Authored by HCFA Executive Director Amy Rosenthal & Mass Medical Society President Dr. Barbara Spivak

MASSACHUSETTS’ HEALTH CARE is the best in the nation, yet care is still out of reach for too many residents. From doctors visits to life-saving medications, too many people can’t access vital services when they need them. Fortunately, a proposal by the House is being considered now in the budget conference committee that would provide critical cost relief for these residents across the state.

Doctors and patients recognize the pressing need to make health care more accessible and more equitable. Physicians know far too well the consequences when their patients forgo follow-up care or treatments they are prescribed because they can’t afford them, and consumers often reach out for help finding coverage options they can afford. At a time of rising costs across the board, we must pursue more affordable coverage options for all residents of the Commonwealth.

That starts with making sure everyone can get and stay covered. As the state is now reviewing eligibility for MassHealth – the state’s Medicaid program – for the first time since the pandemic, there is a risk people will lose insurance coverage or land in a plan that is too expensive for them because their income is now too high to qualify for the state’s subsidized insurance program, ConnectorCare. It has never been more important to ensure there are affordable coverage options for people who learn they are no longer eligible for MassHealth to ease their transition and keep our best in the nation insurance coverage rates.

Accessing affordable health insurance is also a health equity issue. Despite our high coverage rates, more than 40 percent of residents report challenges affording care, and Black and Hispanic/Latinx residents are more likely to report challenges affording care than their white counterparts. One report found that 75 percent of Black adults and 68 percent of Hispanic/Latino adults in Massachusetts face challenges affording care compared with only 46 percent of white adults. The disparities are actually most stark for those above the ConnectorCare eligibility level because of the lack of affordable coverage options.

The two-year pilot program included in the House budget would address these challenges by expanding eligibility for ConnectorCare. Individuals and families earning up to 500 percent of the federal poverty level (approximately $73,000 a year for an individual) would become eligible for insurance with reduced premiums and minimal co-pays and deductibles under the pilot. It is estimated that 47,000 to 70,000 Massachusetts residents would be newly eligible for the more affordable coverage. Leveraging savings from enhanced federal subsidies means the pilot would not require any additional state funding.
The expansion would almost certainly help Debbie, who lives in Brookline, and cares for her husband with Alzheimer’s. She has been on MassHealth for several years but in the last year her husband’s Social Security income increased, and now, with the MassHealth coverage protections ending, she knows she will have to find coverage elsewhere. Unfortunately, Debbie’s income puts her just above the current eligibility for the state’s low-cost ConnectorCare program. Her remaining option is a plan that’s too expensive for her budget, costing more than $300 a month in premiums and with a $3,000 deductible. Debbie takes medications to manage arthritis, elevated cholesterol, and high blood pressure, and she’s worried about the cost of multiple co-pays adding up on a more expensive plan.

Arturo from Newton also experienced this challenge first-hand. The only health insurance plan he and his family of three could afford has a $4,000 deductible, which leaves them with burdensome out-of-pocket costs like a $150 co-pay for a doctor’s visit and a $260 co-pay for a blood test. These costs make Arturo worried about affording future care for his family.

Physicians in Massachusetts too often see patients like Debbie and Arturo sick with worry, and it has a detrimental impact on patients’ health. When patients cannot afford the care they need, they often delay or forgo that care, leading to adverse health outcomes that could be avoided should they have been able to access and afford the care they need.

For tens of thousands of Massachusetts residents, like Debbie and Arturo, the ConnectorCare expansion pilot would make an enormous difference in their lives, giving them access to plans with lower premiums and much lower cost-sharing so they wouldn’t have to worry about affording future care. We are close to this policy getting across the finish line and are hopeful the proposal will be included in the final conference budget to help make Massachusetts more affordable for these health care consumers.

Massachusetts has a history of coming together to tackle big challenges. This is a time for us to do so again to meet this moment and ensure everyone can afford access to coverage and the care they need.

Amy Rosenthal is executive director of Health Care For All. Dr. Barbara Spivak is president of the Massachusetts Medical Society.