Massachusetts health care reform 4860610 217298183 2008-06-05T12:57:58Z Dolph Yehudi 1375285 '''Massachusetts health care reform''' law was enacted in 2006, and requires nearly every resident of [[Massachusetts]] to obtain or purchase [[Health insurance in the United States|health insurance]] coverage. Through the law, Massachusetts provides nearly free health care for residents earning less than the [[Poverty threshold|federal poverty line]], and subsidized access to health care for those earning up to three times the poverty threshold. As of the end of 2007, the law is credited with covering an additional 336,000 Massachusetts residents.<ref>[http://www.mass.gov/Eeohhs2/docs/dhcfp/r/pubs/08/key_indicators_0608.pdf]</ref> The law established a new quasi-public regulatory authority, the ''Commonwealth Health Insurance Connector Authority'' which offers the subsidized coverage and facilitates the selection and purchase of private insurance plans by individuals and small businesses.<ref name='Boston-Globe-AP-LeBlank-2007-11-09'> {{cite news | first= Steve | last= LeBlank | coauthors= (Associated Press) | title= Timing of health care law's penalties could pose risks for Romney | date= November 9, 2007 | publisher= | url = http://www.boston.com/news/nation/articles/2007/11/09/timing_of_health_care_laws_penalties_could_pose_risks_for_romney/\ | work = Boston Globe | pages = | accessdate = 2007-11-18 }} </ref><ref name='LATimes-Rainey-2007-11-18'> {{cite news | first= James | last= Rainey | coauthors= | title= Romney casts a cool eye on a former triumph | date= November 13, 2007 | publisher= | url = http://www.latimes.com/features/health/la-na-romney13nov13,1,4228006,full.story | work = Los Angeles Times | pages = | accessdate = 2007-11-18 }} </ref> Incentives for residents to obtain health insurance coverage include penalties for failing to obtain an insurance plan, of $219, for 2007, the amount of an individual's Massachusetts annual income tax personal tax exemption; in 2008, penalties increase by monthly increments, and can be up to half of the cost of an individual's health insurance plan.<ref name = 'CHIC-penalties'> {{cite web | last = | first = | authorlink = | coauthors = | title = Find Insurance: Individuals & Families: Act Now | work = Commonwealth Health Insurance Connector | publisher = | date = | url = http://www.mahealthconnector.org/portal/site/connector/template.PAGE/menuitem.55b6e23ac6627f40dbef6f47d7468a0c/?javax.portlet.tpst=ab2ef98d75886742e902ac100ce08041&javax.portlet.prp_ab2ef98d75886742e902ac100ce08041_viewID=MY_PORTAL_VIEW&javax.portlet.begCacheTok=com.vignette.cachetoken&javax.portlet.endCacheTok=com.vignette.cachetoken | format = | doi = | accessdate = 2007-11-15 }} </ref><ref name='Boston-Globe-Dembner-2007-11-15'> {{cite news | first= Alice | last= Dembner | coauthors= | title= Insurance deadlines – Nov. 20 and Dec. 31 | date= November 15, 2007 | publisher= | url = http://www.boston.com/news/health/blog/2007/11/insurance_deadl.html?p1=MEWell_Pos3 | work = Boston Globe | pages = | accessdate = 2007-11-18 }} </ref> The law reform was enacted as Chapter 58 of the Acts of 2006 of the Massachusetts Legislature, entitled: ''An Act Providing Access to Affordable, Quality, Accountable Health Care.'' In October, 2006, January, 2007, and November 2007, bills were enacted that amended and made technical corrections to the statute (Chapters 324 and 450 of the Acts of 2006, and chapter 205 of the Acts of 2007).<ref name='2006 Massachusetts Health Reform Law Texts'> For text of the laws, provided by ''The General Court of The Commonwealth of Massachusetts'' <br> * [http://www.mass.gov/legis/summary.pdf Summary of the Massachusetts Health Reform Law]. * [http://www.mass.gov/legis/laws/seslaw06/sl060058.htm Chapter 58 of the Chapter 58 of the Acts of 2006] An Act Providing Access to Affordable, Quality Accountable Health Care :and subsequent amendments and technical corrections bills enacted in the same legislative session: * [http://www.mass.gov/legis/laws/seslaw06/sl060324.htm Chapter 324 of the Acts of 2006] An Act Relative to Health Care Access. * [http://www.mass.gov/legis/laws/seslaw06/sl060450.htm Chapter 450 of the Acts of 2006 ] An Act Further Regulating Health Care Access. * [http://mass.gov/legis/laws/seslaw07/sl070205.htm Chapter 205 of the Acts of 2007] An Act Further Regulating Health Care Access. </ref> ==Background== As of March 2006, there were around 497,900 uninsured residents of Massachusetts.