One by one, health care leaders on Capital Hill are filing plans to cover the uninsured modeled on what is happening in Massachusetts. Last week it was Senator Max Baucus; President-elect Barack Obama campaigned on a Massachusetts styled proposal and Senator Ted Kennedy is expected to throw his power behind something similar. But would the state’s health coverage law work on a national scale? We pose that question to people who helped write and others who are implementing the law.
MARTHA BEBINGER: The architects of the Massachusetts health coverage law are proud of what it has accomplished. 440-thousand residents have signed up for insurance since the law was passed two and a half years ago. The state’s uninsured rate has dropped to about 3%…well below any other state in the country.
RICK LORD: But Massachusetts started off in a different place than the rest of the country.
BEBINGER: Associated Industries of Massachusetts president Rick Lord.
LORD: We had a relatively small number and finally we were spending a lot on the uninsured to start with, so we had a lot on the uninsured to start with so we had a lot of money in the system that could be redirected to providing premiums for the uninsured.
BEBINGER: Massachusetts also had overwhelming political support in attempting to be the first state to cover the uninsured. The Governor, the Senate President and the House Speaker all made passing the law a top priority. The bill that cleared the Senate unanimously and the House with only 2 dissenting votes did not require new taxes, as a federal bill would likely need to do. Jon Kingsdale runs the Connector, the agency charged with implementing the state’s coverage plan. Kingsdale says he would not try a major health coverage effort on a nation scale without knowing he had broad support.
JON KINGSDALE: Implementing that is just as challenging as getting it enacted, you want something more than a 51/49% margin to make this kind of fundamental change and have it continue to be supported as it is implemented by the American people.
BEBINGER: Strong support has been critical, for example, as costs exploded. Enrollment in the state’s free and subsidized health insurance programs jumped past expectations and the state was forced to roughly double funding last year. The national experience might be different because covering the uninsured is more expensive in Massachusetts than in most other states. Nancy Turnbull is an adviser to lawmakers who wrote the bill and is now a member of the board charged with making it work.
NANCY TURNBULL: We are in Massachusetts the most expensive place on the face of the globe to get care. That suggests that the cost of expanding coverage many other places, while it would be greater because there are more uninsured people, the cots of providing care is lower and that will redound to the benefit of other states.
BEBINGER: While many who helped craft the law celebrate expanded coverage…and the fact that public and political support remains strong…they warn that it is still a work in progress. Michael Widmer, president of the Massachusetts Taxpayers Foundation is nervous about health care costs.
WIDMER: We can’t pay for health care indefinitely when we’re seeing 10% growth each year. That’s simply not sustainable. So as successful as we’ve been here in Massachusetts, on the long term success, the jury is still out.
BEBINGER: A key piece of the success, so far, is cooperation among the board created to implement the law. In Massachusetts, the legislature did not define key elements…such as what is affordable coverage or what is adequate health insurance. Those decisions have been left to the Connector board where there have been many heated discussions…but only vote that was not unanimous. Connector board member Celia Wcislo, with the Service Employees International Union, hugs the head of the state’s largest employer group, Rick Lord, before stopping to talk about how this diverse board gets to consensus.
CELIA WCISLO: From the beginning we had our yelling and hissy fits about different things. I think in the end of day, we all started listening to each other too and not just holding on to our needs and perspectives, but recognized, if us 10 can’t figure out how to do this, how do we expect the outside community to think there’s something that can get done.
BEBINGER: Lord is not optimistic that the Connector board’s unified commitment could be recreated in Washington D.C.
LORD: Hard to picture this occurring at a national level, just because the discourse nationally always seem to be much more difficult than it is here in Massachusetts. I think it will take great leadership to make this happen nationally.
BEBINGER: Elected leaders nationally are meeting with employer groups, unions and health policy experts about whether they’ll be able to put aside differences in favor of getting a bill passed that will start to control health care spending and cover the uninsured. And why are they using Massachusetts as a model…given all the ways this state is unusual? Rick Lord says there’s it much choice.
LORD: There’s no other model in place in the US right now that is working like Massachusetts, where we have almost achieved universal health care, so we’re the model that exists and I think a lot of people hope the country can adopt it or something close.
BEBINGER: One more difference to mention…Massachusetts launched programs to cover the uninsured while the economy was still relatively healthy. Now, there’s debate about whether the nation’s economic downturn will undermine health reform efforts or whether desperation about fixing health care will forge a winning compromise.
Forgotten in this article and most discussions about this topic is the key change that Massachusetts made about 10 years ago. The Massachusetts universal health care law could not have happened if they hadn’t passed this previous law first to lay the ground work. This health care law:
1. Did away with (most) exclusions and waiting periods for pre-existing conditions
2. Forced Insurers to offer the same insurance to small companies that they did for big companies at the same rates.
3. Implemented a small health care “tax” on companies have 5 more more employees that did not offer medical insurance.
This law was why Massachusetts had so few uninsured people compared to other states. This last Universal Health Care law just filled in the final remaining gaps.
Martha:
Your report on the Massachusetts health reform this morning was disappointing. You cite statistics from and interviewed only the officials who have consistently been cheerleaders for the reform plan. The statistics on the uninsured that you cited come from the same biased sources that underestimated the number of uninsured at the outset – a number which we disputed back then, and everyone now admits was incorrect. Moreover, even a recent survey by Blue Cross shows a large numbers of Massachusetts residents have grave problems in affording care. Even more disturbing, Bob Blendon’s recent Health Affairs piece found that among those directly affected by the reform, more felt that it had hurt the uninsured than felt it had helped. With the impending dismantling of safety net institutions, which is clearly driven by the rising costs of the health reform, balanced reporting is ever more urgent.
