Note: None of this should be taken as legal or tax advice.

Non-federal governmental employers who sponsor a self-funded group health plan may no longer opt out of certain requirements under Title XXVII of the Public Health Service (PHS) Act.

1. Limitations on pre-existing condition exclusion periods
2. Requirements for special enrollment periods
3. Prohibitions against discriminating against individual participants and beneficiaries    
   based on health status (but not including provisions added by the Genetic Information 
   Nondiscrimination Act of 2008)

Note: None of this should be taken as legal or tax advice.

The Affordable Care Act (ACA) requires health insurers to offer products through health insurance exchanges.  In most cases, the success of a state's exchange will depend on the condition of the state's existing health insurance market.

Note: None of this should be taken as legal or tax advice.

Tuesday, April 12th, 2011 marked the five-year anniversary of Massachusetts' 2006 State Health Care Reform. The reform was signed into law by then-governor Mitt Romney with the goal of providing affordable health insurance coverage to the estimated 6% of Massachusetts residents that were uninsured at the time.

Massachusetts State Health Care Reform and the Affordable Care Act are virtually identical. Both reforms rely heavily on state-based health insurance exchanges, subsidies for qualifying individuals, and mandates for employers and individuals. As a result, Massachusetts presents the most appropriate example of what to expect from federal health care reform.

So, what have we learned from Massachusetts state reform?  The 2006 Massachusetts State Health Care Reform:

1. Created the MAHealthConnector (a state health insurance exchange) to provide guaranteed issue health insurance to MA residents;
2. Mandated that every resident of the state obtain a minimum level of health insurance or face penalties;
3. Mandated that employers provide a "fair and reasonable contribution" to their employees' health insurance premiums or face penalties; and
4. Provided free health insurance and partially-subsidized insurance to qualifying residents based on income.

 Proponents of the law argue that Massachusetts Health Reform:

• Has resulted in Mass. being the state with the highest percentage of insured residents, at 98% in April 2011, including 99.8% of children. 
• Has increased the percentage of private companies that offer health insurance from 70% in 2005 to greater than 77% today. 
• Has lowered the cost of individual health insurance premiums in Mass. due to the fact that primarily healthy people have moved to the individual market. 

 Opponents of the law argue that Massachusetts Health Reform:

• Has increased costs for its residents, $13,788 for a family of four in 2010, in the state that already had the highest medical costs in the nation prior to implementation. 
• Was setup for failure from the start due to its reliance on employer-sponsored health plans, plans that employers cannot afford due to rising costs. 
• Has resulted in more than half of the newly-insured residents receiving health insurance that is partially or completely subsidized by Massachusetts' taxpayers.

Has Massachusetts health care reform been properly utilized as a test bed for federal reform? Will the costs associated with Massachusetts health care reform be sustainable over the long term?