Massachusetts Health Exchange

Massachusetts Health Exchange
Many American citizens have encountered problems and challenges with a
health issue, especially due to uncontrolled health care practices, as
well as health insurance provision. Millions of Americans have survived
without health insurance due to the difficulties in obtaining affordable
health insurance policies. The administration of president Obama
developed a bill that aimed at covering the medical issue of most
Americans to ensure that the people were given a chance to enjoy
affordable care, without discrimination of any category. Further,
patients have been subjected to merciless and exploitative insurance
companies, which charge prohibitive insurance premiums, but fail to
honor the requirements of the healthcare cover in the event that the
patients require medical cover. Such instances of fraud by health
insurance companies were rampant in most states in the US (Neumann &
Chambers, 2012). With respect to these issues, most Americans were left
at the mercies of the preventable and treatable ailments, which claimed
their lives because they could not afford a medical cover for their
medical expenses. Something had to be done to ensure that American
citizens and patients were protected and granted affordable health care
insurance. The patient protection and affordable care act was developed
under the influence of the huge numbers of Americans who were suffering
from exploitation, as well as ailments due to lack of affordable
healthcare services. It is imperative to note that, in the event that
people realize that they cannot afford healthcare services, such people
never seek medical help or consult medical personnel for health related
complication. These people struggle with their diseases until such at
the time that they succumb to their suffering and die.
President Obama gave his assent to the Affordable Care Act to make it a
law recognized by the constitution and the judicial system of the US.
This law introduced and positioned the reforms that were comprehensive
that was tailored to elevate health coverage, which would be affordable
for all Americans. Further, the law sought to protect consumers and
safeguard the interests of the consumers against exploitation and fraud
practices of the insurance companies. The law allowed the entire
American population to make choices, which are related to health
insurance to ensure that the Americans operate with insurance policies,
as well as companies that serve the best of their interests (Neumann &
Chambers, 2012). The vulnerable groups of people in the American society
were also covered with the provisions of the Patient Protection and
Affordable Care Act (PPACA) through improved access to health care
services. Further, the quality of health care services was brought to
the heights of improvement, as well as cutting down the cost of
healthcare to affordable and acceptable levels to all.
Under the Consumer Protection and Rights, the consumers off health
services were protected from malpractices, by the insurance, which could
deny medical coverage for individuals that were born with defects of the
heart or asthma. Such insurance companies would limit the cancel the
coverage of an individual at the detection of a minor error, in the
insurance cover agreement or limit the extent of the cover against
ailments. The law on consumer protection ended discrimination for
individuals who had pre-existing conditions. This requirement of the law
brought significant relief to millions of parents who had suffered
extreme discrimination for their kids with asthma, diabetes and cardiac
complications (Neumann & Chambers, 2012). Further, the law was tailored
to bring to an end the boundary on care, especially to patients with
chronic ailments as cancer. In the past chronic ailment patients lost
their medical cover immediately, they exceeded the insurance company
imposed limit of a dollar. Such practices are being phased out, by the
PPACA law. Finally, medical coverage by insurance companies on sick
individual was valid, regardless of existence of errors and mistakes in
the application for a medical cover.
Besides consumer protection, PPACA provided affordable coverage to
clients of health insurance policies (Neumann & Chambers, 2012).
Further, the law ensured that the insurance companies answered to their
customers on how they spend their premium dollars. The health insurance
market was opened up to encourage competition thus low premium charges
to customers.
Finally, the law improved access to care by clients by tailoring
healthcare to work for the American conditions. The prevention benefits
for ailments were provided to patients, without any charge, and young
adults were provided with more promising cover than the options that
were available. The accessibility to healthcare was extended to patients
who had pre-existing medical conditions.
States that were willing to adopt the exchange had to fulfil a couple of
basic statutory requirements, which were vital to operating an insurance
exchange. The first federal requirement that is stipulated by the
Affordable Act for the exchange is minimum exchanges functions must
undertake by contact where possible or directly. The second federal
requirement as per the Affordable Care Act is that oversight
responsibilities, which required the exchanges to monitor and certify
the performance of health plans, which are qualified. These minimum
requirements are contained in section 1311 (Neumann & Chambers, 2012).
Further, the health insurance insurers were required to have well
established structure, which would provide a range of health insurance
products that offer comprehensive coverage to the clients. Further, the
health insurance companies were required to involve the public actively
in the event that they want to increase the dollar premiums. The law
encompassed small scale business and the businesses benefited from tax
subsidies, as well as protection of their workers through pooling
resources to purchase insurance. However, the small businesses were
required to have a minimum qualification of not more than one hundred
members and not less than fifty. This was the key criteria to determine
the small scale business that were eligible for the benefits of the law,
but not the size of the company or the returns.
