Managed care is an arrangement for health care whereby an organization or an insurance company acts on behalf of a health care demander in receiving health care from a physician. With more than 170 million Americans getting health care coverage through some form of managed care such as health maintenance organization (HMO) or preferred provider organizations (PPO), nearly every state has had to enact laws that relate to the regulation of the managed care (NCSL, 2009). This work looks into the regulation of managed care under the Massachusetts Mandated Health Insurance Law.
Basic elements of the Massachusetts Mandated Health Insurance Law
The Massachusetts Mandated Health Insurance Law is a regulation that provides for access to affordable, quality, accountable health care. The law mainly focuses on ensuring that all residents of the state who get earnings below 300 percent of the Federal Poverty Level receive subsidies for health insurance. At the same time, it caters for other residents who do not qualify for insurance via their employers by ensuring that they obtain low-cost insurance. Commonwealth Connector, a state agency, has been established to oversee the mandatory health insurance. Within this agency are two main programs that help to accomplish the objectives of this law. The Commonwealth Care is there to take care of lesser income residents. A member of this program selects a health care plan and also has a personal choice for a doctor. On the other hand, the Commonwealth Choice program provides private sector as an option to those who are not in the lower income insurance bracket. Here, the Health Connector on behalf of the consumers contacts the insurance plans and asks for options that would fit the different types of consumers. The Connector then approves the plans from having met certain standards in terms of quality and value. In other words, it is like window shopping and then enrolling for the most appropriate plan (Commonwealth of Massachusetts, 2009).
The law and the state insurance regulators
Whereas the Massachusetts State may be thinking of controlling the cost of health insurance in case of small businesses, there is need to look into the stipulations of the Mandated Health Insurance Law. There is need to protect consumers from insurers especially so when you consider that the residents protected by this law are the low income residents whether covered through their employers or not. The costs of insuring these residents has obviously risen but this should not mean that controlling the costs should compromise the quality, affordability and accessibility of health insurance as directed by the Mandatory Health Insurance Law. Therefore, as reforms may be anticipated, the law must remain protective to the Massachusetts resident who may not easily afford health insurance. Furthermore, the cost regulation should not lead to denial of the right to select health care plan and a physician of choice as stipulated in the Commonwealth Care program.
Future of managed care regulation state
In view that the state would like to regulate the managed care by either going against the already established acts that monitor managed care, the future of managed care is likely to be darkened. State intervention will likely lead to a compromise in the standards of managed care or else lead to improved managed care if the interventions will seek to protect customers from exploitation by health insurance providers.
If the state regulations regarding managed care are to remain strengthened and adhered to, the residents of these states will certainly benefit from this. Future position of the managed care in America will depend on decisions made by regulators in the field of health care provision.
Basic elements of the Massachusetts Mandated Health Insurance Law
The Massachusetts Mandated Health Insurance Law is a regulation that provides for access to affordable, quality, accountable health care. The law mainly focuses on ensuring that all residents of the state who get earnings below 300 percent of the Federal Poverty Level receive subsidies for health insurance. At the same time, it caters for other residents who do not qualify for insurance via their employers by ensuring that they obtain low-cost insurance. Commonwealth Connector, a state agency, has been established to oversee the mandatory health insurance. Within this agency are two main programs that help to accomplish the objectives of this law. The Commonwealth Care is there to take care of lesser income residents. A member of this program selects a health care plan and also has a personal choice for a doctor. On the other hand, the Commonwealth Choice program provides private sector as an option to those who are not in the lower income insurance bracket. Here, the Health Connector on behalf of the consumers contacts the insurance plans and asks for options that would fit the different types of consumers. The Connector then approves the plans from having met certain standards in terms of quality and value. In other words, it is like window shopping and then enrolling for the most appropriate plan (Commonwealth of Massachusetts, 2009).
The law and the state insurance regulators
Whereas the Massachusetts State may be thinking of controlling the cost of health insurance in case of small businesses, there is need to look into the stipulations of the Mandated Health Insurance Law. There is need to protect consumers from insurers especially so when you consider that the residents protected by this law are the low income residents whether covered through their employers or not. The costs of insuring these residents has obviously risen but this should not mean that controlling the costs should compromise the quality, affordability and accessibility of health insurance as directed by the Mandatory Health Insurance Law. Therefore, as reforms may be anticipated, the law must remain protective to the Massachusetts resident who may not easily afford health insurance. Furthermore, the cost regulation should not lead to denial of the right to select health care plan and a physician of choice as stipulated in the Commonwealth Care program.
Future of managed care regulation state
In view that the state would like to regulate the managed care by either going against the already established acts that monitor managed care, the future of managed care is likely to be darkened. State intervention will likely lead to a compromise in the standards of managed care or else lead to improved managed care if the interventions will seek to protect customers from exploitation by health insurance providers.
If the state regulations regarding managed care are to remain strengthened and adhered to, the residents of these states will certainly benefit from this. Future position of the managed care in America will depend on decisions made by regulators in the field of health care provision.
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