Talk:Massachusetts health care reform/sandbox

Possibly Misleading Labeling as "Insured"
However, in comparing to other states and other countries, counted as insured for Massachusetts are the 24% of the population covered with a form of Medicaid, including the Affordable Care Act's expanded Medicaid.

The state is one of a number that retain the option that has been granted by the Omnibus Budget Reconciliation Act of 1993 to do Medicaid Estate Recovery for non-long-term-care-related (non-LTCR) medical expenses for people 55 and over. For people 55 and and over, with Medicaid, including the ACA's expanded Medicaid, medical expenses will be paid for the person, but their estate is legally obligated to pay back the full amount of those medical expenses when the person dies. In the view of some, people covered subject to estate recovery should be looked at as having not insurance, but rather a loan for medical expenses until death. Thus, one might reasonably dispute the accuracy of the 97% insured number, because perhaps 4% of the population represented as insured are people 55 or older with some form of Medicaid or expanded Medicaid, which is subject to estate recovery of all medical expenses. It can therefore be argued that the uninsured rate is actually about 7% in Massachusetts.

Possibly Misleading Comparisons
A number of other states don't do Medicaid Estate Recovery for non-long-term-care-related expenses. Thus, for those states, the insurance coverage rate reported in tables might be considered to accurately represent the insured rate, since it includes no people who have what some view as loans rather than insurance. Therefore the comparison to the Massachusetts uninsured rate, may be, in the view of some, considered misleading.

Thus, for example, Minnesota has a 5% uninsured rate, but the state does not currently recover other than long-term-care Medicaid expenses. So the comparison of insured, if people without what might be considered just a loan are removed, would be Minnesota: 5% uninsured, Massachusetts: 7% uninsured.

Attempt to Stop Non-Long-Term-Care-Related Estate Recovery In MA
The state (as of Aug 2019) is one of the states that maintains the policy of estate Recovery for non-long-term-care-related Medicaid and expanded Medicaid medical expenses for people 55 and over. .  Therefore, certain of the coverage offered in the state, including expanded Medicaid offered as part of the ACA on the MA Health Connector (which people with incomes up to 138% of the Federal Poverty Level usually receive ), may leave the holder's estate having to pay back full medical expenses that were paid out, as well as possible capitation charges whether or not medical services were actually used.

Some in the state consider this problematic, particularly since all Massachusetts residents are obligated to carry health insurance, or else pay a penalty. A pair of bills have been introduced into the Massachusetts Legislature to stop non-long-term-care-related estate recovery, retroactively. The bills are S734 and H1197.

(Since the passage of the ACA, objections were raised in multiple places across the country             with the practice of Medicaid Estate Recovery for non-long-term-care-related expenses. These were based generally on the view that much of the coverage provided by the ACA, which includes Medicaid and the ACA's expanded Medicaid, with such recovery, subjected all medical expenses paid out to eventually be paid back from the person's estate at death.  Therefore, the affected ACA coverage might be considered to be a loan for medical expenses, rather than insurance.      The estate recovery of non-long-term-care-related medical expenses was thus considered problematic in how it interacted with the ACA, and in need of being stopped. Between 2013 and 2017, at least 7 states: NY, WA, OR, CT, CA, MN, and CO have modified regulations and laws to stop or limit non-long-term-care-related estate recovery. Bills S734 and H1197 would do the same in Massachusetts.)