A new report published online in the journal Health Affairs showed that 94.2 percent of the non-elderly population in Massachusetts had health insurance, a significant increase over the 86.6 percent who were insured prior to the state's health reforms.
But the report "Massachusetts Health Reforms: Uninsurance Remains Low, Self-Reported Health Status Improves As State Prepares To Tackle Costs" by Sharon K. Long, Karen Stockley and Heather Dahlen had both good news and bad news. While respondents to a 2010 survey self-reported improvement in their health status, the cost of insurance has continued to skyrocket, because legislators deliberately chose to put off addressing the rising costs of care when it wrote the 2006 law.
[See also: Gallup: Uninsured rate is highest on record.]
"Just as Massachusetts's 2006 health reform legislation provided the template for the Affordable Care Act...the state's experience under that legislation provides an example of the potential gains under federal health reform," said the authors.
The report also noted that there was not a significant shift in the source of insurance for adults between 2006 and 2010. Employers continued to be the largest source of insurance for state residents and even increased from 64.4 percent of adults covered in 2006 to 68 percent in 2010.
[See also: Family health insurance up 9 percent in 2010, now over $15,000 per year.]
"In 2010, as in earlier years, there was no evidence of public coverage 'crowding out' employer-sponsored insurance under health reform in Massachusetts," the report noted.
Other key findings of the study:
- Although access to care was generally better in 2010 than 2006, the number of respondents who had reported a general doctor visit declined by 3.5 percentage points between 2009 and 2010, perhaps reflecting increases in the use of specialists and preventive care under reform.
- In 2010, 6.1 percent of respondents said that their level of out-of-pocket health spending was at least 10 percent of their family income - a decline from 9.8 percent in 2006. The cost to employees of premiums, however, increased between 2006 and 2010 from $1,011 to $1,200 for single coverage and $3,128 to $3,444 for family coverage.
- Overall, the authors found that in Massachusetts coverage and access to care remain strong, and the effectiveness of healthcare delivery continues to improve. The affordability of healthcare remains a challenge as the Bay State, like the rest of the nation, continues to struggle with rising care costs.
With a high number of residents now covered by insurance, it appears the state is now ready to tackle the rising costs of care and insurance in the state. Earlier this month, the state approved small group rate increases from the state's health insurance companies that average only 2.3 percent. Governor Deval Patrick said this low increase is proof positive the state is beginning to make inroads on controlling costs.
"We all know it consumes too much of family, small business and government budgets. Our businesses, employees, families, governments – all of us combined – spend $66 billion on healthcare in Massachusetts every year. And that spending doubled in the last decade and, without intervention, will double again in the next ten years," Patrick said in his State of the Commonwealth address last week.
"So, starting two years ago, we intervened. And it's helping," he continued. "Average premium increases were 16.3 percent two years ago. Today, they are 2.3 percent."
The small increases in the small group market weren't dictated by the state, but insurance executives indicated they felt compelled to rein in their rates this year due to pressure from both the state and consumers.
As a result, insurers have been agressively negotiating the rates they will pay healthcare providers.
[See also: BCBS of Massachusetts' global payment system lowers medical spending.]
Earlier this month Tufts Health Plan and Partners HealthCare renegotiated their commercial contract and announced it would save plan members as much as $105 million starting this year. And Blue Cross Blue Shield of Massachusetts announced last week that Children's Hospital Boston was the latest provider to sign its Alternative Quality Contract, a modified global payment model that the company says will hold cost increase to the rate of inflation or lower.
According to the Health Affairs report, an interesting shift occurred in the opinions of Massachusetts' residents of the health insurance reforms. While two-thirds of residents still approved of the reforms, a marked shift has occurred among non-supporters from a neutral position to one of opposing the reforms. In 2010, 26.9 percent of the state's residents opposed the legislation, up from only 17 percent who opposed it in 2006.
The authors noted that polls show support for and opposition to the national reforms are split nearly evenly (41 percent in favor of the reforms and 46 percent opposed).
As a result, the authors concluded, "It is likely that the path to near-universal coverage nationally will be slower and bumpier than it was for Massachusetts in 2006. Yet the findings for Massachusetts are a reminder that major gains in coverage and associated benefits are possible."