By Sara Cushing
Guest contributor

A few weeks ago I resigned from my job as a project manager at one of the largest health care delivery systems in the United States. I have worked in different capacities in the health care industry in the Boston area for the last eleven years, but decided to leave my career because I wanted a change — to follow my dream of becoming a writer.

Many things needed to be considered about such a family-life-altering decision, including one that hadn’t been a concern of mine in the past: what my family’s next steps would be in purchasing health insurance. I have always carried the health insurance — a very robust PPO (“paid provider option”) family plan that was largely subsidized by my employer.

The direct cost to me (paid bi-weekly on a pre-tax basis) was roughly $400 a month. In discussing my career departure with my husband, we knew that the monthly cost for a similar plan purchased through the Health Connector (the Massachusetts state agency that acts as a vehicle to allow uninsured residents to purchase health insurance through local health insurance companies) would likely be higher. Much higher.

Try something closer to $1700. About the same as our monthly mortgage. About half of what my take-home pay used to be — money that was no longer coming in. And we see no way around it.

Because my husband is in a higher income bracket we’re not eligible for subsidized coverage though the state; and because my husband is a contract employee, his employer doesn’t provide subsidized health care coverage.

This means that we’re looking at the same cost for a family plan whether we buy through his employer; the Health Connector; or through my employer’s COBRA plan (which allows me to purchase the same health care coverage as offered by my employer for up to 18 months after ending employment, though I am responsible for 102% of the cost — the additional 2% is for administrative fees).

I live in Massachusetts, where legislation was passed a few years ago mandating health care coverage for all residents. The legislation helped to create the Health Connector agency so that people could purchase health insurance in larger risk-pools instead of directly from health insurance companies, to allow for more competitive pricing and coverage options for individuals and families.

This all sounds great, right? What many people do not understand, however, is just how steep the monthly premium cost gets, just how painful a $1700 bite out of a family budget can be.

Of course there are other plans offered through the Health Connector that have less expensive monthly premiums (for example, $1000/month for a family plan) but these plans have higher co-pays (the flat dollar amount that you would pay for an office visit, for example); coinsurances (usually a percentage of the cost for an office visit); individual and/or family deductibles; and/or out-of-pocket maximums.

If not for my previous work in researching health insurance coverage for patients, I would have no idea what any of these words mean. A deductible is a monetary threshold that an individual (or family) is responsible for paying before their coverage kicks in. For example, if I (God forbid) have to go to the hospital for emergency surgery, I would be responsible for paying up to my individual deductible before my coverage kicks in to cover the rest. This deductible could be anywhere upwards of $2,000.

An out-of-pocket maximum is the annual maximum that I am responsible for paying for my care. For example, if (again, God forbid), my hospital admission required extensive surgery, treatment, or extended stay in the emergency room or intensive care unit, and I have a $10,000 out of pocket maximum, then I am only responsible for the first $10,000 in cost for my care and my health insurance will cover the remaining costs, if they’re determined to be medically necessary. So in the event of something catastrophic, I will pay $1,000/month in premiums and could accrue up to a $10,000 personal expense in the cost of my care.

A lot of the current political conversation about national health care coverage ignores the actual cost to the purchaser. I think that mandating coverage for all is a good thing and will help to initiate access to primary care and preventive health services. But if people can’t afford the monthly premiums and costs of care, what good does the mandated coverage offer for the people who have to pay for it?

My family – thankfully – is healthy and currently does not ‘consume’ a lot of healthcare services; our trips to the doctor are primarily for well-visits. To pay $1,000/month for services we might not even use means drastic cuts to our already pared-down lifestyle and budget: Do we sell one of our (two) cars to eliminate monthly expenses? What if our thirty-year old oil burner doesn’t survive this winter and needs to be replaced? How do we save? How will we continue to contribute to our son’s college tuition savings account?

It seems our only other option is not to purchase insurance and, instead, incur a tax penalty when we file our state taxes next spring. But this also means that we will then take our chances that we won’t need extensive health care services in the near future. And like many parents, this doesn’t sit well with my often overly responsible personality and family management style.

