The Massachusetts Numbers

Last week the Census Bureau released new numbers showing that 5.6 percent of the population in Massachusetts remained without health insurance coverage. That’s a 42 percent drop in the number of the state’s uninsured since the law took effect in 2006. A new study by the Cambridge Health Alliance, one of the state’s safety net providers, showed who was left out, putting a human face on those without insurance. The findings are illuminating given that the Bay State’s health law is the model for the national law, which takes full effect in 2014, and the Romney-Perry feud often flares up around the topic of health reform in the state.

The local press, primarily the Boston Globe and WBUR, covered the story; the national media whiffed on its implications for federal reform. If reform in Massachusetts cut the number of uninsured roughly in half, the same is likely to happen nationally, according to government data. The latest Census Bureau numbers show that nearly fifty million people have no health coverage; the Congressional Budget Office estimates about twenty-three million will be still be uninsured later in the decade. It was as if the national media has forgotten that Massachusetts is a harbinger of what will happen nationally. Or perhaps it’s easier for the national media to cover the he said/he said back and forth between Perry and Romney.

Writing on WBUR’s CommonHealth blog, Carey Goldberg started with an intriguing lead that showed she could sniff out a story—and showed why others should, too.

You figure that when a press release comes in from Physicians for a National Health Program, it has an agenda. But that doesn’t negate the value of the research it highlights—which, in this case, was a paper from Harvard Medical School researchers just out in the Journal of General Internal Medicine. Researchers surveyed 431 patients who sought care in the emergency department of the Cambridge Health Alliance and conducted in-person interviews with 189 who were uninsured. Their results show that fragmentation still exists in a system built on employer-sponsored coverage. Gobs of paperwork also still exist, and private insurance remains unaffordable for many—even with government tax subsidies. The key points from the study are these:

• Finding affordable coverage is hard. One third of the respondents said they were uninsured because they could not buy affordable coverage. Half the sample said that the mandate to buy coverage prompted them to look for insurance, but they couldn’t find any they could afford.

• Two-thirds of the uninsured were working, but only one-quarter of them had employer coverage.

• Some declined employer coverage because of its cost. The state requires an employer to cover only 20 percent of the annual family premium and 33 percent of an individual premium. The authors suggest that if the trend continues that requires employees to pay more out-of-pocket, even fewer employees will take their employers’ coverage.

• One third of the respondents said they were uninsured because they lost their coverage. People receiving subsidized coverage must re-enroll every year. If they don’t get the paperwork sent in within ten days, they lose coverage.

• Eighty-five percent of the uninsured qualified for state-subsidized insurance, but still one-third were without coverage, suggesting, the authors say, “that for some working poor, even heavily subsidized insurance premiums may be unaffordable.”

• Only about six percent said they were uninsured because they didn’t think they needed coverage; in other words, there were few “free riders.” That’s an important point to remember next time the candidates declare that people like to take risks by being uninsured.

Several months ago, a group called PHI, which works to improve conditions for workers who provide long-term care, released a study that meshes with the Cambridge Health Alliance findings. PHI found that while many employers offered coverage, workers were not taking it. About half of the workers surveyed were not eligible for employer coverage because they worked part time or had to satisfy a waiting period for coverage. About one-third of employers raised the level of cost-sharing for their workers. The media showed little interest in this study as well.

“If you don’t find out what the old polices have done, it’s a prescription for bad policy going forward,” says Steffie Woolhandler, one of the Cambridge study authors. Woolhandler and her colleagues offered suggestions for improvement like increasing employer incentives to cover a greater portion of premium costs, reducing cost-sharing for low-wage workers, and making the enrollment process easier. William Woo, who was the editor of the St. Louis Post Dispatch, once told me there’s a master narrative the press follows. Examining the shortcomings of Massachusetts health reform doesn’t fit the master narrative—at least so far.

For more from Trudy Lieberman on the Massachusetts health reform law and its national implications, click here.

10 replies »

  1. Not to mention when in the hiistory of government healthcare reform has it actually achieved the results we were told it would. Premiums and uninsured rates increase every time government tries to fix it, why should we expect different this time

  2. When you achieve something that could have been achieved with much less expense and complexity it hardly constitutes a small battle won, rather a battle lost. It speaks poorly of one’s societal intelligence when they confuse opposition to a poorly designed program as being the same as opposition to the goals of that program.