Regards,
David
There are several other problems that you neglect to mention which might make it difficult to take the MA healthcare model national.
1) Funding – Massachusetts cannot fund the program without federal assistance. In other words it is not self-sustaining. This is partly because of the incredibly high and continually escalating cost of healthcare in this state, partly because employers who do not provide healthcare benefits do not have to furnish significant revenue towards the program, and partly because member’s premiums are subsidized to an unsustainable level.
2) ER visits – There are too many people who continue to use the emergency rooms as their primary care providers. Perhaps refusing to cover visits to the ER except for actual emergency treatment might discourage this. Addressing this will help with #1 above.
3) Physician access – There are an insufficient number of primary care physicians in the state. Addressing this will help with #2 above.
4) Malpractice insurance costs – Coverage is extremely and increasingly expensive due in part to the ability of the James Sokoloves and their ilk to file lawsuits at the drop of a hat and to aggressively advertise for plaintiffs. Many of these suits are settled out of court for relatively short money but this drives up premiums. Perhaps we can mandate trials for any such lawsuit which would greatly increase the money spent by these firms to bring suit and possibly discourage some of this behavior. Addressing this issue will help with all three items above.
Best Regards,
Alan Prodouz
In the health care report it was said that the new health care bill in Mass…did not require new taxes…. I guess the $1 increase in the cigarette tax that the politicians said was going to fund the underfunded health care bill was another lie by the powers that be in Boston Or did your reporter conveniently forget about the new taxes to make the story sound better
Hi Mr. Abisla – the cigarette tax increase was not part of the original bill; an increase did pass this year to fund the “underfunded bill.” My point was that lawmakers had an easier time selling the original bill because it did not include a tax hike. You are also correct that if the cigarette tax increase had been part of the original bill, it would have been a tougher sell and would have drawn more dissenting votes.
Thank you for your careful listening and comment.
Best, Martha Bebinger
Hi David – thanks for your comments. In order:
1) stats – we have used 500-600,000 uninsured as the starting point (the Romney administration number was lower). 500-600k is a mix of the Urban Institute estimate and the Census Bureau rolling avg. The state says there are now 440,000 (not all but mostly) newly insured. If that leaves 160,000 or 200,000 people without coverage…then 3%, or less, seems reasonable to me.
2)cheerleaders – yes I did just interview supporters because I think it is more telling to hear them say it would be difficult to adapt this law nationally than to hear that POV from those who already oppose the law.
3)the Blue Cross survey – there is no question that health care costs are THE issue for individuals, employers and the state. I think I made that point here as I have in numerous other stories.
4) Bob Blendon’s survey – was that the question about penalties? I’ll reread the article and get back to you on that one.
Finally, the safety net tensions are very important. I plan to write more about that soon.
Thanks again for taking the time to weigh in.
Best, Martha
Perhaps you should write a story how the cigarette taxes have been raised to meet various needs, such as anti-smoking efforts, insurance for the children, etc. You can ask the powers that be how come the money from these increases have been diverted to other uses. You can also ask them how the tobacco settlement money is being used, certainly not to prevent smoking or any related causes. Bring a cameraperson so you can record the song and dance act I am sure you will receive.
Martha:
further follow-up to your response to my comment:
1- Calculating the number who are still uninsured using unverifiable state tabulations of the number who are newly insured reproduces the kind of errors that caused the press to accept previous underestimates. No reliable source estimates the current number uninsured by using an old figure for the number uninsured and then subtracting reported numbers of newly covered individuals derived from insurance companies. Such insurance company figures can’t reliably sort out duplicate coverage (e.g. families in which both husband and wife carry family policies); kids away at college who used to carry coverage out-of-state but whose parents have moved them onto their Massachusetts family policy (as allowed under the health reform)and will appear as newly insured; or even some out-of-state residents working for Massachusetts firms.
4- The Blendon survey asked people “directly affected” by the reform (i.e. those who were uninsured in the past year or had changed coverage due to the law) whether the uninsured had been helped or hurt, and whether they personally had been helped or hurt. Their answers provide the best on the ground view of the impact of reform. More say the reform has hurt than helped the uninsured.
Finally, it’s disturbing that even good reporters like you continue to quote data from the Blue Cross Foundation as if it comes from an uninvolved party. Blue Cross Foundation is funded by Blue Cross, which has a huge financial stake in the specifics of reform – and in derailing reform options that might endanger its huge profits – $209 million last year alone. Good reporters would not quote Pfizer-funded drug policy research without pointing out the drug maker’s financial stake. The same should be true of Massachusetts Blue Cross.
Thank you, David Himmelstein.
Some of us who are being seriously harmed by this so-called health care reform have posted time and time again but are ignored, so we’ve stayed away from this blog for a long time.
Glad also that you have mentioned the inconsistent numbers of “newly” insured vs those who remain uninsured and the source of these stats.
I’m working with Healthcare-NOW, CNA and doctors for single payer across the nation as well as people in D.C. educating them about unreported truth regarding the MA plan – not from an emotional standpoint, but based on facts, figures and personal experiences of doctors and residents.
A single-payer system is the only way to achieve equitable, comprehensive, quality care for everyone in a fiscally responsible manner. The bureaucratic nonsystem of paperwork that is MA health care reform is a nightmare for everyone involved to contend with, and is one reason among many why coverage is being dropped.
I pray that the MA plan does not become the model for the nation because the harm will be far more serious on a larger scale. Furthermore, this plan will not help the current economic mess; it will make things worse for many reasons too detailed for this blog.
We who are being adversely affected by this law are definately worse off than before. The stress alone from the unaffordable premiums and penalties combined with reading the success spin and self-congratulatory comments by key players and politicians is harmful to our health when we truly know and understand what is happening to the targeted population.
Thank you again for your candid and meaningful remarks.