Mandating health care coverage through state or national legislation doesn’t mean that the cost of care is going to go down anytime soon to make a difference to the end consumer. Until the cost of care is managed, the cost of health insurance isn’t going to be eased. The industry movement away from fee-for-service payment models will directly impact the out-of-pocket cost to individuals and families – but again, not in the immediate future. And this central issue to those of us paying steep costs for coverage isn’t part of the political or news media conversations. It should be.

I fully appreciate the irony in my leaving a job that provided a health insurance benefit that was at a small cost to my family. But choosing a new career path – one with different benefits, like flexible time to take care of my son and the fulfillment of doing something that I love – shouldn’t present my family with such a financial dilemma. Until the cost of providing care becomes better managed, families like mine will continue to have to evaluate the risk-benefit analysis of whether we can afford to pay steep monthly premiums in anticipation of worst-case scenarios or keep the roof over our heads.

Sara Cushing is a freelance writer. She lives with her family on Cape Cod.

I’d say what stood out to me was that they recognized that the main focus of the law, the key element of the law, is setting a health-care cost-containment goal, but that it is going to be a pretty complex process, both to figure out what that goal should be and to determine the best way to reach it.

In the area of what that goal should be, what’s at issue isn’t just what the state economic growth is, but what it is over time. So it’s looking more at a trend than at a fixed number, and that’s a difficult concept for many people to grasp, both patients and providers.

We do know what the target is going to be for 2013, 3.6 percent. But this is really a question about the next four years after that, when it’s supposed to be right at the potential Gross State Product.

And then if you start to ask, ‘Okay, so what will it mean to get there?’ that’s when it really gets complicated. Because in the process of figuring out whether providers are keeping costs under control, the state is at the same time trying to overhaul the health care system with a focus on prevention.

So that might mean, for example, that — and this is an example that Health and Human Services secretary JudyAnn Bigby used — say you have a primary care practice that is doing a great job at keeping people out of the hospital, but their costs are rising at 5 or 6%. Do you say, ‘That’s fine because you’re saving us money,’ and on the other hand you tell specialists, ‘Your costs can’t grow at all, or maybe only by 2%’?

There also seems to be great misunderstanding out there about how insurers and providers are supposed to think about the goal. So we hear, for example, that some insurers are starting to tell providers, or providers are telling suppliers, ‘We can’t pay you more than 3.6%, that’s the cap,’ but in fact it’s not about everybody doing everything at the same level. It’s about holding overall spending at that level, but making adjustments within that so we get better care.

And in fact, the board doesn’t have the authority to tell anybody what they can or can’t do, but they do have the authority to review what they’re doing and see if it fits the goal the state has set.

Board chair Stuart Altman said he feels like he’s a referee who can blow the whistle but not issue a penalty. They can regulate, but they can’t regulate. They can oversee and manage and maybe cajole, but they can’t actually say yes or no, although eventually they can say, ‘You have to have an improvement plan.’

One other pretty big area of concern is that the state is going to start registering and licensing all larger provider groups. There were a number of concerns raised today about doing that really carefully.

The Division of Insurance will have to certify that a provider is ready to take on risk in a new global payment contract, so that if they go down they have money to cover losses. Several people raised the point that in the nineties, providers didn’t really know how to do this, and so a lot of people got in over their heads and went under because there wasn’t really careful education or scrutiny of just how much risk people were ready to take on and if they understood that. So that’s something the Division of Insurance has to take on pretty soon, and offer some guidance. There’s a lot of trepidation about doing that carefully.

A state law that aims to limit spending on health care takes effect today. 

The law makes Massachusetts the first state to say that health care costs must stop increasing faster than that of most other goods and services.  

A new board that will set a health care spending target and track progress towards that goal has a chairman, and a first meeting date, but the members have not yet been appointed.  

More than a dozen other boards and commissions designed to improve care also exist in name only so far.  

