UMMS team: Some states will face roadblocks in creating Basic Health Program

By Jennifer Rosinski

UMass Medical School Communications

December 30, 2013

A team of UMass Medical School experts, in an article for the Connecticut Health Foundation, conclude that some states will find it challenging to establish the Basic Health Program, an option under the Affordable Care Act (ACA) that could make health insurance more affordable for some individuals and families.

The article, The Basic Health Program Could Help More People Access Health Care, But Recent Challenges Have Emerged, provides an overview of the Basic Health Program, an option created to assist individuals and families with income just over the Medicaid limit. It also outlines roadblocks to creating the program for states such as Connecticut, where many observers believe it would benefit low-income residents in the state. The authors—Rachel Gershon, JD, MPH; Katharine London, MS; and Robert Seifert, MPA—are health care policy experts with the Center for Health Law and Economics, a unit within UMass Medical School's Commonwealth Medicine division.

The article offers hypothetical scenarios to illustrate how the Basic Health Program could reduce health care costs for some Connecticut residents. Increasing the affordability of insurance could lead to better health outcomes, more equitable health care, and less stress over financial concerns, according to the article.

Proponents of the program in Connecticut are encountering some challenges. Draft federal regulations, released in September, require states to contract with health plans or a network of providers to run the program. In a state like Connecticut, which runs its own Medicaid program as opposed to contracting the work out to a separate entity, that requirement could make establishing a Basic Health Program problematic. BHP proponents typically envision the program as an extension of Medicaid, though that is not the only possible model. The Connecticut Governor’s Office of Health Reform and Innovation convened a workgroup in 2012 and, though it could not make a definitive recommendation regarding a Basic Health Program absent federal regulations, it did recommend that the state monitor the experience of people with low incomes purchasing health insurance through the Connecticut marketplace, Access Health CT, to determine if it would benefit residents.

If established in a state, the program is available to individuals and families who earn from 138 percent to 200 percent of the federal poverty level, or up to $31,000 annually for a family of two. Families eligible for the program would otherwise obtain health insurance from state marketplaces and receive a federal subsidy. The ACA allows states to design a Basic Health Program to be less costly to those families than purchasing subsidized coverage in the marketplace. States would fund the program in large part with the federal subsidies their participants would have received if they purchased insurance through the marketplace.

Final rules for the program are expected to be released in the spring of 2014, and states may launch the program beginning in January 2015.

Read the full article on the Connecticut Health Foundation website.