Over the summer, Progressive Massachusetts is highlighting aspects of our Shared Prosperity Agenda. Our members are sharing their experiences and expertise on Education, Healthcare, Housing, Jobs and Wages, and Progressive Revenue.
This week we are focusing on Healthcare –
Quality, affordable health care is a human right. And a single-payer system has been shown time and again to be the most effective at reducing costs and improving outcomes. Unfortunately, multi-billion dollar insurance companies profit too much from our poor health, and it is going to take a powerful grassroots movement to overcome the influence of their armies of lobbyists and cash on Beacon Hill.
The good news is that we have a plan to get to single-payer healthcare in five years, and it begins with a public option. We believe that when people experience first-hand a simplified healthcare system, they will like what they see.
To go deeper into these issues, see our blog posts from our members below: Ari Fertig looked back at the history of Massachusetts’ leadership on healthcare reform, setting the terms for national reforms; and Enku Kedebe-Francis looked forward, writing how a Medicare for All system would benefit the state’s economy and health outcomes.
by Enku Kedebe-Francis, author of Global Health Disparities
Before the implementation of the 2006 health reform, Massachusetts had a fragmented health insurance scheme: many residents lacked coverage and those who were uninsured extensively overused hospital emergency rooms. Shortly after the law was enforced, the first in the nation, 98% of the residents were covered. Nobody can say it was an easy process and twice in 2008 and 2010, the original law was amended and currently Massachusetts is in the process of complying with the Federal program, The Affordable Care Act (ACA), which was modeled after the Massachusetts program.
The next changes that Massachusetts will need to make must be on controlling costs and changing the payment system. Although we have a universal healthcare system in Massachusetts, the current multiple payer system adds difficulties for patients, doctors, nurses and hospitals who have to navigate through layers of bureaucracy and state of Massachusetts pays substantial amounts of money and devote considerable amounts of time. But, fortunately, we have an alternative mode of payment that has worked very well that we could apply. Almost everyone would agree that Medicare is one of the most successful Federal programs and most importantly, according to Center for Medicare and Medicaid, its management only costs 1% of its budget.
In 1965, President Johnson and Congress created Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history.
We argue that if Medicare has worked for those who are age 65 and older, it should also work for those younger than 65. Ask anyone who is receiving Medicare, or their families. You will find out that even those who do not support a government run healthcare program would agree that this government run program, Medicare, has worked for millions efficiently and has kept its management costs to the absolute minimum.
If Massachusetts amends its health insurance payment system by replacing the multiple payment system with a single payer system, a Medicare-for-all, the patients and their doctors will only deal with a single payer and the money the state saves could be used for other programs including research, education, environment and transportation infrastructure, for example. This will not only benefits Massachusetts but the nation as well. If the Massachusetts health insurance scheme could be managed like Medicare and spends only 1-2 percent of it’s current budget, this group of bloggers endorse an amendment that promotes Medicare-for-all.
Progressive Massachusetts has proudly endorsed Dr. Don Berwick for Governor who believes patients, families, workers, businesses, health care providers, and the public treasury would benefit a great deal if the state’s health care costs are lower and, at the same time, the citizens of Massachusetts enjoy better health outcomes.
by Ari Fertig, Health Care For All
Since the 1980s, the state has tried a series of dramatic health policy endeavors, each of which has influenced national policy. To understand where we are going next, and if we want to enact our Shared Prosperity Agenda, it’s worth taking the time to understand the rich history of the health reform movement here at home. Below Ari Fertig has adapted a version of some of that history by Brian Rosman, Research Director at Health Care For All.
In 1988, under Governor Michael Dukakis, Massachusetts enacted far-reaching legislation establishing universal health coverage. The centerpiece of that law was the policy of “pay or play,” requiring most employers to either “play” – provide health coverage to their workers and families; or “pay” – pay an assessment to the state equal roughly to the cost of providing family coverage, which in turn would be used to provide subsidized insurance.
