10 Signs That Mass. Mostly Likes Health Reform, Really And Truly

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You know how it is: When your town or your company or, heaven forbid, your family or friends are portrayed in the media, its funhouse mirror tends to distort them almost beyond recognition. That’s a bit how it felt during the Supreme Court health law hearings this week as national media outlets turned their spotlight onto Massachusetts and came up with headlines like this one in The New York Times: “In Massachusetts, Insurance Mandate Stirs Some Dissent.”

I mean, not that there’s no dissent here. Of course there is. A WBUR poll earlier this year found that 33% of residents oppose the state’s health reform law. But I think many of us would agree that the newsworthy, surprising, man-bites-dog moment here is how little dissent there’s been. (Kudos to the Worcester Telegram & Gazette for choosing this headline for that same Times story: “A few Mass. residents still without health insurance.”)

We asked WBUR’s Martha Bebinger, who has covered Massachusetts health reform with unmatched energy and expertise since before it passed in 2006, for a reality check. “I’ve been looking for a movement of dissenters for six years and haven’t found it,” she said. “I have a handful of people I call regularly and ask, ‘Are you doing anything?’”

The Facebook page for ‘Massachusetts Against The Individual Mandate’ got only43 ‘Likes.’

Here are 10 points that back up our impression that health reform has turned out to be strikingly palatable to most here in Massachusetts:

• A WBUR poll released in February of this year found that  62 percent of residents support the Massachusetts health reform law while 33 percent oppose it. (In the WBUR report on the poll, pollster Robert Blendon notes that people outside the state have a hard time believing how accepted the reform is here.)

• A 2011 poll by The Boston Globe and the Harvard School of Public Health similarly showed that 63 percent of Massachusetts residents supported the state law, and that support had risen since 2009. The federal law has an approval rate of 41 percent, and an unfavorable view by 41 percent of those surveyed, according to a monthly tracking poll by Kaiser.

• In Massachusetts, there have been no major court challenges or attempts to overturn the health insurance requirement.

• Backers of an initiative to repeal the individual mandate in Mass. failed this fall to get enough signatures to appear on the ballot.

• Not only did they fail to gather enough signatures, but the Facebook page for “Massachusetts Against The Individual Mandate” got only 43 ‘Likes.’

• At latest count, 98.1% of Massachusetts residents actually had health insurance, by far the highest rate in the country.

 • 99% of tax filers comply with the requirement to show that they have health insurance. (The penalty kicks in if you can’t prove you have adequate health insurance.)

• The number of people paying the penalty has been going down ever year, Martha reports. She notes that the state does not penalize residents for whom health insurance is not affordable (although the state, not the individual decides what is affordable).  In 2009, the state automatically waived the penalty for more than 40,000 residents because they could not afford coverage.

•The number of appeals of the penalties is strikingly few: Only a couple of thousand a year in a state of over 6 million people.

Note: Though few actually pay it, he threat of the penalty can be plenty unpleasant. Martha’s reporting on the WBUR poll included this:

Cummington resident Paula Zindler, another undecided voter, said the state law, which both Brown and Warren support, has forced up the cost of her health coverage.

“We had to switch to a different carrier, ’cause my insurance, I was told, was inadequate,” Zindler explained. “So I either had to change my insurance or pay a fine, and I’m not happy with that.”

•Of the Massachusetts people who’ve appealed the penalty, the majority generally win and are allowed to go without paying, according to the Connector.

All in all, there just doesn’t seem to be a very large pool of people who feel directly damaged enough to be up in arms. It should be noted: Massachusetts had an unusually high rate of health insurance even before the health law was passed, and many of the residents who had lacked insurance qualified for free or subsidized policies.

I wouldn’t call this a data point, but even the self-same New York Times that wrote about Massachusetts dissent this week proclaimed Massachusetts health reform a resounding and well-accepted success last May.

I messaged Brian Rosman of the nonprofit Health Care For All, which backs health reform in Massachusetts, with a perplexed query, saying the “some dissent” coverage struck me as a “glass half full” description when in fact there were only a few drops in the glass. Would Health Care For All respond? Part of his reply:

For virtually every single Bay Stater – some 98% – health reform has led to secure, affordable coverage. The mandate works when combined with employer fair share requirements, a Connector that makes it easy to shop for coverage, and sliding scale help for low income people…The Massachusetts health reform glass is very, very full – right up to the brim.

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  • http://www.freedomhealth.co.uk/medical-services/private-doctor-services/136/ private doctors


    The number of appeals of the penalties is strikingly few: Only a couple of thousand a year in a state of over 6 million people. ” 

    It’s true. i’m agree with you.

  • Tanya

    Since its start in 2007, health care reform in MA definitely had a positive impact on my life. I could hardly have better things to say about it in my case.

  • http://www.facebook.com/people/Josh-Archambault/68400569 Josh Archambault

    Carey,
    Have you seen any polling pre-reform in MA? It would be interesting to compare the number of those satisfied with our system with the numbers you cite.
    My guess is that– when you start with 92% of folks insured and most getting that coverage from larger employers (and therefore not impacted directly by the reform) they would have reasonably positive impressions.
    Does this disprove Brian’s assessment?
     “For virtually every single Bay Stater – some 98% – health reform has led to secure, affordable coverage.”
    It would seem health reform had very little to do with this. Do you agree?

