Advocacy – Nonprofit Health Insurance Project

Nonprofit Health Insurance Project – Executive Summary of the Report

Full version of Report.

Nonprofit organizations represent a vibrant sector of the Massachusetts economy employing approximately 14% of the Massachusetts workforce and providing countless programs and services contributing to the quality of life in the Commonwealth. In a study of nonprofits across Massachusetts published in early 2009, the issue of quality, affordable health insurance was cited as the number one benefits issue facing nonprofits in the Commonwealth.

Average premiums for family health insurance coverage have increased 119% nationally over the past 10 years, and Massachusetts’ insurance premiums are some of the highest in the country. Despite these facts, health insurance is the most commonly provided employee benefit in nonprofit organizations in Massachusetts, and data show it is a benefit nonprofits are committed to providing even when the financial indications suggest doing so is a strain on the organization.

MNN launched the Nonprofit Health Insurance Project (NHIP) in January 2009 in collaboration with the Blue Cross Blue Shield of Massachusetts Foundation to identify strategies and inform policies to enhance the accessibility and affordability of health insurance coverage for Massachusetts nonprofits and their employees. To do this, MNN assembled a task force of highly knowledgeable and qualified experts from various organizations and sectors; membership was diverse and included representatives from both legislative and executive branches of state government, advocates, nonprofit leaders, and health policy experts. Additional expertise was sought on a consultative basis to further develop the groups’ deliberations.

The NHIP Task Force crafted policy and program options for further exploration within three broad categories: 1) policy options that would expand health insurance coverage and/or reduce insurance costs for nonprofits and nonprofit employees; 2) educational initiatives that would help nonprofits and their employees take fuller advantage of the programs and opportunities currently available; and 3) recommendations to stabilize employer sponsored insurance provided by nonprofits and to assist in nonprofits’ pursuit of compliance with the requirements of health reform. Specific options include the following:

  • Policy Priority Option #1: Expand the employer buy-in options available through the Connector to include access to CommCare, or a comparable product, for low-wage workers of qualifying small businesses by leveraging existing employer and employee premium contributions and providing subsidy for any remaining premium to those under 300% FPL.
  • Policy Priority Option #2: Harness the administrative sophistication, management and purchasing clout of the GIC for the benefit of the nonprofit community by creating a pool within the GIC through which nonprofits can purchase health insurance.
  • Policy Priority Option #3: Explore the possibility of creating one small group purchasing pool overseen by the Division of Insurance for all nonprofits and other small businesses in Massachusetts that requires participating plans cover all state mandated benefits and disallows exclusions for preexisting conditions; create incentives for small business participation.
  • Education Priority Options: Establish a multi-lingual, literacy-sensitive, small employer-based curriculum for training owners and managers, and their employees, on the issues of health insurance coverage and health reform; explore the possibility of establishing a hotline specifically for nonprofits and other small businesses modeled after the Health Care For All helpline for individuals.
  • Priority Options for Stabilizing Employer Sponsored Insurance in Nonprofit Organizations: Further clarify and amend the Fair Share Contribution requirements to make the provisions more easily understood and to recognize the financial limitations of nonprofit businesses struggling to provide employer sponsored insurance; research ways of better coordinating the enrollment procedures and coverage opportunities for individuals within various state-sponsored health insurance programs – such as Commonwealth Care, MassHealth, the Medical Security Program, the Insurance Partnership, and others; add ways of tracking health insurance coverage in the Massachusetts employer base by tax status (nonprofit and for profit).

In the next phase of the Nonprofit Health Insurance Project, MNN hopes to pursue funding for additional data collection and research to further inform the priority policy options and to begin developing an outreach and education strategy for nonprofit employers and their employees. Ultimately, we are hoping to pursue the relevant and appropriate policy and program options as outlined above based on the additional research findings and the outcome of federal health reform.

This project was funded through generous support from the Blue Cross/ Blue Shield Foundation

Prepared by:

Molly Yuska, M.M.
Yuska Solutions


With Support from:

Cathy Dunham, Ed.D.
Executive Director
The Access Project

and David Magnani, Ed.D.
Executive Director
Massachusetts Nonprofit Network