While the pay or play provisions of the law were never implemented, and ultimately repealed in 1996, the Dukakis law included a number of other policy experiments that influenced national policy, including expanded coverage for children, subsidized coverage for people with disabilities who are working, and funding health coverage for people receiving unemployment benefits. Another provision required all college students to have health insurance, the first instance of a state individual mandate. All of these provisions remain in Massachusetts state law today.
Every decade or so, Massachusetts undergoes an effort like this one to make quality, affordable health care available for all. In 1996, the state overhauled its Medicaid program, renaming it “MassHealth,” with greatly expanded eligibility, a simplified application process, and most members enrolled in managed care systems. The expansion was facilitated by a generous deal worked out with the federal government, using the Medicaid waiver process to allow Massachusetts to claim additional federal funds.
But after the recession in 2001, the number of uninsured grew. While the 1996 Medicaid expansion was successful in driving down the number of uninsured (from around 680,000 to 365,000), by 2004 the number of uninsured people had grown to about 460,000 people.
Second, with the growth of the uninsured came increased demands on the state’s Uncompensated Care Pool, a hospital reimbursement program funded by hospitals, insurers and the state. The program was designed to require minimal state funding, around $30 million. But growing numbers of uninsured patients showing up at hospitals led to increased state funding, reaching $206 million in 2006.
And so, a broad coalition of health care groups, organized by advocacy non-profit Health Care For All, formed to push for coverage expansions. The coalition, known as ACT! (Affordable Care Today), included the state’s hospital association, medical society, community health centers, and numerous influential civic and religious groups. Especially important was the role the Greater Boston Interfaith Organization played. A subset of ACT! gathered some 140,000 signatures to place a reform plan on the ballot, with the intent to force legislative action.
The plan worked. The legislature was interested in having its say – and did not want the ballot initiative to move forward. Governor Mitt Romney was interested in finding a market-oriented approach to covering the uninsured.
Governor Romney’s staff consulted with the Heritage Foundation, a conservative Washington think-tank. They had advised him on a number of ideas that had also informed the early-90s Senate Republican alternative to the Clinton plan, centered around an individual mandate, a structured market for coverage, and sliding scale subsidies for private insurance.
These concerns coalesced in the legislative process that led to enactment of “Chapter 58” with virtually-unanimous majorities in both the House and Senate. Note that it was called Chapter 58 or “Massachusetts Health Reform” – nobody called it Romneycare until later, when it was cast as the state version of the Affordable Care Act, or “Obamacare.”
Governor Romney signed the law, with Senator Edward Kennedy looking over his shoulder, in the historic Faneuil Hall, with Romney campaign TV crews capturing the whole thing for anticipated use in Romney For President TV ads.
The elements of the law included further expansion of MassHealth (Medicaid), mainly for children; sliding-scale insurance subsidies for low- and moderate-income adults (Commonwealth Care); a reformed individual health insurance market, with an exchange, called the Health Connector, to make it easy to compare and purchase plans; and requirements on employers to offer and individuals to obtain coverage, if it’s affordable.
This of course proved to be the model for the Affordable Care Act, the national story is worth a post unto itself. But what Chapter 58 did not truly address was the issue of costs.
In summer 2012, the legislature enacted a far-reaching bill, known as Chapter 224 or “payment reform,” aimed at controlling cost growth. The law’s major planks include increasing care coordination, using payment incentives to promote health and efficient care, and investing in public health prevention programs. The law also includes transparency provisions, malpractice reforms, expanded primary care and many other features.
Right now the state is working hard to implement the Affordable Care Act and Chapter 224 simultaneously. A new study suggests that due to the ACA, over 99% of Massachusetts residents have access to some form of insurance.
There is a lot of change coming to the Commonwealth in the way we are shifting paying for care and in the way that consumers will find affordable health care options. Advocates of the Shared Prosperity Agenda must be mindful of these changes and this history as we work to achieve our goals.
See our full statement of Health Care Values here.
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