Massachusetts Single Payer Bill Summary
An Act for Improved Medicare for All in Massachusetts: Providing Guaranteed, Affordable Health Care
Section 1. Preamble - outlines the reasons for establishing Medicare for All.
Section 2. Definitions
Section 3. Establishment of Massachusetts HealthCare Trust - creates Trust and sets out ground rules for Trustees.
Section 4. Powers of the Trust - ability to enact regulations, enter contracts, etc.
Section 5. Purposes of the Trust - lists the goals of the Trust, such as universal, high quality care, cost control, etc.
Section 6. Board of Trustees – lists composition of the Board (23 members: 8 elected, 12 appointed), which will establish policy, evaluate proposals, and set standards.
Section 7. Executive Director - hired by Board of Trustees; decisions subject to approval of Board; primary responsibility for negotiating or establishing terms for provision of high quality health care services.
Section 8. Regional Division - establishes regional offices responsible for outreach and responding to complaints.
Section 9. Administrative Division - day-to-day operations; develops management systems and operational budgets, assists the planning division in developing capital budgets.
Section 10. Planning Division - responsible for annual of adequacy of health care resources and review of capital health care needs.
Section 11. Information Technology Division - develops confidential medical records and prescription systems to simplify the billing process and reduce medical errors and bureaucracy.
Section 12. Quality Assurance Division - sets standards of care, conducts an annual review of the quality of health care services and outcomes, and submits recommendations to the Board of Trustees.
Section 13. Eligible Participants - establishes eligibility of all Massachusetts residents and certain categories of non-residents, such as some who work in Massachusetts, or require emergency care in-state.
Section 14. Eligible Health Care Providers and Facilities - establishes requirements for participating providers and health care facilities: such as no discrimination, no co-payments.
Section 15. Budgeting and Payments to Eligible Health Care Providers and Facilities - Trust sets prospective budgets and retrospective reimbursement rates, capital budgets, etc.
Section 16. Covered Benefits - includes all medically necessary health services; preventative care, physical health, mental health and substance abuse services, laboratory and imaging diagnostic testing; dental, vision, hearing services; acupuncture, physical therapy, chiropractic, and podiatric services; home care, long term care, hospice care; durable and non-durable medical equipment, supplies, and appliances; no co-pays or other cost sharing imposed for covered benefits.
Section 17. Wrap Around Coverage for Federal Health Programs - prior to receiving waivers for Medicare, Medicaid, and other federally matched programs, Trust will provide wraparound coverage for enrollees of such programs to eliminate premiums, co-pays, and deductibles.
Section 18. Establishment of the Health Care Trust Fund - the Fund will be administered by the executive director, will consist of all the revenue sources defined in section 20, and will pay for all claims for health services.
Section 19. Purpose of the Trust Fund - amounts credited to the Trust Fund pays eligible providers and health care facilities for covered services rendered; for education and outreach, training of the health care workforce, and medical research; for retraining workers displaced by the transition to Medicare for All for three years following full implementation; and sets up a rainy day fund. The Fund will pay for administrative costs of the trust not to exceed 5% of income.
Section 20. Funding Sources - Trust is funded from existing public spending on health care, an employer payroll tax of 7.5% (exempting first $30k of payroll with an additional 0.44% surcharge for large businesses), an employee payroll tax of 2.5% (which employers can choose to cover), a 10% payroll tax on self-employed (exempting first $30k), and a 12.5% tax on unearned income. Trust will also recover collateral sources of revenue, and apply for federal waivers for federally-matched funds.
Section 21. Insurance Reforms - insurers are prohibited from charging premiums to eligible participants for coverage of services already covered by the Trust.
Section 22. Health Trust Regulatory Authority - enables the adoption of regulations to implement the provisions of the Trust.
Section 23. Implementation of the Health Care Trust - provides a time frame.