Massachusetts Health Care Reform : The Canary in the Coal Mine

Advocates for health care reform have been keeping an eye on Massachusetts, hopeful that its new health reform law will serve as a pilot program for the nation.

I’m much less hopeful than I was two days ago.

Yesterday I attended the Massachusetts Medical Society’s Eighth Annual Leadership Forum where I was one of four speakers. This year, the Society (which owns The New England Journal of Medicine)  focused on the cost of health care –with a special emphasis on funding universal coverage in Massachusetts. The new was not good. While the citizens of   Massachusetts believe that everyone has a right to health care (when polled 92% say “yes”), no one wants to pay for universal coverage.   When asked “if the only way to make sure that everyone can get the health care services they need is to have a substantial increase in taxes [should we do it] 55% said “no.”

One speaker at the forum recalled a man who explained why taxpayers shouldn’t have to pick up the bill: “The government should pay for it.” (He didn’t disclose who he thinks “the government” is. )

Some citizens of the Commonwealth don’t even want to pay for their own health care insurance. Under the plan, everyone in Massachusetts is required to buy insurance (or pay a penalty), with the state providing a 100% subsidy for those who earn less than 150% of the poverty level. Those receiving the full subsidy are enthusiastic. The state had hoped to sign up 57,000 uninsured and they’ve over-shot their target: 76,200 of Massachusetts’ poorest citizens have enrolled.

At the other end of the spectrum, the program isn’t doing as well. Uninsured citizens earning more than 300% of the poverty level are expected to buy their own insurance. Here, the state hoped that 228,000 of its uninsured citizens would sign up. So far, just 15,000 have enrolled.  Apparently, they’ve done the math and decided that it would be cheaper to pay the penalty.  But their premiums are needed to keep the program going.  If more in this group don’t sign up, it is not at all clear how the state will be  able to continue subsidizing the poor.

Yesterday’s first speaker, Robert Blendon, a professor of Health Policy in Harvard’s Department of Health Policy and Management, talked about what Massachusetts experience might mean for the national health care debate: “Massachusetts is the canary in the coal mine,” Blendon declared bluntly. “If it’s not breathing in 2009, people won’t go in that mine.”

Continue reading this post at iHealthbeat.

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of  “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

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UnhappyNormaChrisMarcPeter Recent comment authors
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Another case of the Fat getting Fatter. Okay, they want to help me find affordable insurance, so why are they taking that precious money I earned and paid taxes on to push me 1/2 the cost of “affordable health insurance” further away from my goal. Okay, take 3000 and cover COBRA to avoid being robbed, or pay my mortgage, and pay out of pocket. Come on – more left mouth, right mouth politics. When I write the check to cover my costs – I am liable for that obligation. What gives, so if ~1000 (912 in 2008) is 1/2 the… Read more »


What Massachusetts health law is discrimination based on income.The poor get health care the wealthy get health care,but not the middle income.The plans are too exspensive and come with high deductables.The individual mandate is a mean law that punishes people because they cannot afford the insurance.I am uninsured and made to feel embarrassed because I am not wealthy.This state is Elitist.


Two thoughts:
1) I guess the penalty should be higher?
2) I assume that no matter what the cutoff for higher taxes will be, some percentage of the electorate will not be “willing to pay…”. The simple question is at what level is it still economically feasible AND politically feasible (i.e. enough votes?) Of course, the wealthy can move across the border to live in NH.


It is so misleading to ask the question, would you support higher taxes to fund universal health care. Of course most people will say no, because they think they will have to pay extra taxes on top of paying for their own health care (insurance). If you phrased the question such as would you be willing to pay (insert $ amount here) extra in taxes, and not have to pay (insert $ amount here) in health insurance premiums, or health care costs, on your own? I’m quite sure you would get an entirely different response, regardless of the demographic makeup… Read more »


I wonder if the same people who do not believe in affordable mandatory universal coverage in healthcare believe in affordable mandatory car insurance? Or that they understand the, “uninsured motorist” clause and premium in their policy is a cost to everyone that provides a safety net. I’m not surprised by the unraveling of the Mass. plan. I realized early that the $200-$300 premium was a teaser rate and it soon went to $800. For that price I’d take the penalty also. That’s OK because the increasing unaffordability of healthcare will capture more and more people and the base for support… Read more »