Hundreds of healthcare journalists will be attending the Association of Health Care Journalists’ (AHCJ) conference in Boston this week to hear from many speakers with rose-colored ideas about both our Romneycare law and a brand new state cost-control law. Yet all is not well in the Commonwealth. State officials now predict “extreme premium increases” for many small businesses under Obamacare.

In a letter to federal regulators the day after Christmas 2012, a perfect day to bury news, Massachusetts officials floated the idea of obtaining a waiver from the Affordable Care Act (ACA) out of fear of the premium spikes. Yet, recently finalized federal regulations slammed the door on that flexibility. Many small companies justifiably feel sick over the decision.

The small business community has been paying more for health insurance since the commonwealth’s 2006 reform merged sicker individuals into the same risk pool. The legislature has also added to costs by passing 12 additional mandated benefits since then, a cost borne completely by small companies and individuals.

Now the future looks even bleaker for small business. Not only will their highest-in-the-nation premiums go up because of these new regulations, but they will be paying on average $8,000 per family, per plan more in taxes over the next ten years. That translates into employers and consumers in Massachusetts paying $213 million in 2014 and $3 billion more over the next decade.

Conference speakers will be sure to mention that the Connector was created to help small companies obtain competitively priced insurance, and other states will experience this benefit in the exchanges required under the federal law. Only one problem, the rhetoric doesn’t match reality in Massachusetts.

At the end of 2012, after spending tens of millions on advertising, the Connector covers less than 1 percent of the small business market and premiums are similar to those outside the exchange.

Finally, those in attendance will hear about a promising law passed in July that will save the Commonwealth $200 billion over 15 years. Yet its approaches are rehashed old ideas. State government gets a steroid shot of market oversight and permission to write regulations freely. The law is heavy with groups of “experts,” requiring 278+ new appointees, with some instructed to “rationally distribute health care resources.” Is this the future of Obamacare?

Requesting a waiver from the ACA implies that Massachusetts deserves to be treated differently. What about the dozens of states nationally where premiums will spike anywhere from 30 to more than 100 percent, especially for young adults?

Massachusetts has embarked on a seven-year health care experiment. It has worked on some fronts and not on others. To argue that we are special because we are leading the way on cost containment is premature and begs the question of whether the ACA’s “one-size-fits-all” approach is misguided to begin with. Let’s hope visiting reporters see the clear picture.

Josh Archambault is the director of healthcare policy at Pioneer Institute, a think tank in Boston.

The post, by University of Chicago Economics Professor Casey Mulligan, argued, among other things, that the U.S labor market is “in for a shock” when health reform takes full effect despite how “smoothly” things may have appeared when Massachusetts carried out its own health reforms starting in 2006. Mulligan writes:

Beginning next year, millions of Americans will be eligible for generous subsidies in the form of cash assistance to pay for their health insurance premiums and out-of-pocket health expenses pursuant to the Affordable Care Act. The subsidies will sharply reduce the financial reward to working because they will be phased out with household income.

Mulligan then goes on to trash MIT economics professor Jon Gruber, a key adviser on both state and national health reform, for his defense of the Bay State’s reform efforts:

When it comes to quantifying the new federal law’s penalty on employment, Professor Gruber and Health and Human Services are incorrect to take comfort in the Massachusetts experience since 2006. As I explained last week, the federal law’s employer penalty is more than tenfold the Massachusetts penalty. In other words, if the Massachusetts penalties pushed down workers’ wages by 16 cents an hour, the federal penalties would push them down $1.67.

Professor Gruber is also incorrect that the federal law is introducing less generous subsidies than the Massachusetts law did. Federal subsidies will be available for people laid off from their jobs, but the new Commonwealth Care subsidies in Massachusetts are not, because Commonwealth Care excludes people eligible for the Medical Security Program (a longstanding program providing health benefits to Massachusetts people receiving cash unemployment benefits).

