Advocates push to expand state subsidized health plan

BOSTON — A proposal included in the $52.7 billion state budget, which was sent to Gov. Charlie Baker's desk on Monday, calls for a two-year pilot expanding eligibility for ConnectorCare, the state's subsidized health insurance program.

Under the plan, coverage would be offered to individuals and families earning up to 500% of the federal poverty level, or about $139,000 for a family of four. The current level is 300% of the poverty level.

The advocacy group Health Care for All said the move would make an additional 37,000 residents eligible for more affordable coverage.

"This would be a really critical support to those individuals and families," said Alex Sheff, the group's director of policy and government relations. "It would help tens of thousands of residents to afford the care that they need, which is often too far out of reach."

Massachusetts law requires people to have health coverage, and the state boasts one of the highest insurance coverage rates in the nation. But Sheff said studies have shown at least a quarter of residents have "unmet health care needs" due to high costs, and more than half face challenges affording care.

"We hear on our helpline daily from hard-working individuals and families who can't make ends meet and are forced to choose between paying rent and going to the doctor or picking up their prescription," Sheff said. "In many cases, these are people who fall just over that eligibility threshold."

He said the expansion targets middle-income individuals and households who make too much money to qualify for coverage from MassHealth, the state's Medicaid program, but are still struggling to afford the cost of private health plans.

The move would cost $140 million to $150 million over the two-year period, according to the advocacy group. But Sheff said the state has accrued savings from enhanced federal subsidies for health insurance provided during the pandemic, which will more than cover the cost of the pilot program.

"We believe this is the best way for the state to reinvest the money it is saving from those enhanced federal subsidies," Sheff said.

The move is backed by the Massachusetts Medical Society, which represents physicians. Dr. Theodore Calianos, the society's president, said the changes will "allow more of our patients to have high-quality insurance while reducing out-of-pocket costs at a time in which so many individuals and families need help."

"We believe that all people have the right to enjoy the highest attainable standard of health and health care and this program is a critical component toward ensuring that is a reality," he said.

The ConnectorCare Care program, which was created as part of the state's landmark 2006 health care law, offers low-premium plans with no deductible and limited cost-sharing to about 150,000 members.

If the proposed changes survive Baker's veto pen, it would be the largest expansion of state subsidized coverage since the implementation of the federal Affordable Care Act in 2014, advocates say.

But critics of the plan say it would create a "cliff" when the two-year pilot project expires, forcing the state either come up with funds to continue the subsidies or drop coverage for tens of thousands who received it as part of the expansion.

Josh Archambault, director of health care policy at the Pioneer Institute, said the move would be a "blank check" for the insurance industry and would "crowd out" employer-based coverage as more people migrate to state-subsidized plans.

The 2006 health care law signed by then-Gov. Mitt Romney included an "anti-crowd out" provision that prevented workers who were offered insurance by their private employers from accessing taxpayer subsidies. But that was eliminated as part of the ACA and changes to the state's health care law.

Archambault said expanding taxpayer health care subsidies would "add fuel to the fire" that will result in more private employers dropping coverage.

"Instead of dealing with why health insurance is so expensive across-the-board, they're going to put a Band-aid on it by having taxpayers fund a subset of the middle-class," he said. "We're just flooding taxpayer money, in an incredibly inefficient manner, without ensuring that we're getting better outcomes."

Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group's newspapers and websites. Email him at [email protected].