(Lucia Sofo via Wikimedia Commons)
The latest report on access to medical care in Massachusetts is looking just about half-full — or half-empty, depending on your disposition. The good news is, the waiting times to see Massachusetts doctors are not generally getting worse, and some even slightly improved. The bad news is, it can still take a month or more to get an appointment — and only about half of primary care doctors are taking new patients. Half of residents surveyed say affordability is the biggest issue in health care.
WBUR carries the AP report here, including:
Access to primary care doctors in Massachusetts improved slightly in 2012, although about half still say they aren’t accepting new patients, according to a Massachusetts Medical Society survey released Wednesday.
The survey found 51 percent of internists and 50 percent of family doctors say they are taking new patients. That’s a small improvement from last year, when 49 percent of internists and 47 percent of family doctors were accepting new patients. Continue reading
WBUR’s Martha Bebinger reports:
The state must restore full health insurance benefits for about 40,000 legal immigrants who were given slimmed-down coverage three years ago to save money.
The state’s highest court said today that the cheaper insurance that the legislature created for legal immigrants in 2009 “violates their rights to equal protection.” Amy Whitcomb Slemmer, the director at Health Care for All, is celebrating the decision. She said:
“We know that this is absolutely the right thing and it’s an affirmation of what this state has done consistently on behalf of the people in Massachusetts and on behalf of the health reform law that we stand so firmly behind.”
Restoring full health coverage through the state’s Commonwealth Care program could cost in the range of $150 million. There’s no word yet from the Patrick administration about how they will absorb this additional cost.
And here’s the report on today’s decision on Health Care for All’s blog:
The SJC just issued their opinion in Finch v. Commonwealth Health Insurance Connector Authority, the case brought by Health Law Advocates contesting the denial of full Commonwealth Care benefits to legal immigrants who did not qualify for federal Medicaid reimbursement. The unanimous decision requires the state to reinstate full coverage for all legal immigrants. Continue reading
You figure that when a press release comes in from Physicians for a National Health Program, it has an agenda. But that doesn’t negate the value of the research it highlights — which, in this case, was a paper from Harvard Medical School researchers just out in the Journal of General Internal Medicine.
It’s titled “Reasons why patients remain uninsured after Massachusetts’ health care reform: A survey of patients at a safety-net hospital.” And here’s its summary:
After full implementation of the Massachusetts health reform, those remaining without insurance are largely the working poor who do not have access to, or cannot afford, either employer sponsored insurance or state subsidized insurance.
The reasons why people lacked insurance varied, from having recently lost coverage through a job to fear of giving their personal data. From the Physicians For a National Health Program press release:
To understand why people remained uninsured after the reform, the study authors surveyed 431 patients, ages 18-64, who were visiting the emergency room of Massachusetts’ second largest safety-net hospital.
The researchers found that of the 189 patients without health insurance, two-thirds (65.9 percent) were employed, but only a quarter had access to employer-sponsored insurance. In addition, about one-third (35.2 percent) of uninsured patients reported having lost previous insurance coverage, with the majority of these (51.9 percent) having lost their coverage due to loss of a job or transition from one job to another. Continue reading
Fresh this morning: A report from the Blue Cross Blue Shield of Massachusetts Foundation called “Lessons From the Implementation of Massachusetts Health Reform.” The full report is here, but let me try to sum it up without using words like “implementation:”
You have to keep learning as you go. You have to get broad buy-in, really spread the word — especially to the uninsured — and support a “health safety net” because even near-universal insurance coverage doesn’t mean everybody gets the care they need. And then, once you get just about everybody insured, you still have to face the much harder problem of cutting costs.
An example of spreading the word:
And here’s the foundation’s own summary of the report’s main points:
This report presents an overview of key lessons from Massachusetts that could be relevant to stakeholders working to implement health reform in other states and nationally.
Ongoing stakeholder engagement in health reform facilitates implementation and helps overcome inevitable obstacles.
Close coordination between Medicaid and new public insurance programs is needed to maximize enrollment and retention while also reducing redundancy and administrative costs.
Connecting uninsured residents to coverage and care requires an intense, statewide effort that draws upon the knowledge and experience of local service groups and organizations.
Moderating future growth in health care spending is far more difficult than achieving nearly universal coverage, but without cost control, coverage expansions are unsustainable.
Dr. Paula Johnson — Chief of the Division of Women’s Health at Brigham & Women’s Hospital, and Executive Director for the Connors Center for Women’s Health and Gender Biology — spoke today of the need for a new grassroots movement — a civil-rights-like activist uprising — to promote equal, high-quality health care for all. Her remarks were part of an event honoring the noted psychiatrist, activist, author, consultant, and Harvard professor, Dr. Alvin Pouissant, who provided medical care to civil rights protestors and worked towards desegregating medical facilities in the Deep South in the 1960’s.