I asked Gruber to respond to Mulligan’s critique. Here, unedited, is what he sent over via email:

Problems with Mulligan argument:

1) He cites as supporting evidence a 1994 article that referred to a completely different policy

2) He ignores the fact that the disincentives to income increase in MA are massively larger than in the federal program. When individuals cross the 300% of poverty threshold in MA they see a huge reduction in subsidies and increase in their out of pocket insurance payments and this dwarfs anything in the federal law.

3) He tries to argue that MA is irrelevant because the unemployed are on the MSP [Medical Security Program].  But the MSP is an income-targeted program as well, which has exactly the same incentives! There is a waiver of costs below 150% of poverty, and eligibility ends at 400% of poverty.  Moreover, only a minority of uninsured are on the MSP since they have to quality for UI.

4) He is correct that the employer penalty is much larger at the federal level.  This will cause a reduction in the wages for those whose employers pay the penalty.  But that is offset by the higher demand for insurance among the mandated population, as argued in the recent paper by Kolstad and Kowalski.  They find that workers, in the face of the mandate, demand insurance from their employers and that employers are able to pay lower wages as a result.  This offsets the employer cost and there is no reduction in employment.

5) Finally, he ignores the large body of economic research which shows that there are not strong responses on the supply side to these kind of incentives.  For example, work on the EITC has repeatedly shown that the high marginal tax rates put in place by that program don’t distort labor supply by low income workers.  Given this research, it seems that we are better guided by the Massachusetts example than by a theoretical presumption of major labor market distortions.

Touche.

I wouldn’t dream of finding fault with many typical wellness offerings: Quit-smoking programs, on-site gyms, more appealing cafeteria salads. Good for worker, good for employer, everybody’s happy. But consider this email I received from an employee at a major national retailer:

Carey,
I see you’ve written several articles about the new health insurance laws, etc. The company I work for has [a major national insurer]. Last year we received a $25 discount bi-weekly if we filled out a health questionnaire, which of course everyone felt compelled to do as that would be a savings of $650 per year. Most people I spoke to felt uneasy doing it, as they felt it would lead to other invasive practices. Well, sure enough, this year, if you DON’T smoke cigarettes you get $10 off bi-weekly, but to get the additional $25 not only do you have to fill out a questionnaire, but everyone employed [here] (and taking the health insurance) has to have a screening which involves:
1. Waistline measurement
2. Blood pressure measurement
3. Blood draw to test for glucose, HDL and triglyceride levels.
If you do not pass these tests, you will lose your $25 if these are not brought down to an acceptable level by August (when we will be tested again).
Needless to say, this really shook a lot of people up, as it is so invasive, and is this even legal?
Would love to hear your thoughts on this.

Let’s cut to the chase. Yes, it’s legal. And it’s a huge trend that began with only “carrots” — discounts on gym memberships, fun health fairs — and is now progressing to sticks. Or at least, to carrots that can feel a whole lot like sticks.

There are some important limits on what your company’s wellness program can do. More on that soon. But here’s the bottom line: Under federal law, your employer can vary your health insurance premium by up to 20 percent based on a “health factor;” that goes up to 30% as of 2014 and the government could eventually raise it as high as 50%.

Readers, what do you think? On the one hand, if you’re a fit, non-smoking, careful eater, why should you have to help foot the bill for all your Marlboro-packing, Miller-cracking, Big-Mac-chomping co-workers? An unhealthy lifestyle is known to be a major contributor to health care bills. and health costs have skyrocketed for years, sending premiums through the roof, hurting businesses and costing jobs. Any levers to bring them down must surely be tried.

On the other hand, there is clearly a potential yuck factor here. Having my employer measure my waist, or draw my blood??? Getting weighed and monitored in the workplace setting, or in the personnel filing cabinet, may not always be comfortable. What if my boss starts a “fun” pedometer contest among our company’s departments and I’m the morbidly obese one? What about my medical privacy?

I asked the retail employee how people had responded to the wellness program. She replied:

I spoke to 3 people – all three are outraged.

