Mass. Health Reform's Impact Augurs Poorly for Federal Health Law: New Report

While the Massachusetts health care reform in 2006 reduced the number of people who are uninsured in the state by about half, it did so at a high price and is unsustainable over the long haul because of skyrocketing costs, a group of Boston-area physicians and researchers say in a new report released today. The results do not augur well for the similarly structured Affordable Care Act, they say.

The report, titled "The Massachusetts Model of Health Reform in Practice," presents data showing how the Massachusetts law has resulted in a surge in the sale of skimpy, inadequate insurance policies with high deductibles, along with a sharp rise in health care premiums for individuals and small businesses.

The authors also document how the law has created a financial crisis for the state's safety-net hospitals and community health centers by cutting their public funding and redirecting the money to subsidize the purchase of private insurance policies.

The financial burden of the reform has fallen disproportionately on lower-middle-class families, they say. Meanwhile, the number of uninsured is once again on the rise.

Those are just some of the findings in a new, exhaustively documented report released today by Mass-Care and the Massachusetts chapter of Physicians for a National Health Program. The report, which is extensively illustrated with tables and graphs, draws on hundreds of sources, including academic studies, government statistics and surveys, in the most comprehensive compilation of its kind.

Other findings include the following:

* The use of high-deductible health plans more than tripled for residents with private insurance

* Good health insurance coverage at small businesses all but disappeared after the reform

* Most of the gains in the number of insured represented a shift of patients from the state's former Free Care Pool to costlier private insurance programs, where the patients sometimes face new co-payments and premiums that impede their access to care

* The reform did not reverse the growing use of the state's emergency departments

* The rate of personal bankruptcies linked to medical debt has not significantly decreased

Benjamin Day, executive director of Mass-Care and the study's lead author, said, "Based on what we've seen in Massachusetts, and given the similarities between our state law and the new federal law, it's reasonable to expect a similar course for the Affordable Care Act: a significant initial expansion of insurance coverage and a moderate improvement in access to care.

"However, by not addressing any of the underlying problems of the health care system - its uncontrollable costs, high levels of inequality, and high administrative costs associated with having multiple private insurers - we will see a worsening cost crisis for the rest of the population and a failing safety net for the most vulnerable populations," Day said.

The report finds that small businesses were hit particularly hard by health reform. Quality coverage for small business employees all but disappeared over a few short years after reform - while the share of all insurance plans with high deductibles tripled - and health care premiums for small employers rose more rapidly after the reform than in other states (7 percent faster for individuals and 14 percent faster for families).

Dr. Rachel Nardin, chief of neurology at Cambridge Hospital, assistant professor of neurology at Harvard Medical School and co-author of the study, said, "The Massachusetts reform built on a complex blend of public and private insurers, adding to the administrative complexity and cost of the system. To achieve cost-effective, high-quality and truly universal care, we need a single-payer system."

Nardin's views echo those of other Massachusetts doctors. The Massachusetts Medical Society's newly released 2011 survey of physician attitudes toward health reform showed 41 percent of the respondents would select a single-payer system as their first choice for national reform, versus 17 percent who would prefer the Affordable Care Act model. Support for single-payer reform rose 7 percentage points in the year since the last survey.

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A PDF of "The Massachusetts Model of Health Reform in Practice" is available here:
https://masscare.org/massachusetts-health-reform-in-practice/

Mass-Care, The Massachusetts Campaign for Single-Payer Health Care (masscare.org), is an umbrella organization of more than 100 member groups who represent diverse constituencies including the elderly, low-income people, religious groups, labor unions, teachers, nurses, social workers, doctors, women, immigrants, and local towns and cities. Together these organizations represent over 500,000 Massachusetts residents who are supporters of single-payer reform in Massachusetts.