Massachusetts

Clinton

McCain

Obama

Estimated incremental cost

$200 million/year

$110 billion/year

Not specified

$50-$65 billion/year

Goal of  Plan

Nearly Universal Coverage for Massachusetts residents

Universal Coverage

Provide access to affordable health care for all by paying only for high-quality health care.

Universal Coverage

Public and Private Insurance Options to Enroll Uninsured

Expands MassHealth (Medicaid) and subsidized coverage through private health plans for low-income residents; unsubsidized private coverage from health plans or the Connector for individuals without employer coverage.

Expand public and private coverage options with Health Choices Menu operated through the Federal Employee Health benefits Program (FEHBP).

Promote competition among private insurers; individuals could purchase coverage across state lines; more flexibility for veterans to use VA benefits.

Create new public plan to enroll children, expanding Medicaid and SCHIP; National Health Insurance Exchange to provide small businesses and individuals with access to public or private coverage.

Requirement for Individuals to Be Covered

Yes, with affordability exceptions based on income

Yes, with tax-related subsidies

No

No for adults, yes for children

New Employer Requirements and Obligations

If over 10 workers, offer employees IRS Section 125 pre-tax premium payment; make “fair and reasonable” contribution to employee coverage

Yes, large employers must provide an employee plan or contribute to cost of coverage; incentives for small employers

No

Yes, employers must offer “meaningful coverage” or  contribute percentage of payroll

Tax Code Changes or Incentives

No changes; incentive to offer IRS Section 125 plans

Employer-provided health premiums would still be excluded from income taxes except for “the high-end portion of very generous plans for those making over $250,000”

Eliminate “bias” toward employer-sponsored health insurance; ; expand use of Health Savings Accounts.

 No changes.

Prohibition Against Insurers Denying Coverage Based on Pre-Existing Illness

Yes, guaranteed issue requirement

Yes, guaranteed issue requirement

No

Yes, guaranteed issue requirement

Mechanisms to Allow Pooling of Insurance Risk

Individuals have access to subsidized and unsubsidized private insurance plans through the Health Insurance Connector Authority; Safety Net pool maintained to pay hospitals and doctors to care for uninsured residents.

Allow employers to buy coverage through Health Choices Menu on behalf of workers or early retirees.

No

Create National Health Insurance Exchange for individuals to purchase public or qualified private coverage.

Approach to Controlling Costs

Cost and Quality Council, price and performance transparency

Prevention, information technology, chronic care, disseminate “best practices,” constraints on prescription drugs and insurance company spending.

Provider payment incentives for prevention, management of chronic conditions and coordination of care, national outcomes standards, price and performance transparency, information technology

Information technology, prevention and management of chronic conditions, promotion of generics and drug competition, price and performance transparency, constraints on insurance companies.