Massachusetts Mandatory Plan
About the Massachusetts Plan - All the facts, along with the personal stories of affected citizens, about this failure are being developed by Massachusetts citizens. The full “story” is yet to be told and is not yet available. In the meantime, following is some preliminary information.
The Massachusetts Health Care Reform is Failing - Boston Globe
Massachusetts’ Plan: A Failed Model for Health Care Reform - Physicians for a National Health Program
Also see Additional Information
About the Massachusetts Plan
Overall Description of the MA plan from the perspective of Massachusetts citizens
State government forcing citizens to purchase private health insurance plans. — The state of Massachusetts implemented a mandatory health insurance plan for the state in 2006. The state government forces every citizen to purchase health insurance from a health insurance company unless their income level fits within the eligibility requirements for a subsidized plan.
The Mandate and Impact — If a citizen is not eligible for a subsidized health insurance plan and does not purchase health insurance, then they owe a fine that is due as part of income taxes due on April 15 of each year. If the fine is not paid, then the citizen is guilty of tax evasion.
Subsidized Plans and Impact — If a citizen is eligible for a subsidized health insurance plan, then they are assisted by the state to help pay the for-profit health insurance company. As part of registering for that assistance the citizen then is obligated to the state under what is called “estate recovery.” When the assisted person dies, the state becomes a first-priority claimant over all monies and properties. The state, therefore, recovers as much as it determines is owned to the state from the assistance that was provided.
Rationing and the Impact — Any citizen who participates in a subsidized plan is subject to rationing via the fact that many physicians in Massachusetts have decided to not treat those citizens. As a result, these citizens use the emergency rooms more often for their health care.
High Cost — The overall cost has been much higher than anticipated by the creators of the mandatory plan.
The Massachusetts Health Care Reform is Failing
by the Boston Globe
Preliminary comments by a Massachusetts citizen
Here’s a piece that was published on the Boston Globe’s opinion page on March 2. Please pass on to your contacts. It’s practically a first that the Globe actually ran a piece like this after three years of this paper hearing from us, and knowing that this law was failing and harming many since the first year.
Note: Although this is a very good article, it doesn’t mention that those in the subsidized plans cannot afford the premiums, and enrollment was flat from Jan. 1, 08 through Nov. 08 when it began to decrease. Oftentimes, people tend to think that those in subsidized plans are all set. Not the case at all with regard to affordability, no doctors and unsavory Federal regulations among other caveats.
From the Boston Globe op-ed page
SUSANNE L. KING Mass. healthcare reform is failing us By Susanne L. King | March 2, 2009
MASSACHUSETTS HAS been lauded for its healthcare reform, but the program is a failure. Created solely to achieve universal insurance coverage, the plan does not even begin to address the other essential components of a successful healthcare system.
What would such a system provide? The prestigious Institute of Medicine, part of the National Academy of Sciences, has defined five criteria for healthcare reform. Coverage should be: universal, not tied to a job, affordable for individuals and families, affordable for society, and it should provide access to high-quality care for everyone.
The state’s plan flunks on all counts.
First, it has not achieved universal healthcare, although the reform has been a boon to the private insurance industry. The state has more than 200,000 without coverage, and the count can only go up with rising unemployment.
Second, the reform does not address the problem of insurance being connected to jobs. For individuals, this means their insurance is not continuous if they change or lose jobs. For employers, especially small businesses, health insurance is an expense they can ill afford.
Third, the program is not affordable for many individuals and families. For middle-income people not qualifying for state-subsidized health insurance, costs are too high for even skimpy coverage. For an individual earning $31,213, the cheapest plan can cost $9,872 in premiums and out-of-pocket payments. Low-income residents, previously eligible for free care, have insurance policies requiring unaffordable copayments for office visits and medications.
Fourth, the costs of the reform for the state have been formidable. Spending for the Commonwealth Care subsidized program has doubled, from $630 million in 2007 to an estimated $1.3 billion for 2009, which is not sustainable.