The first person is refusing to have the tests – without giving too much info she has long term health issues and needless to say has huge out of pocket expenses as it is, but will sacrifice the $25 because she does not want any additional information on file other than what they already have.

The second person feels it is an invasion of privacy, but can’t afford to pass on the $25.

The 3rd person I asked also said she felt it was an invasion of privacy and is furious that we are being “forced” into doing this for the $650 per yr.

And on another note: we all work in the office and overall are paid on a higher level than a typical store associate (cashiers avg $9 per hr). To a store associate that $25 is HUGE.

And of course, $25 is only the beginning. If an average family pays close to $20,000 a year in health insurance premiums, and the health-factor differential could ultimately go up to 50% — you do the math. Kaiser Health News reports that already, among employees of the Swiss Village Retirement Community in Indiana, “Those who don’t smoke, aren’t obese and whose blood pressure and cholesterol fall below specific levels get to shave as much as $2,000 off their annual health insurance deductible.”

So what are your rights? Here are the basics, courtesy of Patricia Moran, an employee benefits law expert at Mintz Levin.

The general rule: Federal law generally prohibits plans from charging different premiums to different employees based on a health factor. However, there is an exception for “bona fide wellness” programs.  These programs allow an employer to vary premiums up to 20% based on a health factor (such as cholesterol, weight, smoking) but only if the employer offers a reasonable alternative to those for whom it is unreasonably difficult to meet the standard.

For example, let’s say the standard is a cholesterol count of 200. If an employee is below 200, he/she gets the better premium.  This is okay so long as the employer offers an alternative standard to employees who are above 200. For example, take a cholesterol drug or attend nutrition classes.

Voluntary programs available to all outside of the medical plan are generally okay – for example, a gym discount, or a reward for attending a health fair.

Health Risk Assessments [like measurement of blood pressure and waist circumference] are sort of a legal land mine under the Americans with Disability Act and GINA [which protects genetic privacy], but it depends on what is asked and what it is used for.

An alphabet soup of other federal laws are at play here along with GINA and the ADA: HIPAA, which protects medical privacy, and ERISA, which governs employer health plans. I asked David Wilson, a partner at Hirsch Roberts Weinstein and an expert on wellness law, to parse all the legalese into a few principles that might be most useful to employees. He offered these points to remember about wellness programs:

Incentives, not penalties: A wellness plan is legal if it creates incentives for participation instead of penalizing an employee for not participating. A wellness program is considered voluntary as long as an employer neither requires participation nor penalizes employees who do not participate.

Avoid specific standards: To comply with the ADA, both voluntary and mandatory wellness programs should refrain from requiring the employee to achieve any specific health standard. The law bans discrimination based on health factors like health status, genetic information, medical condition, medical history and disability. An example of an impermissible health plan is one that gives a 20% premium discount for employees participating in the wellness plan with a cholesterol level under 200.

But the plan can use standards if…The reward is (for now) less than 20% of the total cost of coverage. The wellness program is “reasonably designed” to promote health. It gives employees a chance to qualify for the reward at least once a year. It allows a “reasonable alternative standard” to anybody for whom it is unreasonably difficult due to a medical condition, or medically inadvisable, to satisfy the initial standard. The employer may also choose to waive the standard for an employee who shows good cause. And it discloses that alternative standard in all wellness materials.

When it’s mandatory: Employers may also have a mandatory wellness plan under certain circumstances. A mandatory plan cannot request family medical information or genetic information. If a mandatory program requires an employee to achieve a certain health standard, that standard should account for and be adjusted for age.

“The way to think about these things is that you can’t use a stick, you have to use a carrot,” Wilson said. “Employers can’t use penalties but they can use incentives.” And from the worker’s point of view, you should get the reward “If you meet the goal or if you try to meet the goal.”

And if I think my company is violating these rules? Ideally, he said, I would go to the director of my company’s Human Resources department, who should be “the gatekeeper of fairness.” If I don’t get satisfaction, I can either consult with a lawyer or file a complaint with a government agency.