{{Fact|date=November 2007}} Some of those low income residents and non-residents who are uninsured commonly utilize [[emergency rooms]] as a source of [[primary care]] because of their lack of [[insurance]] coverage.<ref>[http://www.businessweek.com/investor/content/apr2006/pi20060404_152510.htm In Massachusetts, Health Care for All?<!-- Bot generated title -->]</ref> Massachusetts [[hospitals]] are required to provide care even if a patient cannot pay for it regardless of residency status.<ref>[http://www.bphc.org/howto/ins_mucp.asp Boston Public Health Commission - How To Access Health Care - Massachusetts Uncompensate (Free) Care Pool<!-- Bot generated title -->]</ref> As a result, hospitals have been left with unpaid bills and mounting expenses to care for the uninsured.<ref>[http://www.npr.org/templates/story/story.php?storyId=5330854 NPR: Romney's Mission: Massachusetts Health Care<!-- Bot generated title -->]</ref> In Massachusetts, an approximately $600 million fund known as the [[Uncompensated Care Pool]] (or "free care pool") is used to partially reimburse hospitals and health centers for these expenses and the expenses of non-residents. The fund is raised through an annual assessment on insurance providers and hospitals, plus contributions of state and federal tax revenue. MIT professor [[Jonathan Gruber]] studied the state's population and health care needs and determined that there was enough money in the "free care pool" to pay for reform legislation without requiring additional funding or taxes.<ref>[http://www.opinionjournal.com/editorial/feature.html?id=110008213 The Wall Street Journal Online - Featured Article<!-- Bot generated title -->]</ref> == Reform coalitions == In November 2004, political leaders began advocating for major reforms of the Massachusetts health care system to expand coverage. First, the Senate President [[Robert Travaglini]] called for a plan to reduce the number of uninsured by half. A few days later, the Governor, [[Mitt Romney]], announced that he would propose a plan to cover virtually all of the uninsured. At the same time, a broad coalition of health activists introduced a bill that expanded [[Masshealth|MassHealth]] ([[Medicaid]]) coverage, increased health coverage subsidy programs and required employers to either provide coverage or pay an assessment to the state. The coalition stated they would gather signatures to place their proposal on the ballot in November 2006 if the legislature did not enact comprehensive health access reform. The Blue Cross Blue Shield Foundation also sponsored a study, "Roadmap to Coverage," that set out a number of methods to expand coverage to everyone in the Commonwealth.<ref>[http://www.roadmaptocoverage.org Roadmap to Coverage - Research on providing health coverage for the uninsured in Massachusetts<!-- Bot generated title -->]</ref> The state also faced pressure from the federal government, which insisted that changes be made to the federal waiver that allows Massachusetts to operate an expanded Medicaid program. Under the existing waiver, the state was receiving $385 million in federal funds to assist health plans operated for the uninsured by two public hospital systems. The federal authorities directed the state to shift those funds to insurance coverage. == Legislation == These political forces converged in fall 2005 as the House and Senate passed health reform bills that drew on proposals of the Governor, the activist coalition, and legislative initiatives. The legislature made a number of changes to Governor Romney's original proposal, including expanding MassHealth (Medicaid) coverage to low-income children and restoring funding for [[public health]] programs. The most controversial change was adding a provision charging firms with 11 or more workers that do not provide "fair and reasonable" health coverage to their workers. The charge, initially $295 annually per worker, is intended to equalize the free care pool charges imposed on employers who do and do not cover their workers. The legislature also rejected Governor Romney's proposal to permit even higher-[[deductible]], lower benefit health plans.{{Fact|date=February 2007}} On [[April 12]], [[2006]] Governor [[Mitt Romney]] signed the health legislation.