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The state of Massachusetts passed a health care reform law in 2006 with the aim of providing health insurance to nearly all of its residents. The law mandated that nearly every resident of Massachusetts obtain a minimum level of insurance coverage, provided free health care insurance for residents earning less than 150% of the federal poverty level (FPL) and mandated employers with more than 10 "full-time" employees to provide healthcare insurance. The law was amended significantly in 2008 and twice in 2010 to make it consistent with the federal Affordable Care Act. Major revisions related to health care industry price controls were passed in August 2012, and the employer mandate was repealed in 2013 in favor of the federal mandate (even though enforcement of the federal mandate was delayed until January 2015). Among its many effects, the law established an independent public authority, the Commonwealth Health Insurance Connector Authority, also known as the Massachusetts Health Connector. The Connector acts as an insurance broker to offer free, highly subsidized and full-price private insurance plans to residents, including through its web site. As such it is one of the models of the Affordable Care Act's health insurance exchanges. The 2006 Massachusetts law successfully covered approximately two-thirds of the state's then-uninsured residents, half via federal-government-paid-for Medicaid expansion (administered by MassHealth) and half via the Connector's free and subsidized network-tiered health care insurance for those not eligible for expanded Medicaid. Relatively few Massachusetts residents used the Connector to buy full-priced insurance. ==Background== The healthcare insurance reform law was enacted as Chapter 58 of the Acts of 2006 of the Massachusetts General Court; its long form title is An Act Providing Access to Affordable, Quality, Accountable Health Care. In October 2006, January 2007, and November 2007, bills were enacted that amended and made technical corrections to the statute (Chapters 324 and 450 of the Acts of 2006, and chapter 205 of the Acts of 2007).〔For text of the laws, provided by ''The General Court of The Commonwealth of Massachusetts'' * * * * * 〕 The movement to reform Massachusetts healthcare insurance regulations and market between 2004 and 2006 was driven by multiple issues, not all of which were clearly an issue or directly related to then and now most critical issues of rising costs: # A six-year-old federal-government waiver as to how Massachusetts administered its Medicaid program was expiring. Unless the waiver was extended or amended, a large number of people would lose Medicaid coverage as the state reverted to Federal regulations. # Reforms made in 1997 to the portion of the insurance market that related to the individual purchase of insurance had failed. In 2000, over 100,000 Massachusetts residents (about 1.5% of the population) were covered by individually purchased insurance but the number had dropped to under 50,000 by the time of the reform debate. # As illustrated in the state report referenced in the previous sentence, the price of insurance that covered about 600,000 people in the small group market (about 10% of the population) was rising faster than the prices for the vast majority of the non-senior-citizen population, most of which were – and still are – covered by self-insured group insurance from large employers (self-insured plans are not subject to state regulation). # There was a widespread feeling that emergency rooms were misused for non-emergency medical care (the misuse was and is undeniable, not unique to Massachusetts, and continues; the relation to healthcare insurance or lack of it was less clear and apparently did/does not exist). # The taxes that fed the state's "free care pool", which covered uninsured emergency room visits as well as uninsured hospital admissions (as well as funding community health centers), consistently underfunded the pool and had to be raised almost annually (with differences made up by appropriations from general revenue). The combination of issues four and five was dubbed by Romney and others the free-rider problem although subsequent to the passage of the law, it is argued that the free-rider problem did not really exist. Almost all people who did not have insurance could not afford it, but since they were still using the good it is considered free riding. # Advocacy groups wanted a long list of non-traditionally covered (e.g., vision care) or under-covered (e.g., mood-altering pharmaceuticals) healthcare procedures and goods mandated. # Large employers—even large employers that were self-insured—were increasingly dropping health insurance as an employee benefit and/or restricting it to "full-time employees such that the "take up rate" of healthcare insurance by employees was dropping. However, the drop in take-up rate actually accelerated after passage of the law although there is no demonstrable relationship between the law's passage and the accelerated drop. Allegedly because of their lack of health insurance, uninsured Massachusetts residents commonly utilize emergency rooms as a source of primary care.〔(【引用サイトリンク】title=In Massachusetts, Health Care for All? )〕 The United States Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986. EMTALA requires hospitals and ambulance services to provide care to anyone needing emergency treatment regardless of citizenship, legal status or ability to pay. EMTALA applies to virtually all hospitals in the U.S but includes no provisions for reimbursement. EMTALA is therefore considered an "unfunded safety net program" for patients seeking care at the nation's emergency rooms.〔(【引用サイトリンク】work=Boston Public Health Commission )〕 As a result of the 1986 EMTALA legislation, hospitals across the country faced unpaid bills and mounting expenses to care for the uninsured.〔(【引用サイトリンク】work=NPR )〕 In Massachusetts, a pool of over $1 billion in 2004/2005, funded by a tax on paying hospital customers and insurance premiums, known as the Uncompensated Care Pool (or "free care pool"), was used to partially reimburse hospitals and health centers for these ED expenses. A much larger portion of the pool was used for non-ED hospital care for the uninsured and for other care at Community Health Centers. It was predicted that implementation of the 2006 Massachusetts healthcare insurance reform law would result in almost complete elimination of the need for this fund. In 2006, an MIT economics professor Jonathan Gruber predicted that the amount of money in the "free care pool" would be sufficient to pay for reform legislation without requiring additional funding or taxes. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Massachusetts health care reform」の詳細全文を読む スポンサード リンク
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