Blue Mass Group

Reality-based commentary on politics.

Massachusetts Health Reform Outcomes Paint Troubling Picture for National Reform

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Mass-Care and Massachusetts Physicians for a National Health Program today released a comprehensive new report on the outcomes of the Massachusetts Health Reform law, as well as analysis of 5 years of media coverage of the law. The results will surprise many: while Massachusetts reform has had some important beneficial impacts, covering about half of the uninsured and modestly improving access to care, these gains have come at a price:

  • Claims that health reform was a “shared responsibility” are disingenuous: rising costs after health reform have been disproportionately shouldered by lower-middle class families, letting the wealthy off the hook.
  • Small businesses have been particularly hard hit by health reform: quality health care coverage for small business employees all but disappeared in the years following health reform, and reform led to premiums for small employers rising more rapidly than in other states (7 percent faster for individuals and 14 percent faster for families).
  • Health reform accelerated the growth of administration in the Massachusetts health care system, by adding additional complexity to an already expensive and fragmented system.
  • Underinsurance has increased rapidly after health reform, with high-deductible plans tripling between 2006 and 2008.
  • Health reform and subsequent policy decisions have led to a financial crisis for the state’s safety net hospitals and health clinics, which provide care for low-income and minority communities, despite growing demand for safety net care.

Most of the newly insured previously had access to the state’s safety net program for the uninsured (called the Free Care Pool), and certain income groups actually had better access to care when they were uninsured than under Commonwealth Care coverage. Although Massachusetts reform was largely paid for by federal taxpayers, the remaining costs were still high and unsustainable for the state, which has led the state to gradually roll back the Commonwealth Care program (by disenrolled thousands of documented immigrants, increasing the share beneficiaries who are forced to pay premiums, raising co-payments, imposing limited networks, and other strategies that shift costs on to low-income families). Furthermore, the state has regularly increased the share of income it claims residents can afford to spend on health care premiums, in an attempt to continue mandating people to purchase insurance.

Lastly, the report uncovered a pattern of widespread media bias in coverage of the Massachusetts health reform law. Most media sources cite only the lowest estimates of the uninsured in Massachusetts, although these have been demonstrated as inaccurate. It is also common for the media to perpetuate inaccurate myths about uninsured residents’ use of emergency rooms, and to project savings from health reform that never materialized: even as half of the uninsured gained some form of insurance coverage, emergency room use and preventable or avoidable emergency room use continued to rise. Health reform has also failed to significantly reduce the share of families facing medical debt or facing health-related bankruptcy.

You can download the report in its entirety here.

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Comments

    • From the report the post is about:

      Romney’s Democratic successor, Governor Deval Patrick, wrote in March 2011 testimony to Congress that “Today… [m]ore people are getting preventive care instead of waiting until they have to go to the emergency room… We paid for expanded coverage as we said we would, by delivering more care in primary care settings than in emergency rooms.”39 However, reform at best slowed the growth of ED visits, and providing expanded coverage to the uninsured has not created savings to pay for reform.

      A 2006 editorial by the New York Times titled Mandatory Health Insurance,” states that “[V]ery few of the uninsured go entirely without medical care. When they get sick, they typically show up at emergency rooms, where they get very expensive care without paying… By forcing all residents to assume responsibility for their own health coverage, Massachusetts should largely solve this ‘free rider’ problem and tilt treatments back toward routine and preventive care and away from emergency care.” 40

      Boston Globe reporters covering the 5th anniversary of Mass. Health Reform state as background information that “The law also has quietly extended health coverage to hundreds of thousands of Massachusetts’ 6.5 million residents who would otherwise be forced to seek health care in emergency rooms or forgo it altogether.” 41 The uninsured do forego care, but there is no evidence they overutilize emergency departments.

      The ‘free rider problem’ is a myth: the state paid for only the lowest-income uninsured residents, and continues to pay for care for the lowest-income residents through a subsidized insurance policy.

      You can criticize the findings, but a 45 report with an 8 page bibliography and 3 pages of endnotes can’t be attacked for not citing sources…

    • Most of the estimates in the report on the impact of reform use pre-post analysis (comparing rates prior to reform – which we can assume would have continued without reform – to those after) or use other states as a control (another assumption being that rates in Mass. would have behaved like those in other states without reform) or they use both as controls for certain subgroups, which is called difference-in-difference. There’s a lot of data discussed in the report, though – happy to clarify any particular sections.

      The ‘media watch’ sections are on pages 10 (estimates of the uninsured),
      18 (uninsured peoples’ use of emergency rooms), 21 (public opinion), and 24 (costs of the law) of the report, documenting issues of media bias. Additionally, the whole section on the concept of “shared responsibility” (pages 25-27) is also relevant to press coverage. They are all carefully cited. I would say bias in estimates of the uninsured is the most prevalent, though.

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