Would Romneycare Have Been Better?
November 15, 2013
Trick question right? Based upon President Obama’s statements made during his re-election campaign, the Affordable Care Act (ACA) was primarily modeled off the successful healthcare laws of Massachusetts while under the care of then Governor Romney. So will history repeat itself with the ACA?
Well, so far so good. According to Gillian Burdett, a freelance writer for the Examiner, “Prior to the law more than seven percent of Massachusetts residents lacked health insurance. According to the Blue Cross Blue Shield of Massachusetts Foundation’s 2011 five-year progress report on the Massachusetts reform, the percent of uninsured in the state has dropped to less than two percent. During the same period, the average rate of uninsured in the nation rose to more than 16 percent.”
If this truly is the case, then we should expect the same results from ACA. Let’s look to the rest of Burdett’s article for a breakdown of the similarities and differences:
- State-based exchanges – Both laws create exchange authorities charged with operating health insurance marketplaces. The exchanges are internet websites where residents may compare and purchase private insurance policies that meet minimum levels of coverage. The objective of these exchanges is to drive down premium costs by increasing competition, and provide policies with similar levels of coverage for ease of comparison. Both laws also require guarantee issue, meaning consumers cannot be denied coverage due to pre-existing health conditions.
- Subsidies for lower-income households – While the amount of individual subsides vary, and the income levels for eligibility differ, both laws provide financial assistance to lower-income households so that health insurance is affordable. Massachusetts subsidizes private health coverage for families and individuals with incomes up to 300 percent of the Federal Poverty Level (FPL). The ACA provides subsidies for those earning up to 400 percent of the FPL.
- The individual and business mandates – Both laws require that individuals who can afford insurance to purchase insurance or face a financial penalty. The Massachusetts law required businesses with more than 10 employees provide health benefits to their workers or pay a $295 per employee “Fair Share” contribution. This provision was repealed in July 2013 in anticipation of the ACA business mandate. Under the ACA, businesses with 50 or more full-time employees must offer health insurance or pay a $2,000 per employee penalty, which excludes the first 30 employees. The ACA business mandate takes effect January 1, 2015.
- Size and scope – The Massachusetts law applies to the 6.5 million residents of the commonwealth. The ACA covers more than 300 million people spread across 50 diverse states. Massachusetts began its reform with a rate of uninsured that was half that of the nation as a whole, and it was written to meet the unique needs of state residents. These differences led Governor Mitt Romney to oppose the ACA. While Romney’s health reform is working in Massachusetts, he believes one model cannot meet the needs of all 50 states. In addition, the ACA has a much broader scope in that it includes provisions to address healthcare provider shortages, increase wellness and nutrition programs, bolster community health centers, and adjust Medicaid and Medicare.
- Cost sharing for preventative services – The ACA requires insurance policies cover preventative services, such as cancer screenings, with no co-pays or deductibles. This provision is designed to promote wellness and diagnose disease in its earliest stages. The Massachusetts law allowed insurers to require co-pays for these services.
- Medicaid expansion – In Massachusetts, Medicaid was expanded for children, parents, pregnant women and the long-term unemployed. Under the ACA, states have the option of expanding the Medicaid program to all families and Individuals with incomes up to 138 percent* of the FPL. The District of Columbia and 25 states are currently planning to exercise this option.