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Mass success

Posted by: Ella Hushagen on Nov 13, 2008

Lately, it seems like all the headlines about health care are pretty grim. How about a success story to brighten your day?

Massachusetts enacted comprehensive health reform in 2006, and its progress providing high-quality health coverage to the uninsured has been irrefutable. At least 439,000 people who were uninsured now have health insurance; about 191,000 of them found unsubsidized private health coverage.

According to the Urban Institute, the largest gains in insurance have been made by populations that are among the most likely to be uninsured nationally and whose participation in the insurance pool is critical: adults earning less than about $30,000 a year, young adults aged 18-34, and workers in small firms.

Reform of this scale undoubtedly invites criticism and concern. Before the law was implemented, people worried that firms would drop employee health benefits in light of the financial responsibilities imposed on them-a phenomenon known as "crowd out." Two years later, researchers at the Urban Institute say there's no evidence that crowd out is a problem in MA.

Onlookers also fretted that the law's individual mandate-the requirement that all individuals obtain health insurance-would push people to take up bare-bones coverage that would leave them without sufficient protection from high health costs (underinsured). Again, Urban Institute research indicates that while a growing share of Americans is underinsured, the number of underinsured Bay Staters is shrinking under health reform.

The share of insured adults who were underinsured...dropped by about 2 percentage points between fall 2006 and fall 2007....It appears that the gains in insurance coverage in MA under health reform represent a gain of comprehensive insurance coverage....

Surely there's some bad news, right? Well, health reform costs money-that can be bad news depending on your point of view. Massachusetts strikes a delicate balance among stakeholders to fund this worthy undertaking, turning simultaneously to consumers and taxpayers, employers and employees, health plans and health care providers, the state and the federal government. The state is also going after the slippery issue of underlying health care costs, which they realize could undermine their effort.

But, if you asked the 439,000 Bay Staters who now have high-quality health care, "But where's the rub?" they might tell you to look elsewhere.