5 Quick Facts About Mass. Health Reform You Now Need To Know

Prominent backers of Massachusetts health reform speak at the State House after the Supreme Court ruling. (Carey Goldberg/WBUR)

Now that the Supreme Court has upheld the federal health overhaul, which was based on the Massachusetts model, the state’s experience becomes more relevant than ever for the rest of the country. WBUR’s Martha Bebinger has been covering Massachusetts health reform since soon after its inception almost a decade ago. What better time to ask her to distill it all into a 5-part FAQ?

WBUR’s Martha Bebinger

1. Does the requirement that virtually everyone get health insurance actually work to bring universal coverage?

Let’s begin with basic numbers. The latest figures show that about 98 percent of Massachusetts residents now have health insurance, up from 94 percent before the reform (this earlier number varies a bit depending on the source.)

2. Does the threat of having to pay a penalty if you don’t get health insurance actually work?

Some economists say that yes, the threat of the penalty has been the key reason that more people have been signing up for their employer’s insurance or buying their own, but I haven’t seen that quantified.

What we can say is that only a small percentage of the Massachusetts population has actually been penalized since the state reform passed in 2006:  About 200,000 in a state of about 6.5 million. And as the penalties rise (see the chart at left) the number who pay them has been dropping.

The number of residents who, according to their state tax returns, are subject to paying the penalty:

67,000 in 2007
53,000 in 2008
48,000 in 2009
44,000 in 2010

3. How much has the law cost Massachusetts?

The only group that has looked at this question directly is the business-backed state government watchdog, the Massachusetts Taxpayers Foundation. They calculate that the Massachusetts law requiring that virtually everyone have health insurance has increased costs to the state budget by about $91 million a year. That means it’s costing an additional 1.4 percent of the state’s $32-billion budget. It’s important to note that Massachusetts was already spending more than most other states on the care of the uninsured even before the law passed, about $1 billion a year.

4. Has the law driven up health care costs?

The easiest way to answer that question is to look at health care premiums. Massachusetts had the highest health care costs in the country before the law was passed. Now, according to a Commonwealth Fund report, they are the ninth-highest in the country. It’s not clear exactly what’s behind that change; it could be the recession, or the health reform law, or early efforts to control costs. Costs do remain a major issue, and are the focus of the coming phase of the state’s reform.

Source: Commonwealth fund report on health insurance premiums by state

5. Do Massachusetts residents like the law?

About two thirds of them do, according to a WBUR poll this February, and about one-third oppose it.  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. Here are 10 signs that Massachusetts mostly likes health reform.

Out-of-state readers and Massachusetts residents alike, is there anything else you’d most like to know about how health reform is shaking out here? Please post your questions in the comments below. 

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  • Independentthoughtpolice

    In 2009, Massachusetts resident George Fountas sued the Department of Revenue for its “illegal taking of property” when the DOR withheld his tax exemption. He refused to disclose on his tax return his health insurance status and was penalized. Unforunately, there has been no real discussion in Massachusetts’ media or the national media about this lawsuit and its implications. Commonhealth provided a brief, but there was no analysis of Fountas’ position or the State Constitution that informed it. Also, there is no discussion about the differences between “health insurance” and “health plans” and the costs associated with them. There has been no public discussion about the people who work, earn decent incomes, and do not have health plans but who pay their medical bills. The working uninsured, who pay their medical bills out of pocket and do not fit the “free rider” sterotype, are simply discounted as though they do not exist. Yes, many people eventually get sick, but not everyone chooses conventional medicine and not everyone fails or refuses to pay for medical services. Not everyone wants to purchase anything more than “major medical,” which does not include all of the “benefits” Massachusetts health plans force residents to buy. There has been no media coverage (other than a brief article on Newsweek,.com about Beverly Flaxington and her family) about the people being fined for holding policies that doe not include state-mandated  “minimum creditable coverage.” The issues raised here are of very real importance and need open, public discussion.

