Health Care Reform Lessons from Massachusetts

By Stephen Miller, CEBS Mar 17, 2011
Employers' experiences with the Massachusetts version of health care reform, which was signed into law by then-Gov. Mitt Romney in April 2006, provide lessons for those throughout the U.S. now confronting the mandates in the 2010 Patient Protection and Affordable Care Act (PPACA), according to Sandy Reynolds, executive vice president of Associated Industries of Massachusetts, an employer group.

Speaking at the Society for Human Resource Management's (SHRM) 2011 Employment Law & Legislative Conference in Washington, D.C., on March 14, Reynolds noted, "Our experience in Massachusetts has a bearing on what you can expect as the federal law goes forward."

Unexpected Outcomes

Among the unanticipated outcomes that Reynolds pointed to:

  • Compliance with "minimum creditable coverage,"Massachusetts' version of the federal "required essential benefits," contained a surprise: "Noncompliance was a bigger problem for international Fortune 500 employers in the state than for small and mid-sized firms," she observed. The locally based firms were more on top of the new requirements and adapted to them faster.

  • Regarding the "Health Connector"—the state-run insurance exchange that Massachusetts launched in October 2006—the expectation was that a substantial number of employers would stop offering insurance and pay the relatively modest penalty ($295 per employee per year, much lower than the federal law's $2,000 per employee penalty for companies with 50 or more full-time employees that don’t offer health benefits), leaving their workers to purchase subsidized coverage on the Connector. "That hasn't happened," Reynolds said. In 2006, 70 percent of the state's employers offered insurance; in 2009; that number had increased to 76 percent.

Another expected outcome had been that small employers would use the Connector to purchase group policies. "That hasn't happened either," Reynolds said. One reason: "Employers want to keep working with a broker who brings them options, explains the differences among policies and makes recommendations," she noted. "Employers have very strong relationships with their brokers" that they want to maintain, the Massachusetts' experience revealed.

"It's been hard for the Connector to compete with the private market," she added. A related point: Many workers whose employers don't provide group coverage—and who were expected to turn to the Connector—have coverage elsewhere such as through a spouse, or have a low income and are eligible for Medicaid.

Reynolds said the state was planning to revise its rules for the Connector, seeking to make it more user-friendly.

Educating Employees—and Themselves

Reynolds noted what she called "HR's critical role in implementation," remarking that the federal law is more complex, with greater regulatory burdens, than the version in effect in Massachusetts. So it's especially important that employers keep up-to-date on the "what, when and how of compliance." As new federal regulations are issued, "the devil will most assuredly be in the details," Reynolds noted, calling the 2,000-plus page PPACA "just an outline."

Another tip: Conduct plan document audits to see whether:

  • All required documents are in place.

  • Plan documents reflect what employers are required to be doing.

"Be aware of relying on plug-and-play documents provided by some payroll services," Reynolds advised, as they might not capture all aspects of the employer's plan.

As for communications with employees, Reynolds noted that there was much confusion in Massachusetts that needed to be addressed. "Go above and beyond in educating employees," she advised, making sure that they understand how their coverage will be changing and assuring them that their HR department is on top of matters and compliant with ​all requirements.

Having an Impact

"Things that are perfectly logical to many legislators and regulators are just as perfectly illogical and burdensome to a business owner and HR/benefits professional," she stated. In Massachusetts, HR and business groups made a difference in getting the state to revise and streamline some of the most onerous regulations, including those mandating how employers document each employee's coverage—burdens that remain in the federal law, Reynolds noted.

"Provide written comments as proposed regulations and other guidance are issued," she stressed, and "respond to SHRM's advocacy requests. Your collective voice can make a real difference in the outcomes."

Her key takeaway message: As the most significant federal requirements take hold, "Do not be a passive bystander—stay involved; 2014 isn't as far away as it might seem."

Stephen Miller, CEBS, is an online editor/manager for SHRM.

Quick Links:

SHRM Online Benefits Discipline

SHRM OnlineHealth Care Reform Resource Page


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