Massachusetts Plan "Chapter 58" establishes a system to provide citizens with access to health insurance through a combination of private and public plans. To accomplish the intend of the reform, the plan required state residents to obtain insurance, created a state-sponsored "connector" where they could go to buy it, and required all but the very smallest employers to provide insurance or pay a penalty.

Further explanations of some of the Chapter 58 key provisions are listed below:

1. The creation of the Commonwealth Health Insurance Connector Authority – the Connector is designed as a clearinghouse for insurance plans and payments. It performs the following functions:

• It runs the Commonwealth Care program for low-income residents (below 300% of the poverty level) who do not qualify for MassHealth.
  

• It offers health insurance plans for individuals who:
  
  • are not working
  • are employed by a small business (fewer than 50 employees) that uses the Connector to offer health insurance. These residents will purchase insurance with pre-tax income.
    
  • are not qualified under their large employer plan
    
  • are self-employed, part-time workers, or work for multiple employers

• It sets premium subsidy levels for Commonwealth Care
  

• It defines "affordability" for purposes of the individual mandate
  

2. The establishment of the subsidized Commonwealth Care Health Insurance Program (C-CHIP)

3. Individuals who earn more than $50,000 a year, roughly the state's median income, will be considered able to afford insurance and be required to purchase it. For people earning less than that, the policy sets out the maximum they would be expected to pay for insurance. If available policies cost more, they would be exempted.[1]

• For example, an individual earning between $35,001 and $40,000 a year would be exempted if he couldn't find a policy that costs $200 a month or less. A family earning $70,001 to $90,000 a year would be exempted if faced only with policies costing more than $500 a month.
  

4. The Employer Fair Share Contribution - Employers with more than ten employees must offer provide a "fair and reasonable contribution" to the premium of health insurance for employees. Employers who do not will be assessed an annual fair share contribution that will not exceed $295 per employee per year.

5. A mandate that each individual have insurance

6. The statute also expands MassHealth (Medicaid and SCHIP) coverage for children and restores MassHealth benefits like dental care and eyeglasses.

7. Payment rates are increased to hospitals and physicians, and a new "Quality and Cost Council," will issue quality standards and publicize provider performance.

8. Sets up a Disparities Council

9. Funds automated prescription ordering in hospitals

10. Implements changes to the public health council, state insurance laws, mandated benefit requirements, and other health-related programs.

Source: Massachusetts 2006 Health Reform Statute (Wikipedia)

[1]: "Board OK's Rules on Health Coverage: Sets Standards on Affordability and Exemptions" (The Boston Globe, April 13, 2007)

To learn more, please visit: http://www.mass.gov/legis/laws/seslaw06/sl060058.htm