Several provisions in the law take effect immediately or as soon as the state puts new guidelines in place. They include new restrictions on mandatory overtime for nurses, a requirement that providers offer end of life planning to patients nearing death and rules for the use of telemedicine.
 

There’s a nice recent summary of the law and its rationale here: How a new Mass. law can show the future of health reform.

We here at CommonHealth are guilty, too. Our “About This Site” section below even begins, “Massachusetts is the leading laboratory for health care reform in the nation.” But a new report just out from the Beacon Hill Institute at Suffolk University suggests that perhaps we should be a bit less provincially, pridefully myopic. (The institute is “grounded in the principles of limited government and fiscal responsibility,” and judging by recent headlines of its studies, it tends to be quite critical of the Massachusetts reform model.)

The report reviewed several health-reform policies in other states and concludes that there is much worth emulating, particularly when it comes to better serving consumers. From the press release:

BHI reviewed several consumer driven policies from others states. These include establishing Health Savings Accounts (Indiana and Georgia), eliminating the tax bias in favor of employer sponsored health plans (Missouri) and reforming guaranteed issue and community rating (Maine). The paper, entitled “Lessons for Massachusetts from State Health Care Reforms in Other States: What Chapter 58 Missed” also suggested that following Medicaid Reform in Florida and tort reform along the lines of Mississippi and Texas.

The study also examined Utah Exchange, that state’s private alternative to the Massachusetts Connector. The Utah Exchange offers high deductible plan choices which lowered overall premium costs rather than the more stringent ‘seal of approval’ plans vetted by the Connector.

The full study will be available on the Beacon Hill Institute’s Website. I just tried the link in the upper right of the homepage but it doesn’t seem to be live yet.

So what did you mean at the State House, that the cost-control era will involve new responsibilities on the part of the patient?

My thoughts are that if the citizens of Massachusetts want to control the costs of health care, not only do we have to change doctor-hospital-nurse behavior but we also have to change patient behavior. If we want to be leaders in this movement toward getting more people covered and improving the quality of health care outcomes, we as individuals all have to participate.

I would think, in particular, that under this next phase of health reform, doctors will be bearing more financial responsibility for their patients’ health, but so much of their patients’ behavior is out of their control…

What could undermine this undertaking is if doctors and all health care workers work very hard at improving their efficiency and trying to obtain the best outcomes possible for their patients, and the patients don’t cooperate. And cooperation involves taking the best care possible of themselves, and if they have an illness, taking the medications as prescribed for them, exercising or eating properly as prescribed and, very importantly, reporting their progress accurately to aphysician.

For example, if you’re a diabetic and you’re monitoring your blood sugar with a home device, or if you’re hypertensive and you should be monitoring your blood pressure, write down what the numbers are when you take the measurements and bring that in to the doctor to review with you. If the doctor gives you instructions about Physical Therapy or eating properly, either ask for written instructions or write something down that you can use to remind yourself. Or bring a friend to help you understand and remember your instructions. And lastly, keep a log of what you are doing when it relates to whatever treatment has been suggested; write down what you’ve done.

Are you planning a guide on how to be a better patient?

Many such guides exist. Obviously you should: eat healthy, avoid tobacco, avoid substance abuse including excessive alcohol, exercise when you can to the level you can, maintain your weight at a proper level, get enough sleep, get your vaccinations on a regular basis and see your physician. And be safety conscious when you’re driving — don’t do stupid things, which I see every day. Stay mentally active, and take care of your teeth. These are really important things to remind people. It doesn’t matter how old you are or how young you are, what disease you have, there are things you can do to improve the outcomes of your care.

I can feel the debate heating up around this provocative question: If people don’t do what they should, don’t take responsibility for their own health, should they be penalized?

It is a provocative question and I don’t have a glib answer. If we’re trying to control costs and people who are covered by insurance are behaving in ways that are detrimental to their own health and increase the cost of their care, we really need to come up with a way to deal with that. How can we do it humanely? That is the issue. I think the most important thing is to have families and friends urge people to do the right thing. We need to intervene.