Massachusetts State
The population of Massachusetts states was estimated to be 6,646,144 as
per the data that were compiled in the year 2012. This population is
fairly balanced in all the population segments. Further, the population
growth is sufficient for the replacement purposes. Massachusetts is
densely populated and it is ranked third with every square mile being
occupied by 809.8 people (Neumann & Chambers, 2012). Of all the states
in the US, Massachusetts is ranked the seventh states with respect to
small size. Further, most of the residents of this state are foreign
born, and they reside in the urban areas. Massachusetts is located in
the northeastern region of the US in New England. The total area that is
covered with this state is 10,555 square miles and the coast of
Massachusetts are shaped by massive bays, which are distinct (Patient
Protection and Affordable Care Act Establishment of Exchanges and
Qualified Health Plans Proposed Rule, 2011). Massachusetts has several
large cities but Boston is bigger than all other cities in this state.
This state touches the Atlantic coast shorelines, which are very rocky
as the other side of Massachusetts extends from the Appalachian system
mountains. There are several national parks that preserve wild animals,
as well as recreational parks and islands.
Further, on the economic scale, Massachusetts once recorded a gross
state product of $365 billion. Further, Massachusetts State recorded
$50,735 of per capita personal income. This economic performance was
ranked third in the entire nation, and this is an attractive
performance. There are over five hundred companies that are located in
Massachusetts providing residents with job opportunities, as well as
lucrative tax returns to the state. The economy of Massachusetts depends
on various sectors. These sectors include biotechnology, tourism,
finance and tertiary education. Massachusetts has gradually become a
strong hold for the democrats as the democrats dominate the state.
However, the current status of Massachusetts is characterized by
political liberalism, and this is a classic example of modern
liberalism. Since the times of John F. Kennedy, Massachusetts State has
inclined towards democrats and the only republicans that get votes in
this state, are the people with moderate ideologies. However, the state
has retained a governor from the Republican Party, despite the
democrats’ tendency (Patient Protection and Affordable Care Act
Establishment of Exchanges and Qualified Health Plans Proposed Rule,
2011). The key towns and cities of this state give the largest
percentage of their votes to democrats although in isolated cases
republican have won seats in this state with significant margins. Among
other things, Massachusetts has swayed events that have had significant
in the national scale as the legalization of gay marriages. Further.
The voters of this state approved an initiative, which decriminalized
the use of marijuana and possession of small amounts of the same, as
well as the medical use of marijuana (Patient Protection and Affordable
Care Act Establishment of Exchanges and Qualified Health Plans
Exchange Standards for Employers Final Rule and Interim Final Rule,
The government structure of Massachusetts is fragmented into judiciary,
executive and the legislature, which form the government structure. The
executive branch of the government in this state is headed by the
governor who undertakes the entire executive duties of the government.
The legislature is in charge of the making laws and ensuring that the
laws are implemented. Further, the judicial system ensures that justice
is delivered to the entire people of Massachusetts while ensuring that
law is upheld. The secretary of insurance department is in charge of
implementing the insurance exchange and the provision of PPACA
(Washington Post Staff, 2010). Massachusetts enjoys an effective network
of healthcare infrastructure, which offers the best healthcare services
to the residents, regardless of their age economic status or race. This
network of healthcare facilities and programs that offer health services
to the residents of Massachusetts include mass health, which offers
health services to the public (Patient Protection and Affordable Care
Act Establishment of Exchanges and Qualified Health Plans Proposed
Rule, 2011). Further, there is commonwealth care, which is a program of
health insurance funded, by the state to provide coverage for
Massachusetts residents who are moderate or low income earners. Further,
there is also a program called the Healthy Safety Net, which cover
residents of Massachusetts who cannot afford an insurance cover or non
residents. Adult uninsured residents with high income enjoy commonwealth
choice health program. This program offers health insurance that is
private that complies with the health insurance law that is mandatory in
the state. Health insurance networks in Massachusetts include
Children’s Medical Security, as well as Medicare and all these health
insurance programs form a wonderful network of health insurance
services to the residents of this state (Patient Protection and
Affordable Care Act Establishment of Exchanges and Qualified Health
Plans Exchange Standards for Employers Final Rule and Interim Final
Rule, 2012).
State Methodology
Massachusetts State had shown vivid intentions of bring reforms and
changes to the healthcare insurance to ensure healthcare coverage to all
people. Affordability of healthcare insurance in Massachusetts had been
a significant issue in the political, social, and economic domains of
this state. For instance, influential political figure as Romney had
made an attempt of controlling the healthcare insurance in Massachusetts
(Patient Protection and Affordable Care Act Establishment of Exchanges
and Qualified Health Plans Exchange Standards for Employers Final Rule
and Interim Final Rule, 2012). Although the efforts the Romney had made
in bringing health reforms did not show any significant improvement,
this was an outstanding step to indicate prior plans to bring reforms to
the healthcare insurance, which would provide coverage to all people.
