UMass Medical School helps usher in next phase of health care reform

By Tom Lyons

UMass Medical School Communications

September 30, 2013

On Oct. 1, millions of Americans will begin a journey that residents of Massachusetts have been on for the last seven years. But the opening of health insurance marketplaces, also known as exchanges, is just the start of an important period that will continue through 2014 with the full implementation of the Affordable Care Act (ACA).

Although health reform in Massachusetts served as the model for much of the ACA, the federal law still provides many important benefits to the Bay State, according to Jay Himmelstein, MD, MPH, professor of family medicine & community health and chief health policy strategist for UMass Medical School’s Center for Health Policy and Research. He is also a senior advisor to the School’s Office of Health Policy and Technology.

“We’ve already seen important changes brought on by the ACA, such as allowing young adults to stay on their parents’ coverage until age 26, or covering important preventive services without co-pays,” said Dr. Himmelstein. “In 2014, the ACA is really going to help Massachusetts maintain and expand its leadership on health insurance access and coverage.”

Himmelstein and a team from the Office of Health Policy and Technology have been deeply involved in a partnership to build a new health insurance marketplace for Massachusetts. Working with MassHealth, the Medicaid program for Massachusetts, and the Massachusetts Health Connector, the UMMS team is helping design a new gateway through which residents will shop for health insurance and access many of the ACA’s benefits.

In addition to helping the Health Connector update its current marketplace to make it compatible with the ACA, over time the new system will also modernize and streamline the MassHealth eligibility process by allowing residents to determine their eligibility and apply for Medicaid benefits online – a process that is currently paper-based.

For coverage beginning in January 2014, the ACA provides new federal assistance to make coverage more affordable for middle-income families. Through the new marketplace, the law will extend health insurance subsidies to those with incomes from 300 percent up to 400 percent of the federal poverty level (approximately $46,000 for an individual). And many low-income employees who cannot afford their employer’s coverage will become newly eligible for MassHealth. The law also provides tax credits for some small businesses to make it more affordable to cover their employees.

While the October launch of health insurance marketplaces across the country has been the subject of much attention in the press and politically, Himmelstein said that it should be viewed as the “beginning of the next phase of the Affordable Care Act . . . where people will get to learn what these new [insurance[ options mean. The experience may differ from state to state, but I expect that over time we will see a major growth in coverage and better health care for all citizens of the United States.”