    • Brian Rosman

       Josh,
      I think health reform here has been an enormous plus for state residents, even for the vast majority of people who were covered before 2006.

      In Massachusetts, people who have had medical problems can get coverage even if their employer doesn’t offer insurance. This isn’t true in almost all other states, where individual (non-employer) coverage is not available to those with past illness.

      In Massachusetts, people can get sliding scale help with the cost coverage, even if they don’t have children or make more than subsistence income. This isn’t true in almost all other states, where Medicaid only covers parents, disabled, kids and seniors, and only if they are very low income.

      In Massachusetts, employers and individuals can compare coverage from different insurers, knowing that their choices provide good value. This isn’t true in any other state, because only our Connector allows apples-to-apples comparisons of equivalent plans, with all plans screened for quality and value.

      All of these add up to peace of mind and real security, and I think fundamentally change the way people think about health coverage. Even if you now have good coverage through work, knowing that you can get affordable insurance if you lose your job, if you get sick, if circumstances change, is valuable. Don’t you agree?

      Brian Rosman
      Health Care For All

      • Mike

        I am a self employed person. My wife is having a baby this May and is thinking of staying home for a while. I looked at the Commonwealth Choice plans and just about every family plan was well over $1000 per month, almost as much as our mortgage. It appears there isn’t any help for those with a family of 3 with over I think $58K per year. I think that I might be looking at the wrong plans. Any advice on getting an affordable plan? Mike

        • dennis byron

          Mike

          Brian didn’t mean Commonwealth Care scaled very high. 

          Try going directly to an insurer or to another broker (All the Connector is, unless you get to it through the Massachusetts Medicaid bureaucracy, is an insurance broker. My experience as a self-employed customer of Commonwealth Choice is that the Connector marked up insurance premiums 3%-5% above direct charges.)

    • http://byrondennis.typepad.com/masshealthstats/ dennis byron

      @brianrosman

      I think Josh has it right. You say:

      “In Massachusetts, people who have had medical problems can get coverage even if their employer doesn’t offer insurance. This isn’t true in almost all other states, where individual (non-employer) coverage is not available to those with past illness.”

      Wasn’t this true prior to 2006? I believe guaranteed issue started in the 1990s? (And it’s availalbe ONLY if their employer doesn’t offer coverage, correct?)

      You say:
       
      “In Massachusetts, people can get sliding scale help with the cost coverage, even if they don’t have children or make more than subsistence income. This isn’t true in almost all other states, where Medicaid only covers parents, disabled, kids and seniors, and only if they are very low income.”

      I assume this refers to the CommonwealthCare scale where about 75% of the people on the plan get insurance for free and about 25% at slightly higher income levels get $500 a month insurance for an average of $100 a month (old data but newer data not released by state for some reason).  How much of this is from the Medicaid waiver that predates 2006?

      (As an aside, it’s just Medicaid for people not quite as low income as Medicaid eligible. Why not make the case that the Medicaid eligibility band should be widened?   What about the problem that – just as with Medicaid — about half the doctors won’t accept the insurance? And — per the first point — it doesn’t apply if their employer offers insurance?) 

      You say:

      “In Massachusetts, employers and individuals can compare coverage from different insurers, knowing that their choices provide good value. This isn’t true in any other state, because only our Connector allows apples-to-apples comparisons of equivalent plans, with all plans screened for quality and value.”

      This is not true but it also does not address Josh’s point concerning the 97% of us not involved with Commonwealth Care. And people buying individually in Massachusetts – which is all you seem to address — could always compare coverage from different insurers.

      Finally, the whole concept of basing any decisions about how to actually fix health care problems in Massachusetts (since the legislature is now trying to change RomneyCare for the fourth or fifth time and RomneyCare itself was the fourth or fifth reform in my working life, everyone seems to agree it doesn’t work well) on opinion polls is wrong.

      • Mike

        I would like to get a decent family plan for about $500 a month. We are late 30′s and will have one child. Is that possible? Mike

        • http://byrondennis.typepad.com/masshealthstats/ dennis byron

          sorry Mike but I’m not an insurance broker.  I am just suggesting you talk to one or call Blue Cross direct rather than going through the Connector Authority, which looks like it marks up the cost of the insurance it sells to the self-employed more than other brokers

          (Can your wife get COBRA and how much would that be?)

          • Mike

            Cobra is $1300 per month. We looked at a few different options, but most not only cost $1000 +, but have $5000+ family deductables. I don’t doubt the health care law has helped many people, but it still has a long way to go. I can’t imagine how many people are held back from starting a small business once they see these prices.

  • http://twitter.com/Renegotiating HealthCareNegotiate

    It is amazing and sad that none of this is likely to come into the decision that the Supreme Court will render in June. The case will turn on hypothetical orders to eat broccoli rather than evidence from the one state where this has been tried.

    Of course I am biased — I like broccoli, too.