  • Guest

    Why is it that the federal health reform was subject to legal scrutiny and was brought before the supreme court, while the Massachusetts health reform passed without the uproar associated with the ACA?

  • http://twitter.com/mem_somerville mem_somerville

    My individual policy (that I pay in full, no state assistance) is lower than it was in 2006 before this kicked in. And now I have more coverage because I didn’t carry prescription coverage before since it would have cost more.

    My access to various policies is FAR better through the Connector. And I don’t have to pay to join the local biz groups to get access to their more limited options. 

    • Martha Bebinger

      Hey mem_somerville – this is interesting.  The premiums for individual policies were supposed to go down because the state combined the individual and small group markets – and spread the risk over a larger group of people.  Small biz got the short end of the stick initially. But among individuals, I hadn’t heard of anyone who was paying less now than in 2006.  Hope this continues!

      • http://twitter.com/mem_somerville mem_somerville

         I wrote it up years ago here: http://www.dailykos.com/story/2009/12/12/813166/-MA-health-insurance-plan-my-experience and you can see my scans of the bills. In 2006 I paid $388/month, did not carry prescription coverage, and had to pay to join one of the local chambers to even get access to a couple of choices.

        My last bill was $371.19. And I just got my MLR check for over $250. So yeah–I’m ahead. It’s creeping up–but before the change it was rocketing.

  • Amy Lischko

    I don’t know if any other religions forgo medical treatment…..but I doubt that the State asks for much in documentation regarding religious preferences.  As far as affordability goes, I am also somewhat skeptical regarding how much the State investigates these declarations.  “Under the table” income is very hard to trace and it is certainly plausible that contractors and others have moved to a cash business so that insurance appears to be unaffordable (or maybe even makes them eligible for Commonwealth Care!).  I think trends in the number of exemptions (for any reason) certainly should be a factor in measuring the success of any mandate. 

  • Amy Lischko

    I’m not sure I agree with your conclusions about the individual mandate.  Don’t you need to also look at the number of people who are exempted each year?  That number has grown since the mandate was put in place…..and it isn’t just affordability.  For example, the number of people claiming religious exemption has grown from 5000 in 2008 to 7310 in 2010.  The increase in the number of people who find insurance unaffordable are greater from 168,000 in 2008 to 214,980 in 2010.  

    • Martha Bebinger

      Hi Amy – thanks for the note.  To me, the increase in affordability exemptions suggest that the cost of insurance is becoming more and more of a problem, not that the mandate isn’t working.  But I am very curious to know how you would answer the question  - has the mandate been successful to date?

      The rise in religious exemptions is also interesting.  Do you know if most of these people are Christian Scientists?

      Hope all is well!

  • http://twitter.com/josharchambault Josh Archambault

    Martha and Carey,

    Correct me if I am wrong, but it seems that the assumptions outlined in this piece links
    Massachusetts’ circumstances to play out exactly the same way in other states. 

    Do you expect New Mexico with 20+% uninsured, no guarantee issue in their individual market, employer sponsored insurance rates of 48.6 percent, lower income levels, lower education level, low-medical infrastructure, and geographically spread out to
    see the exact same results the Commonwealth?

    In my mind the Massachusetts experience only tells us something about states that are very similar to us from a geographical, cultural, regulatory, and medical standpoint.
    Otherwise I think health policy folks are in for a rude awakening as they watch the ACA implemented in other states.

  • Sara

    This is really helpful. Thank you, commonhealth.

  • Mark

    Have there been any studies that show how the Massachusetts health reform has effected Emergency room care?  With the percent uninsured going from 6% down to 2%; that is two thirds fewer people that might be getting their primary care in an emergency room rather than preventive care in a doctors office. 

    Some interesting statistics might be very telling, when compared before and after reform versus national trends:
    -number of uninsured showing up at ER
    -average ER wait time
    -percentage of ER bills that go unpaid and the cost of this for the providing hospitals