What about doctors, in this new era, who have patients who are “non-compliant” or doing the wrong thing?

The first thing they have to ask is: Is this a behavioral health issue? Should the patient see a counsellor? Ideally, what we should promote through this wellness initiative in the health cost bill is counselling services that people can go to for help with weight control, exercise, substance abuse and more. And more of those resources should be available to doctors, particularly primary care doctors who provide a “medical home,” so patients can be referred to such centers for help.

Ultimately what do we do with the most reticent or reluctant to comply? I don’t have an answer. They are ultimately going to be our burden. If it’s behavioral health problems and being treated, that’s fine. But what do you do? Unfortunately, it’s a societal burden we all have to address.

In this coming era of more financial responsibility for doctors, can a doctor fire a patient for being non-compliant? Should they?

That is not an unethical situation. If you’re trying to help the patient to the best of your ability and they refuse — a doctor could say, ‘I’m trying the best I can to help you, you’re doing everything to hurt yourself. I’d be happy to refer you to someone else or a support service, but I can’t care for you under these circumstances.’ You give the patient options.

If the patient refuses after everything, what do we do? A lot of these people end up in emergency rooms — I’ve seen this thousands of times — and become a burden. This becomes a societal issue. A physician has the obligation to try the best they can, and if the patient intentionally refuses, then what’s the point of having the relationship? You provide alternatives. There are free clinics that take in these patients for episodic care — at the Mass. Medical Society, we give out awards to volunteer physicians who cover such clinics. We’re working on the problem but we don’t have an ultimate solution.

In the new era of cost control, is a patient also responsible for comparing costs, for getting a $500 MRI instead of a $2500 MRI?

That’s a hard thing for me to comment on. You do have to judge price disparities; that’s a factor. But I think it’s important to look at prices in the context of whether you’re happy with the medical care by the team that’s been caring for you. One important point: These are things you should discuss ahead of time and not wait for an acute event: Where would you like to be treated? Where possible, have a family plan for accessing medical care.

The last thing I’d like to hammer home is safe behavior: On the road, around swimming pools, using machines or chemicals you’re not familiar with. Don’t exercise in the heat without adequate hydration. If you’ll be out among mosquitoes, wear proper clothing and repellant. Just think safety.

(Also today from the Massachusetts Medical Society: The latest figures on access to medical care and waiting times to see doctors.)

But I write this just for the historical record. The signing was so expected that it isn’t really news. So I exploited my Nurses Hall visit to pose a forward-looking question to some of the state health care players assembled for the signing. To wit:

Two or five or ten years from now, what do you think people will be saying about this health cost bill? Their replies:

Len Fishman of Hebrew SeniorLife: “Five years from now people are going to see this as a giant step forward — though not the last one. And I think we’ll realize this is every bit as important as the coverage legislation, because if you don’t get costs under control, you can’t afford universal coverage. (I asked: Any criticism?) I think it’ll be the same criticism as now: Some saying it’s too little, some saying it’s too much. But the emphasis will be on finally tackling the other big issue in health care in this country. I think people will be proud that Massachusetts took the lead on both these issues.”

Sarah Iselin of the Blue Cross Blue Shield of Massachusetts Foundation:
I think looking out two years from now, people are going to say, ‘We were leading again.’ This is a critical but in many ways more challenging problem to solve.” It took decades of work to reach a solution to the coverage problem, she noted, and “this is an incredibly significant and important step but it’s going to be a journey.” The lawmakers wrestled with “the role of the market and how far it would go on its own, and the role of government,” she said. “We’ve set really ambitious goals;” now the future will show: “Are the enforcement mechanisms strong enough?”

