August 28, 2009
With lawmakers in Washington deep in the trenches of the national health care reform debate, all eyes are on Massachusetts. Many critics cite Massachusetts as an example of reform gone awry, and it's time to set the record straight. The facts are: Massachusetts has the lowest uninsured rate in the country at 2.6%, and reform is going strong.
- Myth: The costs of reform in Massachusetts are wildly more than projected, destroying the state budget and unsustainable in the long run.
- Fact: Health care reform has added only moderate incremental costs to the state budget. The independent Massachusetts Taxpayers' Association recently found that between fiscal years 2006 and 2010, the annual incremental cost of reform was less than $100 million (less than 0.4% of the state budget), which is consistent with original estimates and a modest investment to reduce the state's uninsured rate to only 2.6%.
Entirely separate from reform is the issue of health care costs, which existed prior to the implementation of reform. Massachusetts has a long history of high costs, especially starting in 2000, when they began to accelerate.
Massachusetts expanded coverage building on employer-sponsored programs and Medicaid to fill in the gaps. We are now poised to build on a growing body of evidence to address rising costs. A state commission made up of providers, insurers, lawmakers, and other experts recently issued recommendations for reforming how we pay for health care. Instead of our current "fee-for-service" system - which rewards more care, not necessarily the right care - the commission endorsed a "global payment" model that prioritizes coordinated, efficient, and effective patient care and will ensure the long-term sustainability of reform.
Myth: Businesses are dropping employees from their insurance plans and paying the fines.
- Fact: The percentage of Massachusetts businesses offering insurance has stayed stable at 72% since reform, far higher than the national rate of only 60%. Massachusetts has checks and balances in place to ensure that people with access to affordable, employer-sponsored insurance do not enter the state subsidized plan. As the national economy has soured and unemployment increases, all states can expect to see residents lose employer-sponsored insurance. The federal stimulus bill provides assistance for unemployed individuals to help them afford COBRA coverage. Massachusetts is aggressively educating the newly unemployed about this benefit.
Myth: Following reform, Massachusetts has a shortage of primary care physicians (PCPs).
- Fact: Massachusetts has the highest ratios of PCPs to population in the country, with more than 125 primary care doctors per 100,000 people, compared to only 88 primary care doctors nationally. Access was a concern before reform, particularly outside of Boston. Since reform, 91% of people in Massachusetts report having a regular source of care, compared to 86% before reform. We have also seen improvements in the percentage of residents who report receiving health care services, having had a doctor's visit for preventive care, and having had a dental visit.
There is always room for improving access to primary care. Massachusetts is supporting efforts to redesign primary care practice and how we pay for primary care to promote coordinated patient care; delivery of preventive care; and effective chronic disease management.
Myth: The burden of reform in Massachusetts is being carried on the backs of businesses.
- Fact: Health care reform in Massachusetts was built on the principle of shared responsibility between government, employers, and individuals. A recent report by the Center for Health Law and Economics at the University of Massachusetts Medical School showed that each group has shared the costs of health care in the same proportion they did prior to reform.
Employers saw more individuals take up insurance. Government costs for low-income individuals increased slightly, but payments for services for the uninsured has declined. Individuals, who are required to have insurance if they have access to affordable coverage, have enrolled in and contributed to employer-sponsored plans or purchased individual plans. Overall, employers and union benefit funds contributed 48%, individuals contributed 25%, and government contributed 27% of spending on coverage in Massachusetts in 2007.
In only three years, Massachusetts' achievements in health care reform have been extraordinary. The Massachusetts model - which includes employers making a fair share contribution to coverage, government helping to cover low-income individuals, and an individual mandate - may not be the right model for every state to achieve 97% coverage, but it works here and has been anything but a failure.
Massachusetts and the nation face continued challenges related to the high costs of care, ensuring the highest quality care for everyone, and paying for coverage during a severe national recession. We are hopeful that national health care reform will help us to successfully meet these challenges.