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Massachusetts health care — wonky, with a healthy dose of reality

More on the Tenth (Tin?) Anniversary of Health Reform

More on the Tenth (Tin?) Anniversary of Health Reform

April 12, 2016

According to the leading crowd-sourced online encyclopedia, the traditional gift for a tenth anniversary is tin. So here's a brief bulletin on how folks marked the tenth anniversary of Governor Romney's signing of Chapter 58, the Massachusetts health reform law.

WBUR's Martha Bebinger was one of the go-to reporters covering health reform in 2005 and 2006. Today, she produced a 6-minute report on people's reactions to the law, talking to ordinary people, including Madelyn Rhenisch, the first enrollee in Commonwealth Care, who calls her insurance coverage "a lifesaver."

Also from Bebinger and WBUR is a handy list of "12 Things to Know" on the law's anniversary, with source links. My favorite: "Three-hundred and twenty fewer people died in each of the first four years of mandatory health insurance in Massachusetts." Appended to the list are 13 short essays on law's birthday, from across the spectrum of views. Among those writing are Nancy Turnbull of the Harvard School of Public Health, Jon Hurst of the Retailer's who critiques the merging of small groups with the individual market, and Elizabeth Browne, of the Charles River Community Health Center, on the need for a renewed focus on primary care. And, WBUR's Radio Boston included a discussion on the legacy of the law, with HCFA Executive Director Amy Whitcomb Slemmer lined up with Jon Hurst.

10 YEARS OF IMPACT: A LITERATURE REVIEW  OF CHAPTER 58 OF THE  ACTS OF 2006For the more wonky among us, the Blue Cross Foundation released a comprehensive bibliography of dozens and dozens of studies looking at Massachusetts reform. In addition to the detailed compendium of studies, prepared by Kelly Love and Robert Seifert of the Center for Health Law and Economics at the University of Massachusetts Medical School, there's a fact sheet summarizing the findings. Some highlights:

COVERAGE

  • Massachusetts became the state with the highest rate of insurance coverage soon after 2006 and maintains that status today.
  • The coverage gap among racial and ethnic groups narrowed post-reform.

ACCESS TO CARE

  • Coverage expansion led to overall improvements in access, but gains were uneven across different groups.
  • Unmet need among Latino, black, and middle-income individuals and those in fair or poor health continued to be a challenge post-reform.

HEALTH CARE UTILIZATION

  • The overall use of preventive care in Massachusetts rose, but increases in the use of specific preventive care screenings varied.
  • Hospital readmission rates rose slightly in the early years post-reform; readmissions for some diagnoses, such as substance use disorder treatment, grew while readmissions for others, such as psychoses, fell.

HEALTH OUTCOMES

  • Health care reform has been associated with overall improvements in health, particularly for people of lower incomes.
  • The greatest gains in health status were among racial and ethnic minorities, women, those with low incomes, and adults ages 60 to 64.

ECONOMIC IMPACTS

  • Chapter 58 helped reduce financial distress, most significantly among people who had limited access to credit markets pre-reform.

AFFORDABILITY FOR CONSUMERS

  • Immediately following 2006, increased coverage contributed to fewer reported problems paying medical bills, particularly for low-income adults.
  • Chapter 58’s individual mandate made insurance more affordable for those purchasing it individually, by bringing healthier people into the pool across which costs are spread.
  • Overall, however, Massachusetts has not escaped the long-term national trends in health care costs, and affordability challenges remain. A significant percentage of insured Massachusetts residents continue to report that health care spending causes them financial problems, that they go without needed care because of health care costs, and that they are worried about their ability to pay medical bills in the future.

Finally, former HCFA ED John McDonough blogged today with his take on the anniversary. John marveled at the strange evolution of conservative opinion on health reform, reminding us first, that the conservative Heritage Foundation spoke warmly of the policies embodied in our bill at the signing ceremony 10 years ago; and second, that this all changed with the advent of Obama and the ACA. He concludes,

There was a time, less than ten years ago, when ideas mattered to both sides of the ideological spectrum on health reform. Not today – for ObamaCare haters, it’s about positioning and political advantage.

UPDATE:  HCFA Executive Director Amy Whitcomb Slemmer was a guest on Radio Boston, talking about the impact of the reform law.

And, here's a joint statement consisting of a few sentences each from the Governor, Senate President and House Speaker on the anniversary. Interestingly, both Democratic Speaker DeLeo and Democratic Senate President Rosenberg mention Chapter 58 serving as the model for national reform, while Republican Governor Baker doesn't mention that. Also, here's the Globe front page from the April 13, 2006, headlined, "Joy, worries on healthcare."

                                                                  - Brian Rosman