Laboratory of Democracy Lab Report

Lessons from Massachusetts Health Reform

The Blue Cross Foundation has released a helpful review of the Lessons from the Implementation of Massachusetts Health Reform (PDF). The report draws out eight lessons that are useful for other states as they begin their ACA implementation process. These lessons are also useful reminders to us as guides for ongoing implementation success. Each lesson is accompanied by a recommendation.

The key lessons and recommendations are:

  1. Ongoing stakeholder engagement in health reform facilitates implementation and helps overcome inevitable obstacles.
    Recommendation: Bring health care stakeholders to the table as quickly as possible to find common ground and keep them engaged.
  2. Strong, centralized coordination among government agencies helps to overcome the fragmentation often inherent in the health care system and in government functions.
    Recommendation: Create processes to facilitate collaboration and accountability among all parties responsible for the implementation of health reform.
  3. Close coordination between Medicaid and new public insurance programs is needed to maximize enrollment and retention while also reducing redundancy and administrative costs.
    Recommendation: Build on existing public programs, and structure eligibility and enrollment rules and processes in ways that will maintain continuity of care and coverage for people at all income levels, and as their income changes.
  4. Connecting uninsured residents to coverage and care requires an intense, state-wide effort that draws upon the knowledge and experience of local service groups and organizations.
    Recommendation: Develop and support a broad array of community-based outreach, enrollment, and retention activities that help uninsured residents sign up for, and maintain, health coverage.
  5. Successful implementation requires high levels of awareness and understanding among individuals and businesses about their opportunities and responsibilities under health reform.
    Recommendation: Create a comprehensive, ongoing communications campaign that draws on both public- and private-sector resources.
  6. No matter how successful health reform proves to be, there will still be uninsured and underinsured people who need access to medical care.
    Recommendation: Maintain a strong safety-net system that can meet the needs of patients who remain uninsured and that supports safety-net providers who provide care for low-income patients.
  7. Health reform implementation is an ongoing process that requires continuous improvement based on feedback from consumers, employers, providers, and other stakeholders.
    Recommendation: Track the impact of health reform, report results, and make changes in policies, processes, and operations as needed.
  8. Moderating future growth in health care spending is far more difficult than achieving nearly universal coverage, but without cost control, coverage expansions are unsustainable.
    Recommendation: Press for continued health system reforms that will reduce the burden of health care costs while supporting expanded access to coverage and care.

The report includes examples illustrating the lessons, and is good summary of health reform achievements so far. It concludes with our central challenge:

After almost five years of experience with health reform, Massachusetts policymakers and advocates have confirmed that implementation is a complex, ongoing process. It has taken a sustained, community-wide effort to enroll virtually all eligible residents, help connect them to the health care system, and maintain unprecedented levels of coverage, even in the face of the worst recession in decades.


Massachusetts has demonstrated that nearly universal coverage is a realistic and achievable goal. Now, the foremost challenge for Massachusetts is to find ways to gain greater control of health care costs without adversely affecting access or quality of care.

-Brian Rosman

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2 Responses to Laboratory of Democracy Lab Report

  1. ? says:

    Shouldn’t the heading be Laboratory of Cleptocracy Lab Report?

    In “Lessons from the Implementation of Massachusetts Health Reform”, why is there no mention of established “processes to facilitate collaboration”, such as between the Board and Cleve with his golden parachute?

  2. Dennis Byron says:

    It’s healthcare insurance reform, not health care reform. And as the sixth point illustrates, it failed.

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