Massachusetts will have to resolve major policy issues in its law that don't match the federal law. Then there will be hundreds of minor ones.

Can you give us an example of one of the major changes?

Sure. One good example is the penalty Massachusetts residents have to pay if they can afford health insurance but don't get it.

This is the annual fee people are charged if they have the means to buy insurance, but decide it's cheaper to pay the penalty than pay the premiums?


And that penalty started, I think, at about $200 a year?

Just about. It started at $219 a person in 2007. It goes up a little every year. Now it's at about $1,000 a year, depending on your income. But under federal law, that penalty would actually start much lower; it would be just $95 in 2014.

How is the state going to square that, since $95 is a lot less than $1,000?

It has a few options. Here's Kingsdale explaining one of them:

If we were to simply say, 'Okay, let's just defer to the federal penalty,' all of a sudden our penalties would drop from over $1,000 in 2013 to $95 in 2014 and then ramp up again in subsequent years.

-- Jon Kingsdale
And the other options?

Well, the state could decide to keep its higher penalty. Or it could come up with some kind of compromise. These are the kind of conflicts Massachusetts is going to have to resolve.

So does Kingsdale think Massachusetts has a harder or easier job than the other states?

He thinks that even though the state law will need some changes, Massachusetts actually has an edge.

I think politically it's going to be far more challenging in some other states that, frankly, don't see near-universal coverage as the top or even one of the top five priorities in their own state agenda.

— Jon Kingsdale
Kingsdale has hinted he wants to work for President Obama on national health reform. Is that a possibility?

Kingsdale told me that at this point he thinks it's unlikely he'll end up working for Mr. Obama. But he did say he's been talking to venture capitalists, academic deans, and both for-profit and non-profit consulting firms.

That doesn't narrow it down very much.

No, it doesn't. He's casting a wide net!

This program aired on April 29, 2010.

Sacha Pfeiffer Twitter Host, All Things Considered
Sacha Pfeiffer was formerly the host of WBUR's All Things Considered.


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