Audrey Morse Gasteier, Executive Director, Massachusetts Health Connector
In an interview with Invest:, Audrey Morse Gasteier, executive director of the Massachusetts Health Connector, talked about her focus on expanding access to affordable health coverage, modernizing the user experience and increasing enrollment. The Health Connector serves as the state’s official health insurance marketplace, covering a record of over 315,000 residents and growing.
What have been your primary objectives over the last year?
Since becoming executive director, I have been focused on doubling down on the Health Connector’s mission of making sure all Massachusetts residents have access to affordable and comprehensive health coverage. That is critical to why we were founded and has been what we have been about for the last 18 years, since we were created as part of Massachusetts’ health reform. I really see it as my job to make sure we are building off of that foundation and are envisioning that next frontier, making sure the experience we provide in getting and staying covered through the Health Connector is state-of-the-art and easy.
How does the Health Connector fit within Boston’s greater insurance landscape?
We are the state’s official health insurance exchange, or marketplace. Anyone who doesn’t already have health coverage through their job or another program can get coverage through us. That makes us the Commonwealth’s primary destination for health care access and financial security for people who might not otherwise have it. We are integral to the greater Boston area and the whole state’s economic and insurance landscape because we provide people with a security that allows them to live full and successful lives. Right now, we cover over 315,000 people, the highest number in our 18-year history, and we are still growing.
What measures are being taken to ensure the organization reaches an increasing number of people?
Over the course of the last year, we embarked on two historic initiatives. First, the state went through the Medicaid redetermination process. As part of the end of the federal pandemic protections, the state had to reevaluate whether all the people on the state’s Medicaid program were still eligible for that coverage. There were a lot of people who had been on that coverage who were no longer eligible. We made sure we could transition people who were losing that Medicaid coverage into marketplace coverage through the Health Connector. We did an incredible amount of work with our colleagues at MassHealth as well as health insurance carriers, health care providers, the business community, advocacy groups and community organizations to reach those people and raise awareness about getting covered through us. That resulted in the Health Connector growing by over 100,000 people and Massachusetts preserving its near-universal rate of health coverage.
The second initiative was implementing the ConnectorCare expansion pilot program earlier this year, whereby the state expanded the number of people who qualify for state financial assistance for health coverage costs. Through ConnectorCare, we take federal Affordable Care Act subsidies for health insurance and augment it with additional state support to lower people’s monthly premiums and their out-of-pocket costs. Coverage through the ConnectorCare program has no deductibles, which is a tremendous asset to its enrollees because it reduces the likelihood of needing to forgo care because of substantial upfront costs at the point of service. The state expanded the number of people who could qualify for the program by extending it to qualifying residents at both lower and moderate income levels. This is a two-year pilot program that was just kicked off and we have over 50,000 people in the program. We are excited to learn more about the impact it’s had on the health care access and financial security of the residents newly benefitting from this pilot program.
With these initiatives and other efforts we’re driving forward, the mission of the Health Connector is to support coverage for as many residents as possible. As a state, we have about 97 percent of our residents covered and we want to go even further.
What regulation are you monitoring that may impact your operations?
As a creation of public policy at both the state and federal level, the Health Connector is strongly interconnected with public policy. For example, at the state level, the impact and learnings from the ConnectorCare pilot program will be important because it will be up to the state legislature whether or not it continues beyond its pilot stage. At the federal level, we are part of the broader Affordable Care Act marketplace landscape, which now has a historic 21 million covered people within it, of which over 315,000 are here in Massachusetts. The future of policymaking around the Affordable Care Act is an area in which we are tightly synced. For example, the American Rescue Plan, which was signed into law in 2021, resulted in a significant expansion to the premium support for people in ACA marketplace coverage that enhanced the federal subsidies available to lower people’s healthcare costs. That was in place for two years and the Inflation Reduction Act further extended those enhanced subsidies. In Massachusetts, we have approximately $222 million coming in annually from the federal government to lower the health care cost of Massachusetts families getting coverage through the Health Connector. Those are slated to expire in 2025, so we are keeping a close eye on what happens on that front federally, while still charting our own course here at the state level for the future to remain unwavering in our commitment to the health coverage of people we are serving.
What is your outlook for the healthcare sector?
There is a lot to be proud of in the health care system here in Massachusetts in general, and that has been true for some time. In so many ways, our system is outperforming the rest of the nation and potentially the world when we think of the healthcare services, innovations, and values we have undergirding our health care system in the Commonwealth. For example, the fact that we have the highest rate of health insurance coverage in the country is a direct outcome of careful forward thinking set in motion by the state and health care leaders here. That being said, there are serious challenges that need to be faced head on; specifically, high and rising healthcare costs and affordability continue to be an area that demands our attention. We need to make sure families can continue to afford this vital coverage that we worked so hard to connect them to and make available. Each year, we are seeing increases in premiums and out-of-pocket spending, outpacing growth in wages, so it will take creativity and out-of-the box thinking to come up with solutions that reverse this trend and can be sustained.
We also face serious health inequities here in Massachusetts, with vast disparities in life span and health outcomes by race and ethnicity, as is the case nationally.
I’m heartened by the fact that our health care community and state leaders are rolling up their sleeves and pushing a more assertive agenda on health equity. We have so much work to do to ensure that — no matter what neighborhood you were born in, what race you are, or what income level you are — you will have the same opportunities for a long healthy life. At the Health Connector, as an example of how we are challenging ourselves to center equity in the design of our health coverage programs, we have taken steps in our ConnectorCare program to eliminate copays for medications for chronic conditions, such as asthma, hypertension, diabetes, and coronary artery disease, that disproportionately impact communities of color. This makes needed care easier to get, and ensures we’re not placing, effectively, an undue financial burden or barrier to care on communities of color. There is a lot of action underway to tackle health equity, and it’s a long game. But the energy surrounding it makes me look forward to the future.