<ref>http://news.yahoo.com/s/ap/massachusetts_health;_ylt=AkMg0NHWbbPPMpo5ese19mKs0NUE;_ylu=X3oDMTA2Z2szazkxBHNlYwN0bQ--</ref> He vetoed 8 sections of the health care legislation, including the employer assessment.<ref>[http://www.boston.com/news/local/massachusetts/articles/2005/11/04/house_approves_healthcare_overhaul/ House approves healthcare overhaul - The Boston Globe<!-- Bot generated title -->]</ref> <ref>[http://today.reuters.co.uk/news/newsArticle.aspx?type=healthNews&storyID=2006-04-12T222644Z_01_N12342304_RTRIDST_0_HEALTH-MASSACHUSETTS-DC.XML&archived=False]{{Dead link|date=March 2008}}</ref> Romney also vetoed provisions providing [[Dental insurance|dental]] benefits to poor residents on the Medicaid program, and providing health coverage to senior and disabled legal [[immigrant]]s not eligible for federal Medicaid.<ref>[http://www.thetranscript.com/headlines/ci_3706699 North Adams Transcript - Romney signs health care bill<!-- Bot generated title -->]</ref><ref> http://news.bostonherald.com/localPolitics/view.bg?articleid=134877 </ref> The legislature promptly overrode six of eight gubernatorial section vetoes, on [[May 4]], [[2006]], and by mid-June 2006 had overridden the remaining two.<ref name= 'Chapter 58-Veto Override'> See chapter 58 text for overrides. [http://www.mass.gov/legis/laws/seslaw06/sl060058.htm Chapter 58, Acts of 2006]: The six prompt overrides were noted at the foot of the chapter: Approved (in part) April 12, 2006. Disapproved sections 5, 27, 29, 47, 112, 113, 134 and 137 <br> 'Sections 5, 29, 47, 113, 134 and 137 overridden on May 4, 2006. </ref> ==Statute== The enacted statute, chapter 58 of the acts of 2006, established a system to mandate individuals, with a few exceptions, purchase or obtain health insurance through either a private or public insurance plan.<ref name="chapter58">2006 Mass. Acts Chp. 58</ref> Chapter 58 has several key provisions: the creation of the Commonwealth Health Insurance Connector Authority; the establishment of the subsidized Commonwealth Care Health Insurance Program; the employer Fair Share Contribution; and a requirement that each individual must show evidence of coverage on their income tax return or face a tax penalty, unless coverage was deemed unaffordable.<ref name="chapter58" /> The statute also expands MassHealth (Medicaid and [[State Children's Health Insurance Program|SCHIP]]) coverage for children of low income parents and restores MassHealth benefits like dental care and eyeglasses. A merger of the individual (non-group) insurance market into the small group market will allow individuals to get lower group insurance rates. Payment rates are increased to hospitals and physicians, and a new "Quality and Cost Council," will issue quality standards and publicize provider performance.<ref name="implementation update">Report from Massachusetts Secretary of Health and Human Services Timothy Murphy, to the Massachusetts General Court, "Chapter 58 Implementation Update" (June 12, 2006).</ref> Chapter 58 also sets up a Disparities Council, funds automated prescription ordering in hospitals, and implements changes to the public health council, state insurance laws, mandated benefit requirements, and other health-related programs. The following are the most prominent features. On October 26, 2006, the Commonwealth enacted chapter 324 of the acts of 2006, legislation making adjustments and technical corrections to chapter 58. The statute contains 82 sections and includes sections amending effective dates for many of the private insurance provisions of chapter 58. Another technical corrections bill, chapter 450 of the acts of 2006, was enacted on January 3, 2007. The statute includes more adjustments to effective dates. A third technical corrections statute was enacted on November 29, 2007, as chapter 205 of the acts of 2007. ===Commonwealth Health Insurance Connector Authority=== The [http://mahealthconnector.org Connector] is designed as a clearinghouse for insurance plans and payments. It performs the following functions: *It runs the Commonwealth Care program for low-income residents (up to 300% of the poverty level) who do not qualify for [[MassHealth]].<ref name="healthcarefaq" /> *It offers for purchase health insurance plans for individuals who: **are not working **are employed by a small business (less than 50 employees) that uses the Connector to offer health insurance. These residents will purchase insurance with pre-tax income.