Lessons from Massachusetts


Recently, Blue Cross Blue Shield of Massachusetts announced that they would lower their minimum employer contribution from 50% of the employee-only premium to 33%. As you likely know, the Mass employer mandate requires the employer have 25% of eligible employees enrolled in a health plan (take-up rate) OR pay 33% of the premium, to avoid the $295 per employee play-or-pay assessment. Blue Cross said that many small businesses struggled to afford the 50% requirement and that 33% would make them aligned with the employer mandate.
Well, in a follow up story, Mass Gov. Patrick put pressure on Blue Cross to maintain their 50% requirement and abandon lowering the employer premium contribution to 33%. The Mass Senate Chair of the Health Care Financing Committee stated that he would like the requirement raised to 50%.
Think about it. An employer must provide insurance in order to reach the 25% take-up rate threshold. If no insurer will sell to small businesses unless they pay 50% of the premium, then that in effect is the law. Gov. Patrick and other realize that.
Now the only step is to raise the $295 assessment (in regulation) to the equivalent of 50% of the employee-only premium. Then maybe a Mass employer will challenge the employer mandate as it likely violates ERISA.
The Mass experience should serve as an example of mission creep and the art of (speedy) incrementialism and what happens when legislators and bureaucrats get even a little more control over health insurance (more than they already have).