DOWNLOAD PRINTABLE VERSION: Detailed Bill Summary
Over fifty members of the House and Senate have sponsored landmark health legislation for the 2001 session. The bill, entitled "An Act Expanding Access to Health Care, Reducing Youth Smoking and the Use of Tobacco Products, and Improving the Public Health in the Commonwealth," has four main goals:
To provide affordable health care to a substantial portion of Massachusetts' residents living without health insurance through an expansion of MassHealth and other public initiatives aimed at uninsured low and middle-income workers and other residents.
To improve public health and address racial and ethnic disparities in health by increasing the support for community health outreach efforts
To reduce youth and adult tobacco use and improve the health of smokers, particularly in low income and minority communities, through tobacco pricing, smoking cessation programs and better access to health care
To stabilize and strengthen our health care delivery system
The bill is coordinated with similar bills being introduced in all of the New England states. A unique coalition, the Alliance for a Healthy New England, is leading efforts to enact legislation throughout the region. The Alliance, formed by the American Cancer Society, the New England Medical Societies and health activists led by Community Catalyst, will conduct an aggressive campaign for a 50-cent tobacco tax increase devoted to public health. The Massachusetts coalition includes over 50 organizations, including health care providers, insurers, consumer groups, labor unions and community organizations.
The bill includes the following provisions:
Tobacco Tax Increase (sec 1,4,17)- The bill raises the excise tax on cigarettes by 50 cents per pack, increasing the total Massachusetts tax rate to $1.26 per pack. The tax on smokeless tobacco is increased by 50% of the wholesale price, and the tax on cigars and loose smoking tobacco is increased by 30% of the wholesale price. The new taxes become effective on July 1, 2001. The tax increases will initially raise about $150 million annually, although the revenue will decline as smoking rates drop.
Tobacco tax increases are the most important method to reduce smoking rates, particularly among young people. The increases proposed in the bill will result in over 27 million fewer packs of cigarettes being sold in 2006, saving over 8000 lives from fatal smoking-related disease, and decrease youth smokers by 8.5%.
MassHealth Insurance Access Expansions (sec 9,10,15)- The bill authorizes a number of expansions to the MassHealth insurance program. The MassHealth program, funded by the Commonwealth and federal Medicaid matching funds, provides comprehensive health insurance to low and moderate income people. The groups made newly eligible for MassHealth by the bill are:
Parents of children currently eligible for benefits. The MassHealth expansions for children enacted in 1996 and 1997 reduced our child uninsurance rate to among the lowest nationally. However, many parents of covered children are not eligible for coverage. Research has shown that both parents and children are healthier when covered under similar plans. The bill allows parents in families up to twice the federal poverty level (about $29,260 for a family of three) to enroll in MassHealth with their children.
Low income workers without children. Individuals up to 133% of the poverty level ($11,425 annual income) are made eligible for coverage through MassHealth.
19 and 20-year olds. Current MassHealth coverage for children ends on a teen's 19th birthday. The bill allows 19 and 20 year-olds with incomes up to 200 percent of the federal povert level ($17,180 for an individual) to enroll in MassHealth.
Implementation of these expansions will require an amendment to the MassHealth waiver currently granted to the Commonwealth by the federal government. The bill includes a provision directing the administration to procure the needed federal approvals.
Adult Medical Security Plan (sec2, 6)- The bill establishes an Adult Medical Security Plan (AMSP), modeled after the highly successful Children's Medical Security Plan. The AMSP will provides basic primary and preventive coverage for adults ineligible for other health programs whose income is under 300% of the poverty level ($43,890 for a family of three). The program will be administered by the Department of Public Health, which will establish benefits and service limits. The program will not cover hospital care, and participants will need to use the Uncompensated Care Pool to cover hospitalization costs. Participation will be free for those under 200% of poverty; a monthly premium of $50 will be charged for individuals above that level.
Community Health Worker Outreach Program (sec 2,6)- The bill establishes an expansive community health worker outreach program to strengthen community-based education and health promotion activities. The program addresses the wide disparities in quality health care among racial and ethnic minorities in the Commonwealth. The DPH is directed to prepare a comprehensive outreach strategy focused on communities facing barriers to adequate health care. The plan must address the cultural, linguistic and logistical gaps between health care providers and these communities, aiming to increase enrollment in public programs and improve community health. Community organizations will be engaged to implement the plan, using community health workers certified by DPH. The bill also directs the Commonwealth to pursue federal funding for health workers, allowing these vital health workers to be integrated into the MassHealth program.
Supplemental state benefits for Medicare beneficiaries (sec11, 16)- The bill authorizes an expansion of state-funded MassHealth benefits for two groups of Medicare beneficiaries. A provision allows the Commonwealth to continue to provide supplemental benefits when disabled people who were receiving CommonHealth benefits qualify for Medicare. Another provision directs the Commonwealth to seek federal approval to use Medicaid funds for low-income people in the catastrophic prescription drug insurance program, scheduled to begin this spring. The benefits would go to persons up to 188% of the poverty level, and could (if federal permission is received) allow the federal government to pick up half of the cost of the subsidized prescription drug benefit, as well as other costs not covered by Medicare.
Hospital Uncompensated Care Pool Relief (sec 12)- The bill directs $50 million of existing federal payments to Massachusetts to the Children's and Seniors' Health Care Assistance Fund. This is the state fund that covers the health access expansions established in the 1996 health reform statute and strengthened by the Health Now! bill. These federal funds, which the Commonwealth receives in connection with the expenses of hospitals that disproportionately care for people with no health insurance, currently are placed in the General Fund. Allocating these reimbursements directly to health access programs will reduce the need to transfer funds from the Uncompensated Care Pool for this purpose. The Pool, which reimburses hospitals for caring for the uninsured, is expected to be in deficit if currently scheduled transfers are made in the next few years. This provision will strengthen the Pool's financial status and reduce pressure on our struggling hospital industry.
Provide smoking cessation assistance (sec 5, 6, 13)- The bill insures that smoking and tobacco use cessation treatment and information are provided by the Commonwealth's public health programs, including Medicaid, MassHealth, and the Children's and the Adult Medical Security Plans.
Tobacco Tax Collection Enforcement (sec 3,7, 18)- The bill includes provisions to prevent residents from evading the excise tax on tobacco products by purchasing cigarettes or other tobacco products from out-of-state mail order or internet dealers. The bill authorizes the Department of Public Health to ban the shipment of tobacco products directly to consumers. The provision would become effective once the constitutionality of a similar law enacted in New York is decided by the courts. Pending the outright ban, the bill directs the Department of Revenue (DOR) to collect the taxes due from Massachusetts residents who buy cigarettes from out-of-state sellers. A federal law authorizes states to receive copies of all invoices for sales to Massachusetts, which will allow the DOR to collect any taxes owed.
Continued Study of the Uninsured (sec 14)- The bill requires that the Division of Health Care Finance and Policy conduct comprehensive studies of the uninsured in the Commonwealth in 2002 and 2004.
Financing-The financing assumptions for Health Now! Massachusetts include an annual decline in tobacco revenues, an increase in Medicaid rates, and maintaining support for previous health care access and smoking prevention programs.