If I think I’ve been discriminated against based on a “protected characteristic,” such as age or genetics, I can file a claim at the Massachusetts Commission Against Discrimination or the Equal Employment Opportunity Commission. They would then send the complaint to my employer for a written response.

If my complaint is based on ERISA or HIPAA, those are federal laws and I could sue in federal court. Also, Patricia Moran noted,  if I think the company’s plan discriminates under ERISA, I can call the Employee Benefits Security Administration for help.

Smart Ways To Wellness

In an ideal world, of course, I’d be so raring to get healthier that nothing my company’s wellness plan did would bother me. That’s the ideal for the wellness programs, too: To help me develop a long-lasting, sincere desire to get healthier. The catchword in the fledgling field of wellness research is “intrinsic motivation,” and the data suggest it’s the best way to go.

In contrast, financial rewards like the national retailer’s $25 outcome-based incentive discount are “extrinsic,” said Anne Marie Ludovici, director of wellness at Tufts Health Plan and a leading author and consultant on the topic. People who are not ready to change but suddenly face a major financial push like that may “dig their heels in further,” she said. And incentives that backfire could reduce employee job satisfaction and engagement.

Yet, she said, it’s becoming typical for large brokers and employers to add progressive requirements to wellness programs, going from simple questionnaires in the first year, to physical tests in the second, to required outcomes such as being tobacco-free or thinner in the third.

The problem: “Even though you’re saying that you’re giving discounts, people see it as being penalized,” she said. “So it is very controversial. That’s called ‘outcomes-based incentives,’ and I would never encourage a client to start with that, because it’s definitely very controversial and may not be very well received.”

What’s a better way? How the whole issue is framed is very important, Ludovici said. The company can explain that it’s putting its faith in its workers, counting on them to try to get healthier even though the company won’t see immediately lower health insurance costs. It can use its wellness program to help give employees the sense that they’re cared about, she said, and working in a good place oriented toward high performance.

She, herself, has been known to use a car-insurance analogy: “If you’re a high-risk driver you’re going to have to pay more in premiums. And I think the industry is driving — excuse the pun — in that direction. If you want to eat triple cheeseburgers every day, go ahead, but you’ll pay more.”

Mari Ryan of AdvancingWellness, chair of the board of directors of the new Worksite Wellness Council of Massachusetts, says similarly that she would recommend starting a wellness program by first explaining to employees how their health is important both to them and to the whole company. “Self-care” can be a company value.

She would never advise going right to a “standards-based” program that offers rewards for reaching health goals; rather, she said, she would focus on creating a supportive environment: through, say, smoking policies and smoking cessation programs, or putting healthier food in vending machines.

Anne Marie Ludovici says that she sees the key as “engagement” rather than accountability. “Our philosophy at Tufts is we try to keep people engaged in health coaching if they need it,” she said, “and keep them engaged in the behavioral change programs that will result in those improved outcomes. That feels right to me. I ran the governor’s initiative in Rhode Island, and I saw that what was really getting people excited was being part of a healthy culture where employees thrive and feel this is a great place to work. And focusing on outcomes could really defeat that whole purpose.”

Readers, please weigh in. How do you feel about your company’s wellness program?

Further reading:

• Consensus statement on reasonable wellness incentives by the Health Enhancement Research Organization.

• Harvard School of Public Health researchers lay out the legal landscape of wellness programs in The New England Journal of Medicine here.

• Also in the New England Journal: Lessons from behavioral economics on how to design more effective wellness programs.

 • A report on wellness programs by the Massachusetts Office of Consumer Affairs and Business Regulation.

Some sort of Red Scare nightmare? No, I’m just in a state of bafflement after reading “The Socialist Behind Romneycare.” Posted by the right-wing group Accuracy in Academia, it targets Harvard School of Public Health professor John McDonough, who was involved in building both Massachusetts and national health reform and is the author of “Inside National Health Reform.” (Also, these days, the Health Stew blogger for the Boston Globe.) The post reveals that (gasp!) more than thirty years ago, McDonough belonged to the Democratic Socialists of America and chaired its Boston chapter for a couple of years.