  3. There are many critics and proponents of the law but in regards to health care cutting down the number of uninsured by half is a step in the right direction. One cannot realistically expect 100 percent universal health care coverage to happen overnight in the way our nation runs but to reduce the number of uninsured by that much is still a small battle won in a very big war.

  4. ” very large dollar amounts. So much so that the powers that be could not bring themselves to let go of the control of that much money,”

    BINGO, the left can’t buy influence and misappropriate money they don’t have….well actually they do but the amount they can borrom is inflated by what they control on an annual basis.

    No solution to cost or access of healthcare is acceptable to the left unless they can dictate who gets what and those people are beholden to them.

    Left prevented AHPs for 15 years becuase they were privately controlled, a State or Federal exchange on the other hand controlled by politicians is perfectly acceptable.

    It always has been about the money not actually controling cost or delivering care.

  5. “The political “right” likes to paint the “reform” as a calculated part of a master plan to bring about universal single payer health care. I don’t think the “left” has any master plan at all.”

    There has been plenty of people on the left opening calling for universal healthinsurance since early 1900s. Medicare for all was originally part of SS but was taken out for political reasons. Medicare was originally for all then scalled back. There is no question the left is driving for all healthinsurance to run through the government. Just ask them.

  6. “No good deed goes unpunished” A lot of colleagues out there should identify with that adage.

    While the mandate is the most obscene part of the legislation, if for at least the reason that if politicians in DC get away with mandating something of this magnitude it only opens the door for future intrusions into alleged public welfare, setting up a committee/board to supervise clinical care decisions will only put people at risk because said decisions will be first and almost always be about money alone, it will prevent good doctors from being able to provide good care.

    The only “good thing” about PPACA is that health insurance companies and big pharma outwardly supported it, and now are coming to terms they are getting screwed. I like to see bad things happen to bad people, and for those who are solely in this field of service to make a buck off it, don’t try to reach out and grab me while you go down!!!

    Plus, read a piece this morning in a city newspaper that just reinforces the entitlement of boomers soon to be retiring, and how their “optimism” is in the end fatal and just insensitive to those around them.

    Talk about a ball and chain!

  7. As an example, I have a patient who is a regional official in the state medicaid program. He described for me a pilot program that the state did with a certain population of mental health patients. They gave the patients control of their budget. In essence the patients where told they had X number of dollars, and how would they like to spend them? The patients decided which services they wanted, where they wanted to receive them, etc. At the end of the study, the patients were significantly more satisfied with the care they recieved, and the overall costs to medicaid were lower. But yet this program was not expanded state-wide. The budget given to each participant was in the tens of thousands of dollars – very large dollar amounts. So much so that the powers that be could not bring themselves to let go of the control of that much money, even though the results suggested they would save money by doing so. If these mentally ill patients could save their fellow citizens money by taking control of their health care spending, don’t you think the rest of us have a chance to bring down costs as well by taking control of what we spend? Just keep in mind that “shopping around for insurance” is not even in the same universe as what is meant by taking control of your own health care spending. Nor, as some of the brain dead idealogues would claim, does taking control mean coming up with you own money every time you have an unforseen large health care expense.

  8. You would think that the results so far would give pause to those who have championed this type of “reform” and perhaps lead them to consider alternatives. But no, instead they will double down and triple down – keep passing laws to foist insurance upon the masses while waiting for the next set of unintended consequences so they can legislate them away too.
    Sorry to sound like a broken record, but insurance is not health care, and health insurance as currently implemented is not even insurance in terms mitigating risk. Much of it is simply pre-paid health care, and any thinking person knows that pre-paying for something you may or may not need is always, always, always more expensive than paying as you go.
    The political “right” likes to paint the “reform” as a calculated part of a master plan to bring about universal single payer health care. I don’t think the “left” has any master plan at all. Instead they are idealogically driven and haven’t a clue what it will look like when they get done mucking around. They are unwiling to factor in ideas that don’t resonate with their idealology even if those ideas would help to bring affordable care to the poor. Where the idea originates from seems to be more important than the idea itself – if it did not come from the right source – a trusted academic or intellectual – then there is no place for that idea in their world.