Tuesday, June 10, 2008

Looking Again at the Massachusetts Experiment

Two years ago in one of my early posts, I wrote about the Massachusetts Health Plan. The Massachusetts plan was an effort to expand access to health care and reduce the number of uninsured and underinsured residents. The plan used a combination of government programs, incentives for companies and individuals to purchase health insurance, and penalties to enroll as many as possible in public or private health insurance programs. At the time, everyone was intrigued. However, everyone also knew this was an experiment, and, like all experiments, it would take time to learn whether this really worked.

Well, we now have some indication. A study of the Massachusetts plan has been published on the web site of Health Affairs. The report, “On The Road To Universal Coverage: Impacts Of Reform In Massachusetts At One Year,” was authored by Sharon K. Long, a Research Associate at the Urban Institute. (You can also read news reports on the study here and here.) The study is based on two telephone surveys, one taken just before the plan was implemented and the second one year after initial implementation. Each survey reached had results from approximately 3,000 households. While the report offers interesting details, you can gain a lot in this quote from the abstract:

In roughly the first year under reform, uninsurance among working-age adults was reduced by almost half among those surveyed, dropping from 13 percent in fall 2006 to 7 percent in fall 2007. At the same time, access to care improved, and the share of adults with high out-of-pocket costs and problems paying medical bills dropped. Despite higher-than-anticipated costs, most residents of the state continued to support reform.

Some specific points from the report:

The percentage of all those contacted who had no insurance dropped in one year from 13% to 7.1%. More specifically, those who had been uninsured at some time in the year previous to each survey dropped more than 4% (from 18.8 to 14.5).

There had also been concerns that there would be an effect of public programs crowding out employer based programs, either because employers would choose not to offer health plans to their employees, or because the employees would choose not to take the plans offered, in favor of government-supported plans. It appears the effect did not occur: “The share of adults overall and the share of working adults who reported that they had a coverage offer through their employer remained stable between fall 2006 and fall 2007.” It also appears that more families could identify a primary care provider, and that there was no increase in use of Emergency Rooms for nonemergency needs. The program did cost the state more than originally expected. This may be because there were more uninsured individuals than expected to incorporate into the program.

There is much more to note from this study, and from a related article, also in Health Affairs, titled "Massachusetts Health Reform Implementation: Major Progress And Future Challenges.” This article goes into more detail about implementation of the various parts of the program.

In this election year, in which access to health care is already a major issue, it is worthwhile to look at the Massachusetts experiment, as well as at similar programs in California and Pennsylvania. While one or two years isn’t a long track record, it can give some indication whether these programs are meeting individual and social needs. With that information, we can be more clear what we expect from those we elect, not only as President, but also in all the Congressional races.

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