The post cites work by blogger and Communist-outer Trevor Loudon: “Loudon’s new report, which is potentially embarrassing to Mitt Romney as he tries to prove his conservative credentials, is headlined, “How DSA Marxists Influenced Health Policies for Both Major Presidential Candidates.”

Now, I know that living in Massachusetts distorts my vision and leaves me insensitive to the realities of national politics, and I know that I should never try to find true logic in political game-playing. But I can’t help asking: Could anybody, anywhere, really care anymore if a politician or a professor — or a health care reformer — once propounded socialism? The Cold War is over, Communism couldn’t be deader, “Are you now, or have you ever been, a member of the Communist party?” has become synonymous with McCarthy-era abuses. And if Mitt Romney praises the Israeli health system, is it some sign of pernicious socialist leanings that in his latest blog post, McDonough praises the French?

A 350-page bill filed five minutes before a legislative deadline for the year sets the first statewide target for health care spending in the U.S. Massachusetts would aim to hold health care cost increases to same rate as the state’s economy through 2017.

Specifically, health care costs could not rise faster than the Gross State Product from 2013 to 2017. The target would go lower (GSP minus .5) from 2018 to 2022. From 2023 on, it would return to even with GSP, but would be open to revision by the new oversight agency created in the bill. (The bill refers to the “potential” growth rate of the state’s GSP). The bill summary is here and the AP coverage here.

That agency will be under the governor’s secretary of Administration and Finance. Legislators say it will look like the current Division of Health Care Finance and Policy (DHCFP), but with two separate missions: collecting unbiased data and establishing health care policy (setting ACO requirements, deciding whether the state has hit the GSP goal, tracking the move to global payments, for instance). The cost of getting this expanded agency up and running is expected to be $31 million, that’s $11 million more than the state spends on DHCFP now. The Legislature plans to file a funding bill for the agency next year.

What to do about hospitals that use their market clout to demand higher prices was one of the most contentious issues in the bill. A House surcharge on hospitals that could not justify their higher price is gone. So is a plan to require separate hospital contracting (breaking up the powerful networks). Instead, this new House/Senate agreement would let DHCFP investigate hospitals suspected of anti-competitive pricing practices. DHCFP would refer findings that suggest a violation to the state attorney general, but that office would not be required to follow up on the findings.

There’s a wide range of reaction to this plan. Some health policy experts say it won’t lead to any change because the state can already conduct such investigations (but doesn’t). Some low-priced hospitals and consumer groups are relieved the state will have something in the bill that deals with market clout. And critics say this section makes hospitals vulnerable to investigations that have no merit.

Members of the committee that negotiated the final compromise bill say they will boost underpaid hospitals. A $225 million surcharge on insurers would be divided three ways with $135 million going into a fund for community hospitals. The bill also increases Medicaid reimbursements by 2 percent. “We have to make a commitment to our community hospitals,” said House Majority Leader Ron Mariano. “If we’re serious about providing low-cost, quality care, we have to shore up our community hospitals.”

The balance of the surcharge would be used to create a Prevention and Wellness Trust Fund ($60 million) and a fund to help small providers buy and start using electronic health records ($30). Critics, including Josh Archambault at the Pioneer Institute, point out that this surcharge will add to health costs.

There are dozens of other small and large items that we’ll dig in on in the coming days as we look at this effort to control costs and improve care in Massachusetts. Many groups wanted to make sure their issue has a place in this legislation, which may become another template for national health care reform.

(Note on jargon: The “potential” growth rate of the state’s GSP is, according to a helpful staffer, “an economic term used for reducing the fluctuations in business cycles to establish long-term average growth, smoothing out the highs and lows.”)

WBUR’s Martha Bebinger reports that the group has just put out a new report on Massachusetts health reform that could act as an important corrective for claims on the national political scene that the reform has been a budget-buster. Read her full report here. It begins:

Outside Massachusetts, talk show hosts and politicians frequently blast the state’s health coverage law as a “budget buster.”