Dr. Johnson (who, full disclosure, has treated a close member of my family) is herself a pioneer, serving as the first African American chief medical resident in the history of the Brigham, and a physician on the forefront of women’s health and cardiology.
Here she describes what health care can learn from civil rights:
What I would like to do now is to share 5 lessons from the Civil Rights Movement that I believe can apply to health.
The first lesson is that:
Change takes time and we must take every opportunity to accelerate change.
It took from 1870 to 1965 for blacks to gain the true right to vote! But there were clear moments in time when change was accelerated, as with the marches in Selma. Today, in Health, we need to accelerate change.
This leads us to the second lesson:
It is a compelling Vision and inspiring leadership that motivate and sustain us as we work toward our goals.
Today, we need a grander, a more ambitious vision for health. And we need leaders willing to step up and help us realize this vision.
The third lesson is:
True change rarely comes from the halls of Congress alone—laws are essential but insufficient to make true change. Continue reading
With court challenges to federal health reform heating up, Ezra Klein, a god-like wonk at The Washington Post, told readers this weekend that it was time to check in on Massachusetts. How are we faring with the mandate that requires everyone to be insured?
Very well, he concludes. More than 98 percent of residents are insured, and the system does all right in the polls.
Read his whole piece here, but here’s an excerpt:
Like the federal law, the Massachusetts law left most people’s health arrangements alone. The exception: people who don’t get their coverage through a large employer or a public program. That accounts for most of the uninsured. It’s also where the individual mandate is primarily in play and where the “exchanges” – the purchasing markets that put individuals and small businesses in a single pool and force insurers to compete for their business and treat them fairly – really matter.
In Massachusetts, that market has worked better than expected. According to data from America’s Health Insurance Plans, the largest health insurer trade group, premiums for that market have fallen by 40 percent since the reforms were put in place. Nationally, those premiums have risen by 14 percent.
There are a couple of reasons for Massachusetts’s success. One is that the market is more transparent, and so insurers are competing more aggressively against one another. Jon Kingsdale, who ran the new health-care market, notes that the lower-cost plans have been much more popular than the higher-cost plans. The bigger reason is that the individual mandate – plus the combining of individual and small firms in the same insurance market – brought healthier, younger people into the mix, which brought average premiums down for everybody.
Just a smidgen away from truly universal health insurance coverage…This just in from state officials on the latest Massachusetts figures:
The Massachusetts Division of Health Care Finance and Policy (DHCFP) is pleased to announce the results of its latest Massachusetts Health Insurance Survey. DHCFP has found that the success of Massachusetts’ health reform continues, with more than 98 percent of residents having health insurance, which reflects an increase since 2009. Only 1.9 percent of state residents remain uninsured in 2010. Nearly every major demographic group is within a few percentage points of universal coverage.
The survey results show that nearly all elderly adults (more than 99 percent) and children (more than 99 percent) are insured, as are 97 percent of non-elderly adults ages 19 to 64.
The full report is here.
New Census Bureau data out today shows that Massachusetts remains the national leader in health insurance coverage, with 94.9 percent of residents covered in the period between 2007 to 2009. (Compare that to most uninsured state, Texas, with 74.5 percent coverage.)
The data is even more impressive considering that with the economic downturn, health insurance coverage has declined nationally, as shown here, in this sobering graphic from the nonprofit research organization, the Massachusetts Budget and Policy Center:
Mass. leads the nation in health insurance coverage; Texas is last
Americans have even less confidence that they can pay for their health care these days than they did in December, according to a Thomson Reuters poll released today.
The survey of 3,000 Americans found that their certainty that they could gain access and afford the care they need had dropped by 5 percent.
The Thomson Reuters Consumer Healthcare Sentiment Index, based on a monthly survey of 3,000 consumers, asks if they have had trouble paying for or had to postpone care in the three months prior. And it asks if they expect to in the coming three months.
On every survey question, responses were more pessimistic in July than they were in December.
“That’s a cause for concern to healthcare providers and policymakers,” Gary Pickens, chief research officer at Thomson Reuters, parent company of Reuters, said in a statement.
Pickens has seen a gradual eroding of confidence since December, despite a few notable peaks, such as in April, the month after Congress passed the Affordable Care Act.
“I doubt the average person really knows what has been implemented,” he said. “They just know there is a lot of talk and there has been a lot of negative publicity.”
The Incidental Economist blog suggests that the problem is not health care reform, it’s simply the bad economy.