Governor Mitt Romney’s achievements in Massachusetts have served as the blueprint for national reforms. Despite wavering popularity, it appears that reform has brought better coverage and access to the people of the Bay State.
The many similarities between the reforms conducted in Massachusetts during 2006 and the Patient Protection and Affordable Care Act of 2010 make it pertinent to frequently review the outcomes and progress of Massachusetts’ health reform. Both reform packages included an expansion of Medicaid, insurance market regulations, a health insurance exchange, subsidized private health insurance, and mandates for both individuals and employers.
Authors from the University of Minnesota and Harvard University examined data from an annual phone survey of non-elderly adults in Massachusetts for which the response rate in the most current year (2010) was 39 percent.
Insurance Coverage – Ninety-four percent of all Massachusetts residents were enrolled in health insurance plans, which was very similar to the previous year’s data and largely different from the 86.6 percent of residents who were enrolled in 2006. An estimated 77.7 percent of nonelderly adults in the United States have health insurance coverage.
Access and Use of Health Care – Since 2006, the increase in access to a ‘usual point of care’ has been maintained, as well as visits to a general doctor in the last year, preventative visits in the last year, and visits to a specialist in the last year. More impressive, though, was the decrease (for the first time since 2006) in the number of people who went to an emergency department or who had a hospital stay in the past year.
Affordability of Health Care – In every year since the Massachusetts’ reforms in 2006, fewer people reported that they did not receive needed health care due to cost. However, there has not been any decrease in the number of people who report problems paying medical bills.
Health Status – Self-reported health status was much improved after the 2006 reforms; this has been maintained through 2010.
The Role of Employers – There has been a steady rise in the percentage of those with health insurance who receive coverage through an employer: up from 64.4 percent in 2006 to 68 percent in 2010. Employees with coverage through an employer continued to report they have favorable services covered and choice of doctors. As health care costs continue to rise, the amount that employers contribute to health insurance premiums also continued to rise.
Support of Reform – Support for health reform has become slightly less popular, with 69 percent of individuals polled in support during 2006 but only 65 percent in support during 2010. The topic also seemed to be more polarized, with those in a neutral position in 2006 shifting to being in opposition of reform in 2010.
As we previously reviewed, Massachusetts has made several moves from the beginning of reform to ensure high participation and success. Looking back on the last few years of data, it appears clear that successes in terms of widespread coverage, good individual health status, and strong employer participation were reached quickly and subsequently maintained. One trend only now being seen is that toward higher use of a general doctor and away from using the emergency room especially for non-emergency issues. Despite these successes, popularity of the Massachusetts health reform is waning, which could be due to the lack of cost-control measures and a soured overall economy.
As much as the 2006 Massachusetts reform can be used as an example for what is in store for the country as a whole under the Affordable Care Act, the real question remains: are the added features of the ACA enough to control costs? Can the experiments with accountable care organizations and bundled payments keep Americans from having trouble paying their medical bills? Can comparative effectiveness research prevent people from missing the care they need because costs are too high? Can the Independent Payment Advisory Board (if it is not repealed) effectively abort the rising cost of health care?
Overall, the Massachusetts example provides hope that even if no specific cost-controls were included that costs might eventually go down as patients make greater use of their primary care providers instead of emergency care and preventable hospitalizations. We must stay tuned to Massachusetts to see if the data will bear out this expectation.
Lisa Maurer, MD