The key element of coverage of the Affordable Care Act remains to be the
health insurance exchanges, which are state-based (Washington Post
Staff, 2010). These exchanges were anticipated to provide marketplaces
that are competitive in which small business and individuals would be
given an opportunity choose the best health insurance cover for their
circumstances, from a rich market of insurance exchange (Patient
Protection and Affordable Care Act Establishment of Exchanges and
Qualified Health Plans Proposed Rule, 2011). The health coverage from
the exchange market was deemed to be comprehensive and affordable plans
of health insurance. The ACA gave the mandate to states to establish
their insurance exchange market and Massachusetts seized the opportunity
to develop her health insurance exchange market, which was to be
effective from 2014. The state submitted her proposal for the
state-based exchange 14th day of December 2012 to HHS (Patient
Protection and Affordable Care Act Establishment of Exchanges and
Qualified Health Plans Exchange Standards for Employers Final Rule and
Interim Final Rule, 2012). This proposal was prepared, as well as
scrutinized by the entire stakeholders of healthcare insurance in
Massachusetts before submission to ensure that the plan was workable, as
well as comprehensive to cover for the entire needs of Massachusetts
residents. In the same line, Massachusetts enacted legislation to create
a State-based Exchange in 2010 following the Affordable Care Act. Back
in 2006, Massachusetts had also established an entity of exchange via
the legislation, which was referred to as the MA Connector. Further,
there have been supplementary laws that have been developed, in MA to
clarify and define the exchange authority of this state. Massachusetts
received a grant award of early innovators, in February 2011 (Patient
Protection and Affordable Care Act Establishment of Exchanges and
Qualified Health Plans Proposed Rule, 2011). There has been plenty of
information concerning the exchange status in Massachusetts, in terms of
articles, journals and other publications, by Zane benefits. These
publications detail the implementation progress, and the adoption of
state-based exchange in the state. The governor of Massachusetts State
clarified the outline of the implementation (Washington Post Staff,
Progress Report
Massachusetts had great ambitions of operating health insurance programs
that were beneficial to all people through reasonable affordability long
before the ACA. This state had long established structures that were
striving to provide health insurance cover to all, as well as stimulate
health reforms. At the time the ideologies of Affordable Care Act were
introduced, Massachusetts had already made significant milestones. In
2006, Massachusetts had enacted healthcare reforms, which were similar
to ACA. Currently, Massachusetts State has established a Health
Insurance Connector, which encompasses Commonwealth Care, Online system
for health plan signing, as well as Commonwealth Choice. Massachusetts
boosts of 95% coverage following from responsibility of individuals, as
well as insurance reforms. This percentage is the highest value in
America, and this state is ranked first nation in health insurance
coverage under ACA (Patient Protection and Affordable Care Act
Establishment of Exchanges and Qualified Health Plans Proposed Rule,
2011). Despite the required date of ACA onset in all states,
Massachusetts has already established operational insurance exchange
markets, and the most recent progress on the same is the building and
establishment of IT infrastructure, which links the state with other
likeminded states in New England.
The functional state exchange in Massachusetts will establish a
sustainable financial situation in the state, which will vary from
positive effects to negative effects with negligible margins. More than
32, million people have benefited from health reforms in the health
insurance coverage. Further, the entire Massachusetts State residents
have enjoyed improved and elevated health services, which are effective
and affordable to all people. The operational health insurance exchange
market has benefited millions of residents of Massachusetts who were
denied medical attention, as well as insurance cover due to the problem
of chronicle ailments. The same benefits were extended to the aged
through elaborate health insurance programs that are available in the
insurance exchange market through a State-based Exchange. Lots of young
adults continue to benefit from insurance covers, which are registered
under the names of their parents. Initially, such young adults survived,
without medical insurance cover as a result of prohibitive charges on
dollar premiums. Further, the small scale business and individuals enjoy
endless list of insurance options in the State-based Exchange, which
provide a wide range of choices for clients and patients to choose.
Therefore, the ACA plan has proved its worth to the people of
Massachusetts through effective patient protection, as well as
Affordable Care Act.
Neumann, P. J., & Chambers, J. D. (2012). Medicare’s enduring struggle
to define a Reasonable and Necessary care. New England Journal of
Medicine, 367(18), 1775-1777.
Patient Protection and Affordable Care Act Establishment of Exchanges
and Qualified Health Plans Proposed Rule. (2011). Federal Register,
76(136), 41867-41927.
Patient Protection and Affordable Care Act Establishment of Exchanges
and Qualified Health Plans Exchange Standards for Employers Final Rule
and Interim Final Rule, (2012). Federal Register, 77(59), 18130-18353.
Washington Post Staff, (2010). Landmark: America’s new health-care
law. New York, NY: Public Affairs-Perseus Books Group.