Is Massachusetts Health Insurance Expansion a Success?
09 04 08 - 13:42
IT MIGHT have made more sense economically if a lower-cost state - say, Utah or Minnesota - had initiated the health insurance expansion that became law in Massachusetts two years ago this week. But the political and economic leadership here had the will and the resources to try what no state, except Hawaii, had ever come close to achieving: health coverage for just about everyone. While the success of this initiative is not assured, Massachusetts should be proud of accomplishing so much, so quickly.
As of Jan. 1, 342,000 people had enrolled in insurance plans fostered by the new law, an impressive achievement. Two-thirds of that number are in Commonwealth Care, which provides subsidized coverage to those just above the poverty line.
According to the Kaiser Family Foundation, healthcare costs much more in Massachusetts than elsewhere: $6,683 per person in 2004, compared with Utah's $3,972, and Minnesota's more typical $5,795. Yet in the short term, this cost disparity meant Massachusetts had more money in the system to expand coverage - notably from a Medicaid waiver by the federal government, which comes up for renewal on July 1.
Support for the Massachusetts initiative has been a major achievement of the US Department of Health and Human Services. Secretary Michael Leavitt, who has the final say, ought to approve an extension.
Even with a renewal, unforeseen costs will become a burden. More people have signed up for Commonwealth Care than anticipated and rates are going up 9.4 percent July 1. Governor Patrick budgeted $869 million for the initiative in the fiscal year that begins July 1, but his administration now believes that figure is low by $100 million.
If only this were Utah, where the healthy Mormon lifestyle keeps costs down, or Minnesota, which is not so dominated by expensive teaching hospitals and specialists. But Massachusetts has one great advantage over other states - the coalition of groups that put the healthcare package together two years ago. This includes businesses, health insurers, hospitals, unions, healthcare advocates, and political leaders. They now need to figure out ways to control costs, maintain quality, and get new money into the system when absolutely necessary.
A generation ago, Hawaii was praised for requiring employers to provide health insurance to all workers. Companies found loopholes, however, and as of 2006, its uninsurance rate was 10 percent, a little less than Massachusetts's 11 percent.
The Massachusetts initiative will fray more quickly unless the coalition reenergizes itself.