Massachusetts: Exploring the Future of Health Reform


Massachusetts led the nation in 2006 with a comprehensive health care reform law that established the Massachusetts Health Connector, a new marketplace designed to make affordable health insurance available to more people. National health reform built upon the successful example set by Massachusetts. Today, over 250,000 Massachusetts residents have health insurance through the Health Connector, and our state has the highest rate of health insurance coverage in the nation.

Even with this progress, Massachusetts continues to strive to improve its health care system. The Commonwealth is leading once again with its landmark law to contain health care costs, Chapter 224. Now the Commonwealth is exploring options under national health reform that would offer greater flexibility to improve health coverage and maintain market stability in Massachusetts.

Public Comment Opportunities and Meeting Materials

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Topic(s) Meeting Details Meeting Materials
Listening Session # 1 Date: Friday, August 4, 2017
Time: 9:00 a.m. – 11:00 a.m.Location: 1 Ashburton Place, 21st Floor, Boston MAConference Line: 1-888-822-7517 Participant Code: 163 4530#
Listening Session # 2 Date: August 16, 2017
Time: 10:00 a.m. – 12:00 p.m.Location: Castle of Knights, 1599 Memorial Drive, Chicopee, MAConference Line: 1-888-822-7517 Participant Code: 163 4530#


December 20, 2017

In September, the Commonwealth submitted a request to the federal government seeking relief, via Code Section 7805(a), from the ACA Employer Mandate. Late this fall, Department of Treasury began enforcing federal employer shared responsibility penalties and has not authorized additional transitional relief.


November 17, 2017

Update on State Flexibility Request. The Baker-Polito Administration has secured from the U.S. Department of Health and Human Services the flexibility to extend for another year the existing use of small group rating factors, to hold down premium increases and maintain stability in the market for small employers. The rating factors are permitted under state law, but are not aligned with requirements under federal law. Through a series of requests to the federal government, the Commonwealth has been able to maintain the state rating factors in order to avoid market disruption and maintain premium consistency for small employers.

The original waiver, as extended in later years, allowed small group insurers to continue to use two-thirds of the state rating factors in effect in July 2013 through January 1, 2017, after which rating factors would be reduced to one-third until December 31, 2017 and phased out entirely on January 1, 2018.

Under the new agreement, brokered by officials from the Executive Office of Health and Human Services, the Executive Office of Administration and Finance, the Health Insurance Connector Authority, and the Division of Insurance, Massachusetts small group insurers can continue to use one-third of the original magnitude of the state rating factors in effect in July 2013 through December 31, 2019.


October 24, 2017

Update on State Flexibility Request.  In an attempt to prevent market instability and member disruption that may be caused by the federal government’s decision to end Cost-Sharing Reduction (CSR) payments, the Health Connector filed a Section 1332 waiver application on September 8, 2017, along with other requests to support Massachusetts carriers and control health care costs for Massachusetts residents.  While this waiver was not granted by the federal government, the Health Connector will evaluate the prospects of filing a similar waiver for 2019 and will continue to dialogue with federal partners about other proposals.

With federal CSR payments halted and $28 million remaining in 2017 payments to Massachusetts carriers, the Baker-Polito Administration will cover this cost through the end of the calendar year to protect the stability of the health insurance market. Earlier in October, the Health Connector announced adjusted rates for 2018 that take into account increased premiums to cover the loss of federal CSR payments, and add an average of 18 percent to premiums on top of the expected 8 percent increase that may impact up to 80,000 members during Open Enrollment.


September 8, 2017

Massachusetts submits three flexibility requests. On June 24, 2017, the Health Connector announced that the Commonwealth is pursuing a number of requests for federal flexibility in order to ensure that the Massachusetts health insurance market remains stable, sustainable, and vigorous in the future. The Health Connector appreciates the thoughtful comments and suggestions from Massachusetts stakeholders it received in response to this announcement, which have been posted below (see Public Comments).

Today, the Health Connector submitted three requests for flexibility to the federal Departments of Health and Human Services and Treasury:

The Commonwealth looks forward to a productive dialogue with federal and state partners on these requests. Over the coming months, the Health Connector will continue to explore additional areas for flexibility, including:

  • A Section 1332 State Innovation Waiver to administer the federal Small Business Health Care Tax Credit
  • Permission to revive Section 125 plans for non-benefits eligible employees to enhance consumer savings and promote private coverage

Additional details regarding the status of these requests are available here. As part of the Commonwealth’s ongoing commitment to a robust public process as it considers and pursues these requests, the Health Connector will continue to accept public feedback on a rolling basis via e-mail at Updates will continue to be posted on this site.


June 24, 2017

Massachusetts is pursuing requests for flexibility. In order to ensure that the Massachusetts health insurance market remains stable, sustainable, and vigorous in the future, Massachusetts has identified opportunities to adjust or re-examine particular federal policies in areas that could further strengthen the employer-sponsored coverage and ensure stability in the commercial insurance market more broadly. Specifically, the Commonwealth seeks to:

  • Promote Market Stability with a Premium Stabilization Fund in Lieu of Cost-Sharing Reductions​;
  • Revive State Employer Shared Responsibility Program in Lieu of Delayed and Less Comprehensive Federal Program;
  • Revive Permissibility of Section 125 Plans for Non-Benefits Eligible Employees to Enhance Consumer Savings and Promote Private Coverage;
  • Permission for Commonwealth to Administer the Federal Small Business Health Care Tax Credit;
  • Allow for State Option to Continue to Use Select State-Based Rating Factors; and
  • Commence a Process to Evaluate Future of Risk Adjustment in the Commonwealth

The Commonwealth will host two public meetings in various regions of the Commonwealth to seek input regarding its flexibility requests. The Commonwealth will consider comments received by August 25, 2017. Comments may be submitted by e-mail to:


May 23, 2016

Massachusetts announced a successful resolution to its initial request for flexibility. Governor Baker announced that the Centers for Medicare and Medicaid Services (CMS) has authorized flexibility for Massachusetts to maintain its merged insurance market for non-group and small group commercial insurance. In response to a joint request from the Massachusetts Health Connector and the Division of Insurance, CMS agreed that Massachusetts can maintain rolling enrollment throughout the year for small businesses and quarterly small group premium rate refreshing within its merged market.

This request was formulated as a result of Massachusetts’ exploration of a Section 1332 State Innovation Waiver. Background materials on this request included:

During this exploration, stakeholders unanimously supported seeking flexibility to retain Massachusetts’ unique “hybrid” merged market structure, which was created under state health reform in Chapter 58 of the Acts of 2006. This merged market structure has promoted affordability for individuals while maintaining familiar enrollment cycles for businesses. CMS has determined that the current market structure provides appropriate consumer protections and will permit Massachusetts to continue its version of a merged market.

How to Get Involved

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