“It has been an abject failure,” Senator Rick Santorum told the audience during a presidential primary debate in January, directing his comments towards former Mass. Gov. Mitt Rommey. “He’s stood by the fact that it’s $8 billion more expensive than the current law.”

That’s just one of the myths the Massachusetts Taxpayers Foundation (MTF) hopes to debunk with a report out Friday. The facts will help. Michael Widmer, president of the MTF, says the state has spent just $91 million more a year since 2006 to cover the uninsured than it was spending before the law passed.

“That’s a very tiny additional costs to taxpayers for huge benefits,” argues Widmer. “No way can one say that this has been anything close to a budget buster. The facts put a lie to this myth.”

 

Now, she has just signed up with an agency that’s aiming to improve her health while cutting costs, by putting her care on an overarching budget instead of paying piecemeal for each service. That’s exactly the sort of plan involved in the second stage of health reform now brewing in Massachusetts. Martha writes: “As more and more patients are covered by global payments, Beder represents the future of health care in Massachusetts. And, if health care on a budget doesn’t work for high-cost patients such as Sue Beder, it may not make sense for any of us.”

Be sure to read the whole story here, and please let us know what you think in the comments section below. My initial reaction: The budgetary side remains to be seen, but for goodness sakes, anything that keeps a patient from needing to call the fire department 40 times a year for help has got to make sense.

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?’”

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.

• 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.

A new study this week that has policy-types aflutter suggests that yes, reform does lead to better “self-reported” health. (OK, self-reporting can be iffy, and this still needs more verifying, everyone notes, but still, the data seems solid.)

Here’s Harvard’s John McDonough, in his column Health Stew, explaining:

Two economists, Charles Couremanche of the University of Louisville College of Business, and Daniela Zapata from the University of North Carolina Department of Economics, using data from the CDC’s Behavioral Risk Factor Surveillance System, “provide evidence that health care reform in Massachusetts led to better overall self-assessed health.”

Not just correlation, they found causation, and positively affecting physical health, mental health, functional limitations, joint disorders, body mass index, and moderate physical activity. “The health effects were strongest among women, minorities, near-elderly adults, and those with incomes low enough to qualify for the law’s subsidies.”

The Atlantic ran this chart in its story on the study and noted:

The graph below charts changes in Massachusetts’ health status index against the rest of the United States between 2001 and 2010. After a few years of decline, the state seems to have started improving its health in 2005, before Romney’s legislation was implemented. But the researchers ran a regression analysis controlling for a number of factors that could affect health outcomes, and found that the reform law’s expansion of coverage was responsible for the improvements during the second half of the decade.

And here’s Ezra Klein’s analysis in The Washington Post:

Some of those results are a bit odd. Although it’s possible to tell yourself a story about how the Massachusetts health reforms affected the body mass indexes of the newly insured, you have to stretch a bit.

But most of them make perfect sense. The reforms led to more people having insurance, which is to say more people having more opportunities to see a doctor and get early and/or regular treatment for ailments. That led to improvements in health. If that hadn’t led to improvements in health, it would be the worth of going to the doctor and getting timely medical care that would be called into question. And if going to the doctor and getting timely medical care isn’t worth doing, the Massachusetts reforms are pretty far down the list of practices and policies we need to rethink.

WBUR’s Martha Bebinger reports:

BOSTON — Across the national airwaves and on the Republican campaign trail, the Massachusetts coverage law that many now call “Romneycare” is routinely trashed. Here’s Texas Gov. Rick Perry in a debate last October:

“Romneycare has driven the cost of small business insurance premiums up by 14 percent over the national average in Massachusetts.”

And from former Sen. Rick Santorum last month we heard, “it (Romneycare) was the basis of Obamacare and it was an abject failure.”

So you might think this drubbing would rub off on Massachusetts residents, about two-thirds of whom have consistently endorsed the state’s coverage plan since it passed in 2006. Not so. In the latest WBUR poll, 62 percent support the law and 33 percent oppose it.

Read the full WBUR report here.