<ref>[http://www.opinionjournal.com/editorial/feature.html?id=110008213 Mitt Romney, "Health Care for Everyone?" ''Wall Street Journal'' (April 11, 2006)]</ref> **are not qualified under their large employer plan **are self-employed, part-time workers, or work for multiple employers *It sets premium subsidy levels for Commonwealth Care. *It defines "affordability" for purposes of the individual mandate The Connector is run by the Commonwealth Health Insurance Connector Authority, an independent agency with a 10-member board. The Connector will make health insurance portable by allowing employees to keep the same plan even if they leave an employer. The Connector will also allow employees to aggregate the contributions of multiple employers, e.g. if they are part-time workers or work for multiple employers, and apply them to one insurance plan.<ref name="healthcarefaq" /> The Connector is currently managed by former Tufts Associated Health Plans executive Jon Kingsdale, who serves as its executive director.<ref>[http://www.mass.gov/eoaf/pressreleases/new_healthcare_director.html Administration and Finance<!-- Bot generated title -->]</ref> On October 28, 2006, the Connector Authority Board held its annual meeting, a day-long retreat to plan its actions through 2007. At the meeting, CEO Jon Kingsdale distributed a schedule of major activities.<ref>[http://blog.hcfama.org/?p=621 Health Care For All blog report, (October 29, 2006)]</ref> ===Commonwealth Care Health Insurance Program=== [http://macommonwealthcare.com Commonwealth Care] is one of the newest subsidized health insurance programs offered by the [[Massachusetts|Commonwealth]], and is a key part of Health Care Reform in Massachusetts. It is designed primarily for income-eligible Massachusetts adult residents who are not otherwise eligible for [[Masshealth]], who either do not work or who work for employers that do not offer health insurance. Specifically, it allows eligible residents access to certain subsidized private insurance health plans -- currently a [http://www.mass.gov/Qhic/docs/CCplanchart_030107.pdf choice of four plans] -- for individuals without health insurance who make below 300% of the [[Poverty in the United States#Recent poverty rate and guidelines | federal poverty level]]. <ref name="implementation update" /> There are no deductibles. For individuals below 150% of the federal poverty level, no premiums will be charged; for those below the poverty level, dental insurance is also provided. For those above 150% of the federal poverty level, a sliding scale premium schedule based on income is used to determine the amount of money a person contributes to their policy.<ref name="implementation update" /> Commonwealth Care for those below poverty has been available through the Connector since October 1, 2006. Plans for those between 100% and 300% of the poverty line have been available since January 1, 2007. As of Dec. 1, 2007, over 158,000 people have enrolled in Commonwealth Care. ===Employer Taxes=== Employers with more than ten employees must provide a "fair and reasonable contribution" to the premium of health insurance for employees.<ref name="sec47">2006 Mass. Act Chp. 58, sec. 47</ref> Employers who do not will be assessed an annual fair share contribution that will not exceed $295 per employee per year.<ref name="sec47" /> The fair share contribution will be paid into the Commonwealth Care Trust Fund to fund Commonwealth Care and other health reform programs.<ref name="implementation update" /> The Division of Health Care Finance and Policy defined by regulation what contribution level meets the "fair and reasonable" test in the statute. The regulation imposes two tests. First, employers are deemed to have offered "fair and reasonable" coverage if at least 25% of their full-time workers are enrolled in the firm's health plan. Alternatively, a company meets the standard if it offers to pay at least 33% of the premium cost of an individual health plan. There is an additional Free Rider Surcharge that can be assessed to the employer.<ref name="sec44">2006 Mass. Acts Chp. 58, sec. 44</ref> This surcharge is different from the fair share contribution. The surcharge is applied when an employer does not arrange for a pre-tax payroll deduction system for health insurance, and has employees who receive care that is paid from the [[uncompensated care pool]], renamed in October 2007 as the Health Safety Net.