Advice From Massachusetts: Beware Of ‘Unstable Compromise’ On Health Reform

Three years after Massachusetts implemented a state program to provide near universal health care, officials said that a key to their success was that stakeholders from the state’s health care sector and the business community had a commitment to implementing the program.

Offering lessons for national efforts to overhaul the health care system, the Massachusetts leaders also emphasized the importance of a strong education and community outreach program to explain the different aspects of the plan and the establishment of a minimum standard of coverage that is understood by the community.

“Ultimately, you need a national solution but Massachusetts has shown the power that states can have on health care reform,” said James Mongan, the president and CEO of Partners HealthCare, a nonprofit, integrated health system.

The officials, however, noted that while they now have coverage for nearly all the state’s residents, they are only beginning the second – and more difficult — stage to contain health care costs.

“Cost containment is harder than access to coverage,” said Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority. The Connector is the public entity created to oversee subsidized coverage and the selection and purchase of private insurance plans by individuals and small businesses.

An estimated 600,000 people – about 10 percent of the state’s population — were uninsured prior to 2006. After the program’s first two years, about 2.6 percent of state residents remained uninsured, according to Kingsdale.

His comments came at a conference Tuesday, entitled “Health Reform In Massachusetts: Lessons for the Nation,” that included a panel of leaders involved in the development of the Massachusetts plan. The conference was organized by the Kaiser Family Foundation. (KHN is a program of the Foundation.)

Kingsdale pointed to other indicators of progress:

–Forty-four percent of the newly insured have private insurance.
–Public approval of the effort so far ranges from 69 percent to 75 percent.
–New state costs have totaled roughly $350 million, or 1 percent of the state’s budget.

Kingsdale said the central elements that have enabled the state’s dramatic coverage expansion include the creation of insurance market reform and insurance exchanges as well as shared responsibility among residents, government and employers.

Despite predictions that Massachusetts residents would drop their employer-based insurance, the number of people enrolled in employer insurance increased by 150,000 after one to two years, according to Michael Widmer, the president of the Massachusetts Taxpayers Foundation.

“We have a remarkable employer community and that’s not the case in all states,” said Celia Wcislo, an assistant division director of SEIU United Healthcare Workers. “Getting through the initial stages and rough patches requires shared responsibility.”

The state’s reform effort has faced challenges including those caused by the recession and issues of affordability. Like other states, Massachusetts is experiencing a full fiscal crisis with virtually every state program being scaled back and roughly 100,000 job losses since the economic downturn began, Widmer said.

Mongan, of Partners Health Care, spoke about the critical and often difficult role of financing. “This discussion has never been about health care, it is about financing,” Mongan said.

He also expressed concerns that efforts in Congress could get bogged down and result in a weakened bill that could lead to an “unstable compromise.”

“If a less than fully robust plan passes, I would hope incentives would be in place to encourage states to do more,” he said.