Massachusetts Health Insurance Law poses huge challenge - Costs
30 06 08 - 12:07
Per USA Today report - Mass. pioneering health plan turns 1
By Julie Appleby, USA TODAY
CAMBRIDGE, Mass. — Self-employed Patricia Pelletier says she has better health insurance than she did before Massachusetts became the first state to require almost all residents have coverage, but it's costing her more.
The plan she now buys, through a system set up by the state, covers more, she says, but her monthly premium is going up from $422 to $615 in August.
"I almost fell on the floor," says Pelletier, 55, of Newbury. "Costs are getting out of control."
Tuesday marks the one-year anniversary of the deadline for most Massachusetts residents to carry health coverage. Those who don't face tax penalties. Since the program began, the percentage of uninsured adults has dropped by nearly half, from 13% to 7%, according to studies cited by the state.
Yet the Massachusetts experiment, enacted in 2006 by a Republican governor in a Democratic state, still faces a huge challenge — costs.
FIND MORE STORIES IN: United States | Massachusetts | Legislature | Medicaid | Kaiser Family Foundation | Health Affairs | Drew Altman | Newbury | Stout | Pelletier
Most of the newly insured are lower income residents who qualify for low- or no-cost coverage through the state and there were more uninsured than the state anticipated. Both factors pushed costs to $625 million the first year, up from estimates of $472 million, according to figures from the state agency overseeing the program.
In the fiscal year that starts Tuesday, the governor has requested $869 million for the program, up from 2006 estimates of $725 million.
Monthly premiums for those who qualify for the partially subsidized program went up an average of 9.4% going into the second year of the program, state figures show. For higher income residents who buy coverage without a state subsidy, such as Pelletier, the average premium increase was 5.1%.
As both presidential candidates outline their own health proposals — and several states consider insurance expansion efforts — Massachusetts' health care law is both touted as an example to copy nationally and criticized as a model to avoid.
"Some will say it's an overwhelming success story. Others will say it has cost somewhat more than expected, so we can't afford to expand coverage," says Drew Altman, president of the non-partisan Kaiser Family Foundation, which studies health policy. "The truth is somewhere in the middle."
A boost in preventive care
The new insurance law in Massachusetts is being felt keenly in hospitals, doctor's offices and clinics, like the Revere Family Health Center, about 15 minutes from Cambridge. Cambridge Health Alliance, which runs this center and 20 others, says their clinics have seen a 16% increase in visits since the expanded program helped many patients get insurance.
Center Director Somava Stout says insured patients are more likely to come in for preventive care. For some, insurance has meant survival.
Kathleen Richard, who is battling thyroid cancer, is among them. "She would not be alive today if she didn't have insurance," says Stout.
Without insurance, Stout says, it would have been difficult, if not impossible, to get Richard the complex surgery she needed. Until she became ill, Richard, 55, always worked and had insurance. Her illness caused her to lose her job and her coverage.
Her cancer was discovered after an emergency visit in 2005 to Cambridge Hospital, which has since helped Richard sign up for several different types of subsidized coverage through the state.
"When you go from having insurance, then having nothing, it's very frightening," says Richard, whose cancer is now in remission. "It's such a plus not to have to worry about insurance."
'A heroic commitment'
The first priority of the Massachusetts effort was to broaden coverage so that residents such as Richard could be insured, says Jon Kingsdale, head of the independent state agency that oversees the program. Tackling costs would come later.
"The way to do this is to make the moral commitment to cover everybody," Kingsdale says. That forces "the political leadership, doctors, hospitals and health insurers to grapple with how to make this affordable. I don't know any other way to get America to confront this very tough problem."
The state has 355,000 newly insured residents, as of April, according to the journal Health Affairs, a leading chronicle of health policy, which recently outlined the success and challenges of the effort.
January figures cited by the state show most of the newly insured qualify for help: 37% are eligible for free state-subsidized coverage, 17% are in an expanded Medicaid program, and 14% only pay for part of their coverage.
Only 7% of the newly insured bought it on their own without a subsidy. The remaining 25% signed up through their jobs.
A bill before the state Legislature aims to save money through a variety of efforts, Kingsdale says, including increasing the use of electronic medical records.
"The state made a great commitment, a heroic commitment," says Assaad Sayah, chief of emergency medicine at Cambridge Hospital. "Is it perfect? No. I'm not sure any system in the world is perfect. But it's better than what we had before."
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