<ref name="healthcarefaq"> [http://www.hcfama.org/_uploads/documents/live/HCReformFAQ.pdf Massachusetts General Court, Committee on Health Care Financing, "Health Care FAQ" (April 4, 2006) PDF]</ref> If an employee receives free care more than three times or all of an employer's employees use free care a total of five times, then the employer must pay a portion of the health care costs.<ref name="healthcarefaq" /> ===Individual taxes=== {{update}} Residents of Massachusetts must have health insurance coverage under Chapter 58.<ref name="section12">2006 Mass. Acts Chp. 58, sec. 12</ref> Residents must indicate on their tax forms for the 2007 tax year if they had insurance on December 31 2007, have a waiver for religious reasons, or have a waiver from the Connector. The Connector waiver can be obtained if the resident demonstrates that there is no available coverage that is defined by the Connector as affordable.<ref name="implementation update" /> By June 2007, the Connector is scheduled to issue its affordability schedule that will allow residents to seek a waiver. If a resident does not have coverage and does not have a waiver, the Department of Revenue will enforce the insurance requirement by imposing a penalty. In 2007, the penalty will be the loss of the personal exemption. Beginning on January 1 2008, the penalty will be up to half the cost of the lowest available yearly premium which will be enforced as an assessed addition to the individual's income tax.<ref name="actfactsheet">[http://www.hcfama.org/_uploads/documents/live/MA%20Health%20Reform%20Law.pdf Health Care for All "Massachusetts's Health Care Reform Law Fact Sheet" PDF]</ref> ===Young Adult Coverage=== Starting January 1, 2007, insurers' family coverage plans are required to cover young adults up to age 25 for up to two years past the young adult's loss of dependent status. Beginning in July 2007, the Connector offers reduced benefit plans for young adults up to age 26 who do not have access to employer-based coverage. ==Implementation== {{update}} The implementation of chapter 58 began in June, 2006, with the appointment of members of the Connector board, and the naming of Jon Kingsdale, a Tufts Health Plan official, as executive director of the Connector. The Board started meeting biweekly. On July 1, MassHealth began covering dental care and other benefits, and began enrolling children between 200% and 300% of the poverty level. The federal [[Centers for Medicare and Medicaid Services]] approved the state's waiver application on July 26, 2006, allowing the state to begin enrolling 10,500 from the waitlist for the MassHealth Essential program, which provides Medicaid coverage to long-term unemployed adults below the poverty line.<ref>[http://www.mass.gov/?pageID=pressreleases&agId=Agov2&prModName=gov2pressrelease&prFile=gov_pr_060726_fed_approved_HC_.xml Press Release on waiver approval, July 28, 2006]</ref> In September, 2006, the Division of Health Care Finance and Policy issued regulations defining "fair and reasonable" for the fair share assessment. The regulations provide that companies with 11 or more full-time equivalent employees will meet the “fair and reasonable” test if at least 25 percent of those employees are enrolled in that firm’s health plan and the company is making a contribution toward it. A business that fails that test may still be deemed to offer a “fair and reasonable” contribution if the company offers to pay at least 33 percent of an individual’s health insurance premium.<ref>[http://mass.gov/?pageID=pressreleases&agId=Eeohhs2&prModName=eohhspressrelease&prFile=pr_060908_fair_share.xml Press Release on Fair Share regulations, September 8, 2006]</ref> Also in September, the Connector Board set premium levels and co-payments for the state subsidized Commonwealth Care plans. Premiums will vary from $18 per month, for individuals with incomes 100%-150% of the poverty line, to $106 per month for individuals with incomes 250%-300% of poverty. The Connector approved two co-payment schemes for plans for people 200%-300% of poverty. One plan will have higher premiums and lower co-payments, while a second choice will have lower premiums and higher co-payments.