Thanks for posting this rather incredible story. Any time the nay-sayers take potshots at the ACA, the example of Massachusetts should be laid out front and center.
Minnesota could in theory do more or less the same thing if the MinnesotaCare program was stretched from 200% of poverty all the way up to 500%. However, this improvement has not gained traction in the legislature because it would call for higher taxes.
I am not sure how Massachusetts handled the needed taxes. As I remember back to Romneycare, Massachusetts had some transfer money from Medicaid....but one would think that this money would have run out by now.
Maybe Massachusetts just has a European-level tolerance for high taxes.
Thanks, Andrew, for this update. I live in Massachusetts, and though I am now over 65 and on standard Medicare with a Medigap (much more reliable and easy-to-use than the ACA here in Massachusetts), I did not know about the expansion of the ConnectorCare subsidies.
As you clearly state in your discussion, what ConnectorCare is is the reflection of a statewide program to give additional funds to the subsidized on-exchange plans to lower out-of-pocket costs and in some cases premiums, vs. those that would be available from Federal-law ACA funding alone. As you report, that additional state money will now be used for people with incomes up to 500% of the Federal Poverty Level who are eligible for on-exchange plans.
As you know, but other readers may not, people whose incomes are below 138% of the Federal Poverty Level (regardless of assets) are NOT eligible for subsidized on exchange plans, with this ineligibility extending to Massachusetts' ConnectorCare. They get ACA expanded Medicaid in Massachusetts, and, if they are 55 or older when they have that expanded Medicaid, that expanded Medicaid is subject to estate recovery. Further, as far as I can tell from reading through the state policy documents, what can be recovered is potentially all medical bills paid out. If a person had $800,000 in medical bills during a year with ACA expanded Medicaid, that amount can be recovered. (The person has no insurance -- they have precisely a loan for medical expenses.)
Now, there is some legislation proposed to stop this recovery -- by bringing Medicaid recovery in Massachusetts to the Federal Minimum required. After failing to pass last year, it was resubmitted this year, (https://malegislature.gov/Bills/193/SD259 ) and has gone before a committee. I know testimony has already occurred -- I am not sure the status of the bill -- the status seems to be out of date on the state website.
Hopefully the bill will get passed.
(For those unfamiliar with the issue, which exists in Massachusetts and a pile of other states, see Andrew's coverage and/or the Wikipedia article on Medicaid estate recovery.)
Because of this issue, where a generally fairly effective health-insurance system in Massachusetts, threatens to take hundreds of thousands or millions of dollars from people's estates should their income ever drop below 138% of the Federal Poverty Level, I have to disagree with Ms. Sprung and find that progressive government, engineered as a sloppy patchwork as it in the U.S., can often be a highly inconsistent and highly dangerous thing. (I hope that have it worked out better in Western Europe!)
Mass. gives "progressive government" the good name it deserves.
Thanks for posting this rather incredible story. Any time the nay-sayers take potshots at the ACA, the example of Massachusetts should be laid out front and center.
Minnesota could in theory do more or less the same thing if the MinnesotaCare program was stretched from 200% of poverty all the way up to 500%. However, this improvement has not gained traction in the legislature because it would call for higher taxes.
I am not sure how Massachusetts handled the needed taxes. As I remember back to Romneycare, Massachusetts had some transfer money from Medicaid....but one would think that this money would have run out by now.
Maybe Massachusetts just has a European-level tolerance for high taxes.
Thanks, Andrew, for this update. I live in Massachusetts, and though I am now over 65 and on standard Medicare with a Medigap (much more reliable and easy-to-use than the ACA here in Massachusetts), I did not know about the expansion of the ConnectorCare subsidies.
As you clearly state in your discussion, what ConnectorCare is is the reflection of a statewide program to give additional funds to the subsidized on-exchange plans to lower out-of-pocket costs and in some cases premiums, vs. those that would be available from Federal-law ACA funding alone. As you report, that additional state money will now be used for people with incomes up to 500% of the Federal Poverty Level who are eligible for on-exchange plans.
That's good.
However, my own hobby-horse issue (and one of your own: e.g. https://xpostfactoid.blogspot.com/2021/01/the-117th-congress-should-end-medicaid.html ) is Medicaid Estate Recovery when it is done, as it is STILL done, in Massachusetts, for people who have coverage at 55 and over under ACA's expanded Medicaid.
As you know, but other readers may not, people whose incomes are below 138% of the Federal Poverty Level (regardless of assets) are NOT eligible for subsidized on exchange plans, with this ineligibility extending to Massachusetts' ConnectorCare. They get ACA expanded Medicaid in Massachusetts, and, if they are 55 or older when they have that expanded Medicaid, that expanded Medicaid is subject to estate recovery. Further, as far as I can tell from reading through the state policy documents, what can be recovered is potentially all medical bills paid out. If a person had $800,000 in medical bills during a year with ACA expanded Medicaid, that amount can be recovered. (The person has no insurance -- they have precisely a loan for medical expenses.)
Now, there is some legislation proposed to stop this recovery -- by bringing Medicaid recovery in Massachusetts to the Federal Minimum required. After failing to pass last year, it was resubmitted this year, (https://malegislature.gov/Bills/193/SD259 ) and has gone before a committee. I know testimony has already occurred -- I am not sure the status of the bill -- the status seems to be out of date on the state website.
Hopefully the bill will get passed.
(For those unfamiliar with the issue, which exists in Massachusetts and a pile of other states, see Andrew's coverage and/or the Wikipedia article on Medicaid estate recovery.)
Because of this issue, where a generally fairly effective health-insurance system in Massachusetts, threatens to take hundreds of thousands or millions of dollars from people's estates should their income ever drop below 138% of the Federal Poverty Level, I have to disagree with Ms. Sprung and find that progressive government, engineered as a sloppy patchwork as it in the U.S., can often be a highly inconsistent and highly dangerous thing. (I hope that have it worked out better in Western Europe!)