Massachusetts
Health Policy rankings
| Health indicators | Rank |
| Population | 6,344,536 |
| Number of insurance mandates | 43 |
| Death rate per 100,000 | 741.1 |
| Percent of adults overweight or obese | 52.90% |
Percent of adults who have visited a dentist in the last 12 months | 79.50% |
| Number of births (2004) | 78,484 |
| Ranking public policy | Rank |
| Overall health ownership rank | 45 |
| Government health care rank | 40 |
| Private health insurance rank | 47 |
| Medical tort rank | 16 |
| Provider burden of regulation rank | 40 |
Sources
*Policy ranks are from the U.S. Index of Health Ownership, published by the Pacific Research Institute.
*Health indicators are from State Health Facts, a service of the Kaiser Family Foundation.
*Number of insurance mandates comes from Health Insurance Mandates in the States 2007 (PDF), a publication of the Council for Affordable Health Insurance.
State Policy Network members
Government offices
Tuesday, May 6, 2008Ohio Considering Individual MandateExpanding Medicaid, introducing guaranteed issue also on the table By Marc KilmerCategories: Individual Mandates, Massachusetts, OhioAs the Gongwer News Service($) reports:
These are probably going to be the recommendations of a 42-member stakeholder group convened by Ohio's governor. This includes insurers, employers, and others who you would think would see the flaws in this approach. Essentially Ohio is trying to replicate Massachusetts even though the Massachusetts Plan is far from living up to expectations, either on its fiscal side or its coverage side. This push for health care reform is motivated by the number of Ohio's uninsured. But this effort will merely make insurance more unaffordable for some and increase its cost for the rest. Ohio should be considering market-based reforms, but it seems that perspective has been left off the Governor's task force.
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Monday, May 5, 2008Medicaid's Share of State Budget Doubles Since 1987By John LaPlanteCategories: Massachusetts, MedicaidHere's one way of measuring the increasing role of Medicaid in state budgets: How large does Medicaid loom as a share of a state's budget? In 1987, Medicaid was 13% of the Massachusetts state budget. In 2006, it consumed 26% of the state budget--doubling its share.
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Monday, April 28, 2008The Lesson of Massachusetts is NOT Single PayerBy Grace-Marie TurnerCategories: MassachusettsThe American Prospect, a magazine of liberal thought, carries an article in its current issue by Marcia Angell, M.D., of Harvard and former editor-in-chief of The New England Journal of Medicine that does indeed offer fuel for thought. Her article, "Health Reform You Shouldn't Believe In," examines the universal health coverage law in Massachusetts, criticizing "incremental efforts to increase coverage by expanding private insurance." She concludes that a single-payer system is the only viable option. Dr. Angell's earlier diatribes against the pharmaceutical industry are evidence of her animosity toward any private involvement in the health sector. And this latest article shows her clear hostility toward private insurance. While I agree with some of her assessment of the flaws in the Massachusetts health reform experiment, I could not disagree more about her conclusions. In a section of her article subtitled "Massachusetts miracle or mirage?," she acknowledges a truth that Massachusetts politicians are reluctant to admit: "While those beneath the poverty level signed up for free insurance in even greater numbers than anticipated, very few people who were required to pay for their own insurance signed up. Even those eligible for partial subsidies were slow to enroll," Angell says. "The deadline to purchase insurance had to be extended, and 60,000 uninsured people were exempted from the mandate because — yes, that's right — they couldn't afford it (so much for universality)," according to Angell. "Don't get me wrong," she says. "Massachusetts is to be congratulated for seeking to extend health care to everyone in the state. Every decent society should ensure health care, just as it does education, clean water, and police and fire protection. Massachusetts' plan is an ambitious and well-intentioned effort. But unfortunately, it's extremely unlikely to work for three main reasons," she says. To summarize her points: "First, the individual mandate is harsh, regressive, and probably unenforceable. It requires the near-poor to pay a much higher percentage of their income on health care than their more affluent neighbors…It also lets employers off