Push-back against employer penalties in MA

Health care reform in Massachusetts required many grand compromises, and was ultimately passed with broad support from the provider community, the health plans, and employers.  For the provider community, the legislation included incremental Medicaid payment, which decreased hospital losses on this program.   For health plans, the legislation opened up a new market. For employers, the "mandate" was substantially watered down - and the assessment on employers not offering health insurance was capped at $295 per employee -- an amount calculated as the equivalent to previous employer contributions to the uncompensated care pool.  

Considering that an individual insurance plan now costs  more than $3000 per year for a plan with a $2000 deductible -- this employer assessment seems quite low.  On the other hand, employers vehemently opposed an employer mandate passed in the late 1980s and later repealed - so keeping employers "on board" for the current effort is critical.  Further, there is federal legislation (ERISA- the Employees Retirement Income Security Act) which preempts any state regulation of self-funded health insurance plans.  Partners Health Care, a big supporter of state health care reform, testified on Beacon Hill last week that higher employer assessments could lead to an ERISA challenge to the state law.   A successful ERISA challenge could undermine the entire health care reform package.

The challenge remains for Massachusetts' efforts to achieve near-universal insurance coverage - how to pay for it!