How the Health Care Law is Making a Difference for the People of Massachusetts

Because of the Affordable Care Act, the 96% of Massachusetts residents who have insurance have more choices and stronger coverage than ever before. And for the 4% of Massachusetts residents who don’t have insurance, or Massachusetts families and small businesses who buy their coverage but aren’t happy with it, a new day is just around the corner.

Soon, the new online Health Insurance Marketplace will provide families and small businesses who currently don’t have insurance, or are looking for a better deal, a new way to find health coverage that fits their needs and their budgets.  

Open enrollment in the Marketplace starts Oct 1, with coverage starting as soon as Jan 1, 2014.  But Massachusetts families and small business can visit HealthCare.gov right now to find the information they need prepare for open enrollment.

The health care law is already providing better options, better value, better health and a stronger Medicare program to the people of Massachusetts by:

Better Options


The Health Insurance Marketplace

Beginning Oct 1, the Health Insurance Marketplace will make it easy for Massachusetts residents to compare qualified health plans, get answers to questions, find out if they are eligible for lower costs for private insurance or health programs like Medicaid and the Children’s Health Insurance Program (CHIP), and enroll in health coverage. 

By the Numbers: Uninsured Massachusetts residents who are eligible for coverage through the Marketplace. 

  • 238,541 (4%) are uninsured and eligible
  • 181,265 (76%) have a full-time worker in the family
  • 102,045 (43%) are 19-34 years old
  • 145,006 (61%) are White
  • 24,922 (10%) are African American
  • 48,236 (20%) are Latino/Hispanic
  • 11,692 (5%) are Asian American or Pacific Islander
  • 147,015 (62%) are male

204,253 (86%) of Massachusetts’s uninsured and eligible population may qualify for lower costs on coverage in the Marketplace, including through Medicaid. 

Massachusetts has received $180,067,775 in grants for research, planning, information technology development, and implementation of its Health Insurance Marketplace. 

New coverage options for young adults

Under the health care law, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old. Thanks to this provision, over 3 million young people who would otherwise have been uninsured have gained coverage nationwide, including 21,000 young adults in Massachusetts.

Ending discrimination for pre-existing conditions

As many as 2,931,068 non-elderly Massachusetts residents have some type of pre-existing health condition, including 339,504 children.  Today, insurers can no longer deny coverage to children because of a pre-existing condition, like asthma or diabetes, under the health care law. And beginning in 2014, health insurers will no longer be able to charge more or deny coverage to anyone because of a pre-existing condition.  The health care law also established a temporary health insurance program for individuals who were denied health insurance coverage because of a pre-existing condition.  19 Massachusetts residents with pre-existing conditions have gained coverage through the Pre-Existing Condition Insurance Plan since the program began. 

Better Value


Providing better value for your premium dollar through the 80/20 Rule

Health insurance companies now have to spend at least 80 cents of your premium dollar on health care or improvements to care, or provide you a refund.  This means that 173,454 Massachusetts residents with private insurance coverage will benefit from $34,250,845 in refunds from insurance companies this year, for an average refund of $457 per family covered by a policy.

Scrutinizing unreasonable premium increases

In every State and for the first time under Federal law, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. Massachusetts has received $4,385,165 under the new law to help fight unreasonable premium increases.

Removing lifetime limits on health benefits

The law bans insurance companies from imposing lifetime dollar limits on health benefits – freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits. Already, 2,520,000 people in Massachusetts, including 975,000 women and 633,000 children, are free from worrying about lifetime limits on coverage. The law also restricts the use of annual limits and bans them completely in 2014.

Better Health


Covering preventive services with no deductible or co-pay

The health care law requires many insurance plans to provide coverage without cost sharing to enrollees for a variety of preventive health services, such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults.

In 2011 and 2012, 71 million Americans with private health insurance gained preventive service coverage with no cost-sharing, including 1,773,000 in Massachusetts. And for policies renewing on or after August 1, 2012, women can now get coverage without cost-sharing of even more preventive services they need.  Approximately 47 million women, including 1,212,350 in Massachusetts will now have guaranteed access to additional preventive services without cost-sharing.

Increasing support for community health centers

The health care law increases the funding available to community health centers nationwide. In Massachusetts, 36 health centers operate 295 sites, providing preventive and primary health care services to 615,708 people.  Health Center grantees in Massachusetts have received $133,177,171 under the health care law to support ongoing health center operations and to establish new health center sites, expand services, and/or support major capital improvement projects.

Community Health Centers in all 50 states have also received a total of $150 million in federal grants to help enroll uninsured Americans in the Health Insurance Marketplace, including $3,448,106 awarded to Massachusetts health centers. With these funds, Massachusetts health centers expect to hire 61 additional workers, who will assist 110,754 Massachusetts residents with enrollment into affordable health insurance coverage. 

Investing in the primary care workforce

As a result of historic investments through the health care law and the Recovery Act, the numbers of clinicians in the National Health Service Corps are at all-time highs with nearly 10,000 Corps clinicians providing care to more than 10.4 million people who live in rural, urban, and frontier communities.  The National Health Service Corps repays educational loans and provides scholarships to primary care physicians, dentists, nurse practitioners, physician assistants, behavioral health providers, and other primary care providers who practice in areas of the country that have too few health care professionals to serve the people who live there.  As of September 30, 2012, there were 288 Corps clinicians providing primary care services in Massachusetts, compared to 124 in 2008.

Preventing illness and promoting health

As of March 2012, Massachusetts had received $42,700,000 in grants from the Prevention and Public Health Fund created by the health care law. This new fund was created to support effective policies in Massachusetts, its communities, and nationwide so that all Americans can lead longer, more productive lives.

A Stronger Medicare Program


Making prescription drugs affordable for seniors

In Massachusetts, people with Medicare saved nearly $115 million on prescription drugs because of the Affordable Care Act.  In 2012 alone, 59,062 individuals in Massachusetts saved over $39 million, or an average of $667 per beneficiary.  In 2012, people with Medicare in the “donut hole” received a 50 percent discount on covered brand name drugs and 14 percent discount on generic drugs.  And thanks to the health care law, coverage for both brand name and generic drugs will continue to increase over time until the coverage gap is closed.  Nationally, over 6.6 million people with Medicare have saved over $7 billion on drugs since the law’s enactment.

Covering preventive services with no deductible or co-pay

With no deductibles or co-pays, cost is no longer a barrier for seniors and people with disabilities who want to stay healthy by detecting and treating health problems early. In 2012 alone, an estimated 34.1 million people benefited from Medicare’s coverage of preventive services with no cost-sharing.  In Massachusetts, 686,735 individuals with traditional Medicare used one or more free preventive service in 2012.

Protecting Medicare’s solvency

The health care law extends the life of the Medicare Trust Fund by ten years.  From 2010 to 2012, Medicare spending per beneficiary grew at 1.7 percent annually, substantially more slowly than the per capita rate of growth in the economy.  And the health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology. Over the last four years, the administration’s fraud enforcement efforts have recovered $14.9 billion from fraudsters.  For every dollar spent on health care-related fraud and abuse activities in the last three years the administration has returned $7.90.

 

Last updated: Aug. 1, 2013

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