the hook… "Second, like all such plans, the Massachusetts strategy pretends that having insurance is the same as having health care. The Connector makes much of the fact that some 300,000 people who were previously uninsured now have insurance, but most of those already had access to health care, either through the free-care pool or Medicaid. So it's something of a shell game, with money that would have been spent directly on health care passed through insurance companies instead… "Third and most important, there is no effective mechanism for containing costs… And sure enough, premiums have continued to rise faster than the background inflation rate (10 percent for Commonwealth Care next year). The only way to hold them in check is to cut benefits or increase deductibles and co-payments…The state, which now faces a $1.2 billion budget shortfall and health costs of $147 million more than projected, will not be able to contribute much more from general revenues. Funding depends utterly on the Medicaid waiver being renewed in July, by no means a sure thing." All incremental efforts at reform are doomed because they leave "our current dysfunctional system essentially intact," Angell concludes. Her verdict: "The only workable solution is a single-payer system (there, I said it), in which everyone is provided with whatever care he or she needs regardless of age and medical condition. There would no longer be a private insurance industry, which adds little of value yet skims a substantial fraction of the health-care dollar right off the top. Employers, too, would no longer be involved in health care. Care would be provided in nonprofit facilities. The most progressive way to fund such a system would be through an earmarked income tax, which would be more than offset by eliminating premiums and out-of-pocket expenses." Angell says the reason this has not happened is because "the private insurance industry has managed to convince many political leaders, including progressives, that a single-payer system is unrealistic. But what is truly unrealistic is anything else," she says. "My greatest concern about the Massachusetts plan is that when it unravels, people will draw the wrong lesson. They will assume that universal care at a cost we can afford is impossible, and give up on it. It's not impossible; it's just unlikely to be achievable while leaving our dysfunctional system in place." So she envisions a utopia where "everyone is provided with whatever care he or she needs regardless of age and medical condition," with care "provided in nonprofit facilities" and funded by "an earmarked income tax." The lack of understanding of economic and political forces is alarming. And there also is no indication that she recognizes the positive forces in our health sector today that are advancing medical progress, such as:
And the list could go on and on. Are we really so polarized? We agree on the problem, but we have such vastly different views on the solution that you wonder if we ever will make progress. Starting with a good diagnosis is important. But, my goodness, we will need to reach some agreement on a treatment plan.
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Tuesday, April 15, 2008When an Individual Mandate Doesn't Mandate MuchBy Grace-Marie TurnerCategories: Individual Mandates, MassachusettsThe risks associated with individual mandates suggest that they are no panacea, Sherry A. Glied of Columbia University writes in the New England Journal of Medicine. One important concern, says Dr. Glied, is that the government will provide insufficient funds for the subsidies intended to accompany the mandate. In that case, the mandate will act as a very regressive tax, penalizing uninsured people who genuinely cannot afford to buy coverage. This concern has led Massachusetts to create a hardship exemption for its mandate -- an escape clause that effectively undoes the mandate if subsidies are inefficient. The ease with which it is possible to lift the mandate if the legislature fails to appropriate funds may make the individual mandate a rather rickety form of universal coverage. Further, if subsidies are insufficient or benefits inappropriate, the mandate will be very difficult to enforce and draconian in effect. To be effective, an insurance mandate should be in place at the beginning of an insurance term, ensuring that people have coverage when an adverse event occurs. Developing a system to promptly identify and penalize scofflaws will take effort and ingenuity, particularly in our diverse and mobile country and may require a degree of intrusiveness and bureaucracy that some will find unpalatable.