Prof. Stuart Altman: “I think it was an initial, interim step. Ultimately…Either it will turn out that we didn’t hit the goals, or hitting the goals was really tough. Some groups could feel the losers. You can’t control health care costs without there being some parts of the industry who feel like they’d be better off without it.” As national experience has shown, “Ultimately, what you find is the losers scream and the political system gives in. We have to decide, as a state and as a society, the relative worth of controlling spending. But do I feel this is important legislation? Yes. It’s exactly where we should be. The state wasn’t ready for the tougher regulatory aspects, but it would have been a shame to do nothing.”

Dr. Richard V. Aghababian of the Massachusetts Medical Society: “I think they’ll be saying that it was a very innovative, forward-thinking law which addressed the issues of quality and cost-effective care for all patients. I’m sure we’ll find some things we could have done differently but for pioneers, that’s often the enviable — or not quite so enviable — position.”

Dolores Mitchell of the Group Insurance Commission: “It was groundbreaking. It set the stage for what a lot of us in the health care business needed to do and went on to do for for the next 10 years.”

John Auerbach of the state Department of Public Health: “For the Public Health and Prevention Trust, I think it will demonstrate that by supporting population health, you can decrease the cost of clinical health care.”

Dr. Paul Hattis of the Greater Boston Interfaith Organization: “I think they’re going to say it was an important first stake in the ground. The cost issue has been plaguing us for 45 to 50 years in this country, so the solution to it — like a chronic disease — is going to take a long time, but you’ve got to start somewhere.”

Josh Archambault of the Pioneer Institute: “It hasn’t controlled health care costs and state bureaucrats are slowing down the whole industry and how it innovates.” (I asked: And patients?) “I expect we’ll see something similar to the HMO backlash by some.”

Brian Rosman of Health Care For All: “Either that it was the start of a true transformation of Massachusetts health care that became the model for the rest of the nation — or that it was a great attempt but in the end did not make a major change.

And the difference will be in the implementation. How well do the state officials, health care industry and consumer advocates work to make the promise of the bill a reality? The tools are all there, but it’s how they’re used.” (I noted that the landmark 2006 law left open a similar question, and people are generally happy with the aftermath.) “Will that happen again? We shall see.”

Readers? Please add your own predictions in the comments below. And you can listen to a full report from WBUR’s Martha Bebinger here.

Attorney General Martha Coakley, the state’s top insurers and several consumer groups argue that price is a critical issue. “Any meaningful health care reform legislation must include efforts to address the market power of providers and the negative impact on costs that we identified in our reports,” said Corey Welford, Coakley’s chief of staff, in a statement.

But it’s been clear for a while now that a House plan to penalize high cost hospitals that couldn’t justify their prices would not be part of the final bill.

In response, some of the lower-cost hospitals and the Greater Boston Interfaith Organization have told lawmakers and the Patrick administration that it wouldn’t be smart or look good to pass a law that paid little attention to what’s known in health-care-speak as “provider price disparity.”

So last week, Gov. Deval Patrick began floating a late compromise (full text here) to tackle health care prices. The governor’s plan would let government dig into a provider’s books and forward findings of anti-competitive behavior to the attorney general. The AG would use his or her existing authority to launch an investigation. The AG’s office offered a different plan that would let the administration use the license renewal process to demand lower prices, but a spokesman says “there are positive steps taken in the House, Senate and governor’s proposals” as well.

Sources say the conference committee isn’t paying much attention to the governor’s compromise. Members don’t like the idea of requiring another state office holder (the AG) to take action based on an investigation that would begin in the governor’s office. And it’s not clear how effective the governor’s plan would be. It does not give the AG any new authority, although it might give her better information to use in an investigation.

Some of the high-cost hospitals are lobbying against the governor’s compromise, and Mike Widmer with the Massachusetts Taxpayers Foundation says “the open-ended nature of the governor’s proposal is just ripe for misuse and abuse.”

Widmer argues that consumers will drive down high prices by choosing lower-cost hospitals that deliver good care. But Harvard School of Public Health Associate Dean Nancy Turnbull says “government will have to take a much more active role in overseeing prices” if it hopes to take on market power.