<ref>[http://www.hcfama.org/index.cfm?fuseaction=Page.viewPage&pageID=587 Health Care For All's Commonwealth Care page]</ref> Four managed care plans began offering Commonwealth Care for people up to the poverty line on November, 1, 2006. Coverage for people above 100% of poverty up to 300% of poverty began on February 1, 2007. As of December 1, 2007, around 158,000 people were enrolled in Commonwealth Care plans. Initial bids received by the Connector showed a likely cost for the minimum insurance plan of about $380 per month. The Connector rejected those bids, and asked insurers to propose less expensive plans. New bids were announced on March 3, 2007. The Governor announced that "the average uninsured Massachusetts resident will be able to purchase health insurance for $175 per month."<ref>[http://hcfama.org/_uploads/documents/live/HealthInsurancePressRelease.pdf Press release on minimum creditable coverage plans, March 3, 2007]</ref> But plan costs will vary greatly depending on the plan selected, age and geographic location, ranging from just over $100 per month for plans for young adults with high copayments and deductibles to nearly $900 per month for comprehensive plans for older adults with low deductibles and copayments. Co-payments, deductibles and out-of-pocket contributions may vary among plans. The proposed minimum creditable coverage plan would have a deductible no higher than $2,000 per individual, $4,000 per family, and would limit out-of-pocket expenses to a $5,000 maximum for an individual and $7,500 for a family. Before the deductible applies, the proposed plan includes preventive office visits with higher co-payments, but would not include emergency room visits if the person was not admitted.<ref> Dembner, Alice. [http://www.boston.com/news/globe/city_region/breaking_news/2007/01/outline_for_new_1.html Outline for new insurance plan proposed] Boston Globe. January 19, 2007. Retrieved January 19, 2007.</ref> In February of 2008 the Boston Globe reported that Commonwealth Care covered 169,000 people and had a projected cost of $618 million for the fiscal year. By June of 2011 enrollment was projected to grow to 342,000 people at an annual expense of $1.35 billion. The original projections were for the program to ultimately approximately 215,000 people at a cost of $725 million.<ref>Alice Dembner, [http://www.boston.com/news/health/articles/2008/02/03/subsidized_care_plans_cost_to_double/ "Subsidized care plan's cost to double: Enrollment is outstripping state's estimate,"] The Boston Globe, February 3, 2008</ref> Enrollment in the Commonwealth Care Health Insurance Program reached approximately 170,000 by April 1 of 2008. Enrollment in the Commonwealth Choice Plans, offered through the Commonwealth Health Insurance Connector, was almost 18,000 by the same date. Enrollment in the Commonwealth's Medicare program, MassHealth, was up by 50,000 by January of 2008. Data from the Massachusetts Association of Health plans suggest that enrollment in employer-sponsored health insurance was up by 85,000, but the number of people with individual coverage increased by less than 10,000.<ref>[http://www.kff.org/uninsured/upload/7777.pdf "Massachusetts Health Care Reform: Two Years Later,"] [[Kaiser Family Foundation]], May 2008</ref> In March of 2008 the [[The Boston Globe|Boston Globe]] reported that some "safety-net" hospitals serving low-income individuals in urban areas were facing budget shortfalls due to the combination of reduced "free-care" payments from the state and low enrollment in Commonwealth Care. The reduced state payments anticipated that by reducing the number of uninsured people Commonwealth Care would reduce the amount of charity care provided by hospitals.<ref>Jeffrey Krasner, [http://www.boston.com/business/healthcare/articles/2008/03/18/safety_net_hospitals_strained_by_reform/ "Safety net hospitals strained by reform,"] [[The Boston Globe]], March 18, 2008</ref> In a subsequent story that same month the Globe reported that Commonwealth Care faced a short-term funding gap of $100 million and the need to obtain a new three-year funding commitment from the federal government of $1.5 billion. The Globe reported that a number of alternatives were under consideration for raising additional funding, including a $1 per pack increase in the state's cigarette tax. Health care costs in the state were rising at an annual rate of 10 percent, and the state budget deficit was $1.3 billion.<ref>Alice Dembner, [http://www.boston.com/news/local/articles/2008/03/26/healthcare_cost_increases_dominate_mass_budget_debate/?page=full "Healthcare cost increases dominate Mass. budget debate,"] [[The Boston Globe]], March 26, 2008</ref> ==Possible legal challenges== A legal challenge to the law may arise under the presumption that it is an attempt to preempt the federal [[Employee Retirement Income Security Act]] (ERISA).