On Friday, the Blue Cross Blue Shield of Massachusetts Foundation released Massachusetts Health Reform: A Five Year Progress Report (pdf). The report, written by Alan Raymond, is the key summary of the status of coverage reform in Massachusetts in 2011.
At 98.1% Massachusetts has the highest rate of insured residents in the nation. This fact is largely due to the passage and implementation of Chapter 58, Massachusetts’ landmark 2006 health reform law.
The Blue Cross Blue Shield of Massachusetts Foundation report finds that Massachusetts health reform has been largely successful in meeting its goals:
- Make coverage affordable for uninsured, low-income residents who do not have access to employer coverage and who do not qualify for Medicaid: Prior to health reform, nearly three-quarters of the state’s uninsured were from low- and moderate-income families whose earnings were too high to qualify for Medicaid coverage. Commonwealth Care now covers most uninsured adults in this population.
- Maximize enrollment of low-income residents eligible for Medicaid and CHIP and take full advantage of federal matching dollars available through the state’s MassHealth waiver: The 2006 health reform law also expanded MassHealth (Medicaid and CHIP) eligibility and restored programs and benefits that had been suspended during a state budget crisis several years earlier. For both Commonwealth Care and MassHealth, statewide coordinated outreach and enrollment efforts were integral to connecting people to the coverage they are eligible for.
- Maintain a mechanism to pay acute care hospitals and community health centers for “essential health care services” provided to low-income, uninsured and underinsured Massachusetts residents: When tens of thousands of the state’s previously uninsured, low-income residents were converted to coverage at the outset of health reform, the use of the new Health Safety Net – formerly the Uncompensated Care Pool – care fell dramatically, as expected. Due to the economy and several budget cuts mentioned above, HSN utilization has trended upwards in the past three years, but is still below pre-reform levels.
- Create the largest possible pool of insured in order to spread the financial risk among healthy and sick residents; discourage “free-riders” who do not pay into the system even though they cannot be denied needed care; and encourage more workers to accept their employer’s offer of coverage: The 2006 law requires all Massachusetts residents 18 and older to obtain health insurance if affordable coverage is available, or else be subject to a state income tax penalty. The most recent data provided by the Department of Revenue, show that 97% of those who were required to verify their health insurance status, complied with the requirement.
- Make employers financially accountable for failing to participate in their employees’ health coverage: Data from the Commonwealth’s 2010 fair share contribution filings show that more than 95 percent of employers subject to the requirement are meeting the “fair and reasonable contribution” standard.
- Spread the financial risk of ensuring individual and small group populations over a larger pool of insured and help make individual insurance more affordable: After the individual and small-group markets were merged on July 1, 2007, coverage for non-group members became significantly more affordable
- Create a “health insurance exchange” that makes it easier for individuals and small businesses to find and purchase affordable coverage: The Commonwealth Choice program through the Connector allows individuals and small businesses to make apples-to-apples comparisons of quality health plans.
- Increase the public’s access to cost and quality information and act as a catalyst for health system changes that enhance the quality and affordability of health care in Massachusetts: The Health Care Quality and Cost Council has created a website called MyHealthCareOptions, which allows consumers to compare hospitals and physician groups using quality- and cost-related information.
- Understand and begin to address the various factors, both inside and outside the health care system, that contribute to disparities: The Health Disparities Council has adopted a framework for planning, implementing, and evaluating efforts to eliminate racial and ethnic health disparities.
Overall, expanded coverage has been accompanied by improved access to care, especially among low-income adults, with significant increases in physician office visits and the use of preventive care, and in the percentage of adults with a usual source of care. Fewer residents report they have unmet needs for care, with decreases especially notable among middle- and low-income residents, racial and ethnic minorities, and people with chronic diseases. And, the state did this without breaking the bank. In fiscal year 2011, the state’s share of spending for health reform amounted to just over 1% of the state’s $32 billion budget.
However, the state has also faced several challenges in sustaining reform. In 2009, a state budget shortfall resulted in elimination of Commonwealth Care coverage for over 26,000 legally documented immigrants; with another 25,000 people of similar status only unable to access care through the Health Safety Net. The next year, still facing a budget shortfall, the state eliminated certain dental benefits for adults in the MassHealth program.
So, what’s next? All of the stakeholders involved in shaping the 2006 health reform law now agree that the top priority for Massachusetts health care is to make it more affordable. Governor Patrick filed a payment reform bill with the legislature in early 2011, and most stakeholder organizations are shifting their focus to this effort – including Health Care For All.
The future of Massachusetts health reform will also be shaped by implementation of the Affordable Care Act. Although Massachusetts health reform clearly provided a model and framework for the ACA, there are significant differences in the two approaches that need to be resolved.
Massachusetts health reform provides a strong foundation from which to make even more improvements in our health care system. The Foundation report’s author sums it up well: “If Massachusetts is able to moderate future increases in health care spending while continuing to expand access to coverage and care, its status as a pioneer in transforming the U.S. health care system will be assured. The ultimate test of success, however, will be whether the state can achieve sustainable, measurable statewide improvements in the health and well-being of its residents regardless of income, race, ethnicity, or employment status.”