What to do about health care prices may be an issue left for the next health care bill in Massachusetts. As one government spokesman says, “this is not the end, it’s just another step.”

For more on the proposal, see today’s Globe: Patrick proposes new way to target providers that abuse market power. It includes the pithy line: “Patrick and Coakley have treated the market power issue like a hot potato.”

And here’s an update from the Massachusetts Hospital Association:

The MHA Board of Trustees discussed the proposal by the Administration regarding a new state agency’s review of provider costs and market impact review and the role of the Attorney General in relation to the work of the new agency regarding these matters. After a full discussion of the proposal and expression of concerns about the proposal, the Board concluded that it did not support the proposal.”

This is becoming as much a Massachusetts ritual as the annual re-firing of the Shot Heard Round the World. The legislature grapples with the complexities of health care reform so long and so hard that it bumps right up against its midnight, July 31 deadline for the end of its formal session, then passes a bill in the nick of time.

Something of that sort happened in 2008 and 2010, recalls Brian Rosman of Health Care For All. And now here we are in 2012 with a particularly tricky bill aimed at cutting costs. As of this writing, the conference committee has not yet finished resolving the differences between the House and Senate versions — and the formal session closes this coming Tuesday.

CommonHealth reform watchers, let us now open our pool for this round: Just how close do you think the passage of the latest health reform bill is going to get to midnight on Tuesday?

We promise a nice piece of WBUR paraphernalia to the reader whose bet comes closest. Please post your entry in the comments below, and specify whether you mean, say, 10 minutes before midnight or after midnight. (I hear that the 2008 session voting on a health reform measure actually ran a few minutes past midnight — fortunately, the powers of the legislature seem to extend to re-calibrating the space-time continuum.)

Also welcome in your comment: Which aspects of the proposed reform do you think legislators are likeliest to give up for the sake of compromise?

A pool is a frivolous thing, of course, but some are expressing serious concerns about whether there has been enough time for serious debate over this next, cost-cutting phase of health reform. State House News reports that Gov. Deval Patrick is among them:

“I think we’re going to get a good bill,” Patrick told reporters in front of his office on Tuesday afternoon, continuing, “There are a couple of hard issues. I wish it weren’t going down to the wire the way it seems to right now.” The health care legislation has been a major focus since early last year of Patrick and legislative leaders, and the diverging House and Senate bills are larger in size than other items that have been before conference committees. “We’ve been working on health care cost for a long time,” Patrick said. He expressed concern that he would have enough time to go back and forth with the Legislature, even if the bill is sent to him before the July 31 end of formal session. “It’s important we close out soon and given the late hour of the session that they give me something to sign because there isn’t a lot of time for the backing and forthing that sometimes happens,” Patrick said

p.s. To clarify: Brian Rosman specifies below that the final, key legislative moment will be when the bill is enacted by the Senate. So yes, that’s the timing that our pool is referring to, and my personal bet is 11:30 p.m on July 31. (I know, WBUR contests aren’t open to employees, but maybe I could just ask for an extra station mug to bring home?)

(Why we love Wikipedia: The expression means “that something is sold or bought without the buyer knowing its true nature or value, especially when buying without inspecting the item beforehand,” and “A poke is a sack or bag. It has a French origin as ‘poque.’”)

But I digress. Josh warns:

The fact that a bill which overhauls our complex health care system was passed in mere hours without debate should worry all of us. President Calvin Coolidge once said, “It is much more important to kill bad bills than to pass good ones.” Legislators failed to take heed.

The health care cost control bill is a symptom of our current “Facebook” legislative process. It limits deep and meaningful debate and allows members to “like” a bill without understanding it. Taxpayers deserve more.

He expresses particular concern that the bill will undermine the health care industry and cost “billions in unintended consequences.” He writes:

The so-called “health reform 2.0” restructures 18 percent of the state’s economy, promises over $100 billion (yes, billion) in savings and changes the rules of one of the largest employment sectors of the state. Yet the House passed the bill almost unanimously (with a mere 7 “no” votes) without debating the bill. To be fair, five of the 275 amendments were debated, but the 188-page, 51,731-word bill was apparently unworthy of discussion beyond that.

