In at least one way, Massachusetts’ health reform has been a huge success. Since late 2006, state figures show, it has added more than 430,000 people to the insured rolls. As of November, only 2.6 percent of Bay State residents were uninsured, versus 15.3 percent of all Americans.
And as the recession has left millions jobless and without coverage, in Massachusetts – where about 100,000 jobs have been lost in 18 months – a sturdy safety net has eased the blow.
Yet if you asked most Americans whether they would like Massachusetts’ model to be implemented nationwide, many would be befuddled, if not opposed. Among their reactions: “It’s so complicated. But isn’t it also bankrupting the state, overburdening employers and just unsustainable?”
Aiming to clarify the lessons from Massachusetts for the nation, the Kaiser Family Foundation this month published two new reports and a fact sheet, and hosted a forum in Washington, D.C., to look at the pros and cons so far of health reform.
The reports’ key finding is that Massachusetts’ expansion of public programs, including a new set of subsidized plans and a “Connector” that sets standards and helps people buy insurance, has greatly improved access to health care for lower-income people and kept rates affordable.
But many people on employer-sponsored plans – which covered 81 percent of non-elderly adults and 70 percent of children in the Bay State as of last year – “seem to be struggling more than ever with health care costs,” one report says, with the result that many people with supposedly “good” coverage forgo care because they cannot afford it.
Not explicitly discussed in the reports is the impact on employers, which local business leaders say is substantial. Since July 2007, employers with 11 or more workers have been required to make a “fair and reasonable” contribution toward health insurance for their staff or pay a “fair share” penalty of up to $295 per worker.
But at the Kaiser forum on Sept. 1, Michael Widmer, president of the Massachusetts Taxpayers Foundation, cited another, far costlier impact of reform. Because individuals are now required to be insured, many workers who used to decline coverage now take it. In the first two years of reform, employer plans added nearly 150,000 people, or 34 percent of the newly insured. That cost employers an estimated $750 million, Widmer said.
But the high cost has soured many business leaders on reform.
“There are many businesses out there that say, ‘I’ve been providing for my employees for many, many years, and I don’t get any help,’ ” said Jack Lank, president of the United Regional Chamber of Commerce, which covers 16 communities in southern Massachusetts, in an interview.
“We have not seen more affordable options come up,” Lank said, “unless you buy a very trimmed-down version of what you used to have.”
One thing to note, however, said James Roosevelt Jr., president and CEO of Tufts Health Plan, is that “reform itself has not raised medical costs. What it hasn’t done is significantly reduce them.”
“We decided in Massachusetts to do coverage first, but we were always clear that we were going to tackle costs next,” he said, “and that’s what we’re doing now.”
In some cases so far, it’s been a tradeoff. For example, he noted, the state’s merger of the individual and small-group markets resulted in new choices and a “significant” drop in premiums for individuals, but it also raised small businesses’ premiums slightly.
To help struggling employers, insurers, business leaders and others are pushing a bill this year to create a new “Affordable Health Plan” for groups of 50 or less, with benefits equal to the cheapest Commonwealth Care plans and caps on providers’ pay and on insurers’ profits and administrative costs. More than 90 percent of Massachusetts employers have fewer than 50 workers, and the new plans could reduce their premiums by up to 22 percent.
A long-term effort to do that is already under way: A state commission has proposed a switch to “global” payments for health care – with providers grouped together and paid a flat amount per patient, rather than for each service. Though it will take years to implement, Roosevelt said, that approach gets to the core of the problem.
Dr. Justine Carr, chief medical officer of Caritas Christi Health Care, the Catholic health system that includes St. Anne’s Hospital in Fall River, offered a similar view.
Hospitals now get paid best for “high-tech acute care services,” she said, but they are paid poorly – or not at all – for many things that can really improve outcomes for patients, such as follow-up home visits after surgery, which can help prevent additional hospitalizations.
Yet efforts are under way to change that. Caritas is expanding primary care on its own, offering 24/7 access now so people can avoid emergency rooms.
And reform has clearly improved access to care for lower-income people, Carr said; Caritas doctors see it every day. Those with employer coverage do still struggle, she said, but now they don’t need to fear that they will be uninsured if they lose their jobs, which is a big relief.
That’s why in the big picture, she said, “we feel very proud to be part of Massachusetts and leading the way in health reform.”
And though it has been challenging, she said, “there is no turning back.” •
The Kaiser reports and a video of the Sept. 1 forum are available at www.kff.org.
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