Bill > H1033

This bill establishes a "Public Health Insurance Option," a government-run health insurance plan that will compete with private insurance companies in Massachusetts. This new option, referred to as the "Public Option," will be available through the Commonwealth Connector, a state agency that helps residents find health insurance. The bill defines various terms, including "Carrier" (which refers to different types of insurance providers), "Health benefit plan" (various insurance policies), "Eligible individuals" (residents not offered employer-sponsored insurance), "Eligible small groups" (businesses with 1-50 employees), and "Eligible large groups" (businesses with 51 or more employees). The Public Option must meet the same quality and value standards as private plans that receive the "Connector seal of approval," which is a designation indicating a plan meets certain criteria. The bill mandates that the Public Option be available to eligible individuals and small groups by January 1, 2014, and to eligible large groups by July 1, 2014. The executive director of the Commonwealth Connector can contract with managed care organizations to administer parts of the Public Option, with a preference for those already working with Medicaid. The bill also establishes a "Public Health Insurance Option Trust Fund" to cover the costs of the plan and outlines how premium rates will be set to fully finance its operations and administrative expenses. Healthcare providers participating in Medicare will automatically be part of the Public Option unless they opt out, with specific provisions for opting back in and annual enrollment periods for providers. Additionally, the bill introduces a risk adjustment system to ensure that health plans with enrollees who have higher healthcare needs receive payments, and those with lower needs contribute, to balance the financial risk across all participating plans.