The promises for this bill — now being considered by a joint House-Senate conference committee — are historic, according to the rhetoric of the elected officials who authored it. It “completely alters the landscape of our delivery system,” and “will result in an estimated $150 billion in savings over the next 15 years.” “It is going to work because it is well thought out … It is not going to hurt our best hospitals… We will be the first state in the country to manage the cost-quality conundrum.”

Sounds like a good idea, but what specifically in the bill gets us these promised savings? No one asked. There hasn’t even been a cost estimate done for how much new spending is in the legislation. Yet a quick review of the proposal reveals hundreds of millions of new surcharges, assessments and penalties that will be passed along to consumers. Will gauzy promises of cost savings plus concrete new fees really equal a billion dollars in savings?

Readers? Is this just follow-the-leader politics as usual in Massachusetts, or should the bill in fact have been debated more?

Obamacare will hurt business by making labor more expensive, the committee’s Republican chairman, Darrell Issa of California, warned. It will encourage employers to pay their workers less, to hire workers part-time instead of full-time, and to stay small instead of expanding. It will mean higher taxes and more government red tape. (See his statement here.) A line-up of witnesses shared other concerns and warnings.

Then there was Dan Wolf, a Democratic state senator from Massachusetts — in a role a bit like the fairy at Sleeping Beauty’s party who contradicted all the other fairies. Actually, he testified, in his experience as the founder and CEO of Cape Air and a resident of Massachusetts, health reform doesn’t stunt business growth or cost jobs. His full testimony is here. Some excerpts:

I’m here to debunk myths, and dispel fear and misunderstanding about the 2006 health care reform act that Massachusetts enacted with strong bipartisan support. It also is the template for much of the Affordable Care Act now sanctioned as the law of our land.

From Cape Air’s first day in business, we offered health care coverage, knowing that affordable health care coverage helps us retain a great workforce. This year, Cape Air’s health insurance premiums will total close to $3 million, roughly 3 percent of the company’s gross income. The company will pay just over half of that cost, employees the rest.

In 2007, when Massachusetts health care reform went into effect, there were dire predictions of the impact on businesses like Cape Air.
Here’s what really happened:
We added some new dependents under 26 years of age to family plans. Beyond that, the transition was seamless. There was no bureaucracy or heavy lifting in the front office.

Since then we’ve added a solid 15 percent more Massachusetts-based jobs, with our total revenue growing far faster.
Health care reform has not stifled business.

And:

…Health care costs have not spiraled because of the plan, far from it.

This year, Cape Air saw a 5 percent increase in premiums – too much, but far from the 15 to 20 percent increases we saw year after year before reform took effect. Last year, our increase was 4 percent. The previous year, we were able to negotiate a 5 percent DEcrease.

So Cape Air’s success should be seen in a state context.
Unemployment in Massachusetts has dropped from 8 percent in 2009 to 5.8 percent in May of this year. This is 2.4 percent below the national average.
Massachusetts ranks 8th in the nation in job creation this year, adding 37,800 new jobs through May.

Since January, 2007, Massachusetts ranks third in the nation in economic performance.
Meanwhile, additional state spending for health care programs resulting from payment reform only represented 1.4 percent of the state budget in 2011 — again, with more than 98 percent of our residents covered, which includes a 400,000 net increase in the number of non-elderly insured residents.

And the Health Connector – the Massachusetts version of the health insurance exchanges in the Affordable Care Act – has reduced premiums in the last 2 years by 10 percent.
These facts explain why surveys consistently find that about two-thirds of our residents support the state’s health reform.

Readers? Who wants to be the first to point out that the Massachusetts experience may not be generalizable to the rest of the country? Other thoughts? Here’s the video of Dan Wolf’s testimony:

Hat-tip to the Alliance for Business Leadership for calling our attention to the hearing. The statement they submitted is here.