<ref name='USA Today-2006-07-16' >[http://www.usatoday.com/money/industries/retail/2006-07-19-walmart-healthcare_x.htm USA Today July 19, 2006: Walmart Healthcare Litigation]</ref> A somewhat similar law with respect to employer spending on health insurance in Maryland was struck down by a federal judge on July 19, 2006.<ref name='USA Today-2006-07-16' >[http://www.usatoday.com/money/industries/retail/2006-07-19-walmart-healthcare_x.htm USA Today July 19, 2006: Walmart Healthcare Litigation]</ref> The law in question had required employers with more than 10,000 employees to spend no less than 8% of their payroll on health insurance benefits.<ref name='USA Today-2006-07-16' /> The ruling effectively delineated that states cannot interfere in the administration of employer provided benefits to their employees and such interference was a violation of federal law.<ref name='USA Today-2006-07-16' /> However, some policy analysts argue that the Massachusetts reform differs in that it does not mandate business to change coverage, but rather, simply imposes a tax -- one of the states' rights guaranteed by the [[10th amendment]] of the Constitution.<ref>Butler, Patricia. "Fact Sheet: ERISA Implications for State Pay or Play Laws." California HealthCare Foundation. [http://64.233.169.104/search?q=cache:quk36Rm3KOkJ:calhealthreform.org/pdf/ERISAfactsheetButlerP.pdf+massachusetts+state+mandate+tax+ERISA&hl=en&ct=clnk&cd=2&gl=us]</ref> == See also == * [[Employee Retirement Income Security Act|Employee Retirement Income Security Act (ERISA)]] * [[Medicaid]] * [[Medicare (United States)]] * [[Massachusetts general election, 2006]] * [[California Speaks]] - Citizen discussion on similar legislation in California, 2007 * [[United States National Health Insurance Act]] == References == {{reflist|2}} == External links == * [http://www.mahealthconnector.org Commonwealth Health Insurance Connector Authority] Official web site. Describes the Massachusetts health reform act, authorized health insurance plans, regulations issued, board members and board minutes. * [http://hcfama.org/index.cfm?fuseaction=Page.viewPage&pageId=839&parentID=736&nodeID=2 Health Reform Timeline] Month-by-month chronology of the passage and implementation of the Massachusetts health reform law. * [http://usliberals.about.com/od/healthcare/i/MassHealthIns.htm About.com's Pros & Cons of Massachusetts' Mandatory Health Insurance Program] * [http://www.hcfama.org/act/about.asp Affordable Coverage Today] Health Care for All. (A health care advocacy group in Massachusetts) * [http://www.mass.gov/?pageID=eohhs2terminal&L=4&L0=Home&L1=Government&L2=Special+Commissions+and+Initiatives&L3=Healthcare+Reform&sid=Eeohhs2&b=terminalcontent&f=eohhs_healthcare_reform_rpts_legislature&csid=Eeohhs2 EOHHS Health Reform Reports to Massachusetts legislature] Bi-monthly progress reports on the implementation of Massachusetts health reform. * [http://www.bcbsmafoundation.org/foundationroot/en_US/documents/2006HealthReformPollingreport.pdf The Massachusetts Health Reform Law: Public Opinion and Perception] A Report for the Blue Cross Blue Shield of Massachusetts Foundation. November 2006. * [http://www.newamerica.net/files/MA%20HC%20Reform%20Lessons%20Learned%20to%20Date%20Aug%2007%20FINAL1.pdf Lessons learned to date from the Massachusetts Healthcare Reform] by Celia Wcislo (August 2007) (Celia Wcislo, is a Board Member of the Massachusetts Commonwealth Health Insurance Connector Authority) Publisher: Local 1199 Service Employees International Union (SEIU) United Healthcare Workers East. *[http://www.heritage.org/Press/Events/ev012606b.cfm Presentation by Governor Mitt Romney, January 26, 2006] Massachusetts Health Care Reform. The Heritage Foundation, Washington D.C. (Using Power Point visuals. Available as video, or audio MP3) *Bela Gorman, [http://www.soa.org/library/newsletters/health-watch-newsletter/2008/january/hsn-2008-iss57.pdf "Update on Massachusetts Health Care Financing Reform,"] Health Watch, Issue No. 57, [[Society of Actuaries]], January 2008 [[Category:Healthcare in the United States]] [[Category:Medicare and Medicaid (United States)]] [[Category:Government of Massachusetts]] [[Category:Health care reform]]