Massachusetts Health Care Reform

Massachusetts leads the nation in the movement towards universal health care coverage with its landmark legislation, “An Act Providing Access to Affordable, Quality, Accountable Health Care,” which is aimed at providing affordable health care coverage to all residents. This law also restored adult dental benefits for adults on MassHealth. Yet despite the comprehensive nature of this new health care reform law, there are many unresolved issues within its provisions which could hinder the legislation from achieving its greatest potential. For this reason, monitoring the implementation of the Act has become a major priority for HLA.

HLA’s goal is to ensure that all Massachusetts residents enjoy the maximum benefits of the new health care reform law. Towards this end, HLA represents those residents who have been wrongfully denied access to the Commonwealth’s subsidized insurance products, Commonwealth Care or MassHealth, as well as residents who suffer from gaps in coverage that result in medical expenses. HLA also represents clients who are filing for financial hardship waivers to reduce their co-payments or premiums, and those seeking exemptions to the new law’s “Individual Mandate” due to extenuating circumstances. This work will become even more critical in the year ahead, when penalties for non-compliance with the Individual Mandate to purchase health insurance will increase substantially. Also, HLA was the first organization to successfully file litigation and resolve coverage disputes with state authorities.

In addition to individual client representation, HLA also works to identify systemic problems within the new law that need to be remedied. For example, even as HLA succeeds in getting the disadvantaged exempt from the Individual Mandate with no tax penalties, unaffordable employer sponsored insurance blocks these residents from accessing the Health Safety Net for medical treatment. HLA is using both its legal and advocacy expertise to address this problem. HLA testifies at hearings before the Commonwealth Connector and the Commonwealth’s Division of Health Care Finance and Policy to explain the impact of provisions on consumers and to suggest remedies. And as a member of the steering committee and executive board of the community coalition, Affordable Care Today (ACT!!), HLA also provides legal expertise to its members, which include community and religious organizations, labor unions, doctors, hospitals, community health centers, public health advocates, and consumers, regarding health care reform.

 

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Commonwealth Care should not be offered to every low-income worker who prefers state subsidized health care to an employer’s offer of group health insurance. Some low and moderate-income workers, however, do not choose to be uninsured. They simply cannot afford to enroll in employer-sponsored insurance. HLA filed an Amicus Brief on behalf of Health Care For All, which supports a legal issue raised by Legal Assistance Corporation of Central Massachusetts before the Massachusetts Appeals Court. This matter is now under review by the Massachusetts Supreme Judicial Court with oral arguments tentatively scheduled for December 2009.

Although the Legislature granted the Connector Authority the discretion to determine guidelines for Commonwealth Care eligibility, it carved out an exception under a waiver provision. Despite this, there are no forms or applications in place for low and moderate-income workers to apply for the waiver. The Connector Authority has a statutory duty to implement a waiver process.