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Monday, April 14, 2008Massachusetts Health Reform: Can the Last Smoker Cover the Last Uninsured Bay Stater?The Commonwealth Connector’s “Terrible Twos” By John R. GrahamCategories: Individual Mandates, MassachusettsThe Boston Globe ran a story about the 2nd anniversary of former Governor Romney’s signing Chapter 58, the landmark Massachusetts health “reform”, which resulted in a joint individual and employer mandate to purchase insurance. According to the Globe, it’s still a “work in progress.” What “progress” remains to be done? Oh yeah: Hike the tax on smokers! The Mass. health system’s costs are spiraling out of control so fast that legislators have resorted to proposing another hike in the cigarette tax to raise $154 million of a budget of $869 million proposed by Governor Patrick. Recall that the proposed tobacco tax alone is actually one fifth higher than the public funds originally anticipated for the entire program’s first year, which was $125 million, as reported by legislative committee in April 2006. Despite now costing taxpayers almost seven times the amount originally budgeted, the reform has failed to “cover the uninsured”. Indeed, residents who are heavily subsidized are signing up, but those who have to pay full freight are dodging the mandate. Indeed, the Boston Globe reminds us that the state does not even know how many uninsured residents it has, but it thinks about half a million. Most infants come out of the “terrible twos” pretty well adjusted. I doubt the Massachusetts health reform will mature in the same fashion.
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Monday, April 14, 2008Double Your WaitBy Grace-Marie TurnerCategories: Individual Mandates, MassachusettsMassachusetts' law requiring everyone to have health insurance is putting added pressure on primary care physicians and lengthening the wait for appointments--an unintended consequence of universal coverage, reports The New York Times. Physician Patricia A. Sereno said an influx of the newly insured to her practice just north of Boston has stretched her daily caseload to as many as 22 to 25 patients, up from 18 to 20 a year ago. To fit them in, she limits the number of 45-minute physicals she schedules each day, thereby doubling the wait for an exam to three months. "It's a recipe for disaster," Dr. Sereno said. "It's great that people have access to health care, but now we've got to find a way to give them access to preventive services. The point of the legislation was not to get people episodic care."
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Monday, April 7, 2008Massachusetts Doctors Stretched ThinAnother unintended consequence of RomneyCare By Marc KilmerCategories: MassachusettsWhile the Massachusetts health care plan has not produced its promised universal coverage, there are more people signed up for health insurance than before the law took effect. Unfortunately for some of them, they are finding that health insurance does not necessarily equal the ability to see a doctor. The article reporting this claims that many of these newly-insured people are seeking deferred care. It also talks about the assumptions that there would be cost savings when the newly-insured seek preventative care. What is not discussed is the tendency of people to overuse something if the cost to them is very small. Also not discussed is the fact that preventative care does not seem to save money in the long run. If more people are utilizing health care without this utilization producing promised cost savings, this would seem to provide yet another reason why the Massachusetts health plan is going to be much more expensive than anticipated.
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Tuesday, April 1, 2008Insight from MassachusettsBy Marc KilmerCategories: MassachusettsAlthough the failings of the Massachusetts health plan have been well-documented here and in other free market blogs, some states are still pursuing similar health care proposals. It's good to see that at least one politician from Massachusetts recognizes the plan for what it is -- a failure.
Hopefully politicians in other states will listen to this on-target analysis.
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Wednesday, March 26, 2008Massachusetts Plan Facing More ProblemsBy Marc KilmerCategories: MassachusettsThe Boston Globe reports on the continuing problems of the Massachusetts health plan:
With a state funding shortfall that would only temporarily be closed with higher cigarette taxes and a federal shortfall that depends on the generosity of HHS, the financial sustainability of this plan is highly questionable. And yet other states seem determined to look to Massachusetts as a state to emulate.
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Wednesday, March 19, 2008Massachusetts Plan in New Jersey?Proponents say it won't cost the state any new money By Marc KilmerCategories: Individual Mandates, Massachusetts, New JerseyIt seems that New Jersey legislators are considering following in the footsteps of Massachusetts and requring all residents to have health insurance. Of course, the plan's authors think they can design such a plan that won't cost the government any new money:
The article says that the plan's authors want to enroll more people in the state's Medicaid program, somehow cut the costs of that program, and then set up a "self-financed" program to provide low-cost insurance for people in the state. How realistic is that? In going down this road it is clear that these legislators have not been paying attention to the failure of the Massachusetts plan as Michael Cannon and Michael Tanner of the Cato Institute continue to point out.
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