UMass Medical School team finds some states would face challenges creating a Basic Health Program

December 27, 2013

A team of UMass Medical School experts say in an article for theConnecticut Health Foundation that it could be a challenge for some states to establish the Basic Health Program (BHP), an option under the Affordable Care Act (ACA) that could make health insurance more affordable for some individuals and families.

The article, “The Basic Health Program Could help More People Access Health Care, But Recent Challenges Have Emerged,” provides an overview of the BHP, created to assist individuals and families with income just over the Medicaid limit. It also outlines roadblocks to creating a BHP for states like Connecticut, where many observers believe a BHP would benefit low-income residents in the state. All three authors – Rachel Gershon, JD, MPH, Katharine London, MS, and Robert Seifert, MPA – are health care policy experts with the Center for Health Law and Economics, a unit within UMass Medical School's Commonwealth Medicine division.

The article offers hypothetical scenarios to illustrate how the BHP could save Connecticut residents money on health care costs. Increasing the affordability of insurance could lead to better health outcomes; more equitable health care; and less stress over financial concerns, according to the article.

Proponents of a BHP in Connecticut are encountering some challenges. Draft federal BHP regulations, released in September, require states to contract with health plans or a network of providers to run the program. In a state like Connecticut, which runs its own Medicaid program as opposed to contracting the work out to a separate entity, that requirement could make establishing a BHP problematic. (BHP proponents typically envision the program as an extension of Medicaid, though that is not the only possible model.) The Connecticut Governor’s Office of Health Reform and Innovation convened a workgroup in 2012 and, though it could not make a definitive recommendation regarding a BHP absent federal regulations, it did recommend that the state monitor the experience of people with low incomes purchasing health insurance through the Connecticut marketplace, Access Health CT, to determine if a BHP would benefit residents.

If established in a state, the BHP is available to individuals and families who earn from 138 percent to 200 percent of the federal poverty level, or up to $31,000 annually for a family of two. Families eligible for the BHP would otherwise obtain health insurance from state marketplaces and receive a federal subsidy. The ACA allows states to design a BHP to be less costly to those families than purchasing subsidized coverage in the marketplace. States would fund the BHP in large part with the federal subsidies their participants would have received if they purchased insurance through the marketplace.

Final rules for the BHP are expected to be released in the spring of 2014, and states may launch a BHP beginning in January 2015.