Fifth, reform does not assure access to care. High-deductible plans that have additional out-of-pocket expenses can result in many people not using their insurance when they are sick. In my practice of child and adolescent psychiatry, a parent told me last week that she had a decrease in her job hours, could not afford the $30 copayment for treatment sessions for her adolescent, and decided to meet much less frequently.
In another case, a divorced mother stopped treatment for her son because the father had changed insurance, leaving them with an unaffordable deductible. And at Cambridge Health Alliance, doctors and nurses have cared for patients who, unable to afford the new copayments, were forced to interrupt care for HIV and even cancers that could be treated with chemotherapy.
Access to care is also affected by the uneven distribution of healthcare dollars between primary and specialty care, and between community hospitals and tertiary care hospitals. Partners HealthCare, which includes two major tertiary care hospitals in Boston, was able to negotiate a secret agreement with Blue Cross Blue Shield of Massachusetts to be paid 30 percent more for their services than other providers in the state, contributing to an increase in healthcare costs for Massachusetts, which are already the highest per person in the world. Agreements that tilt spending toward tertiary care threaten the viability of community hospitals and health centers that provide a safety net for the uninsured and underinsured.
There is, though, one US model of healthcare that meets the Institute of Medicine criteria: Medicare. Insuring everyone over 65, Medicare achieves universal coverage and access to care, is not tied to a job, and is affordable for individuals and the country. Medicare simplifies the administration of healthcare dollars, thereby saving money. We need to improve Medicare, and expand this program to include everyone.
A bill before Congress, the United States National Health Insurance Act, would provide more comprehensive coverage for all. The bill includes doctor, hospital, long-term, mental health, dental, and vision care, prescription drugs, and medical supplies, with no premiums, copayments, or deductibles.
People would be free to choose doctors and hospitals, and insurance would not be tied to a job. Costs would be controlled because health planning in a national health program can reestablish needed balance between primary/preventive care and high-tech tertiary care. A modest, progressive tax would replace what people currently pay out of pocket. This program would pay for itself by eliminating the wasteful administrative costs and profits of private insurance companies, and save $8 billion to $10 billion in Massachusetts alone.
We must let Congress know we want improved access to affordable healthcare for all, not more expensive private health insurance we can’t afford to use when we are sick. Massachusetts healthcare reform fails on all five Institute of Medicine criteria. Congress should not make it a model for the nation.
Susanne L. King, M.D., practices in Berkshire County.
Massachusetts’ Plan: A Failed Model for Health Care Reform
by Physicians for a National Health Program
Full text is below from Dr. Don McCanne’s Quote of the Day (QOTD)
Prepared by Dr. Rachel Nardin, Assistant Professor of Neurology, Harvard Medical School, with Drs. David Himmelstein and Steffie Woolhandler (both Associate Professors of Medicine, Harvard Medical School) February 18, 2009
Executive Summary
The Massachusetts Health Reform Law of 2006 expanded Medicaid coverage for the poor and made available subsidized, Medicaid-like coverage for additional poor and near-poor residents of the state. It also mandated that middle-income uninsured people either purchase private health insurance or pay a substantial fine ($1,068 in 2009). Smaller fines (up to $295 per employee) were also levied on employers who fail to offer insurance benefits.
The reform law has not achieved universal health insurance coverage, although half or more of the previously uninsured now have some type of insurance policy.
The reform has been more expensive than expected, costing $1.1 billion in fiscal 2008 and $1.3 billion in fiscal 2009. In the face of a state budget crisis in fall 2008, Gov. Deval Patrick announced that he will keep the reform afloat by draining money from safety-net providers such as public hospitals and community clinics.
While the number of people lacking health insurance in Massachusetts has been reduced, several recent surveys demonstrate that substantial problems in access to care remain in the state. While the new health insurance improved access to care for some residents, many low-income patients who previously received completely free care under the state’s old free care program now face co-payments, premiums and deductibles that stop them from getting needed care.
In addition, cuts to safety-net providers have reduced health resources available to the state’s remaining uninsured, as well as to others who rely on safety-net providers for services in short supply in the private sector. These safety-net services include emergency room care, chronic mental health care, and primary care. The net effect of this expensive reform on access to care is at best modest, and for some patients, negative.
By mandating that uninsured residents purchase private health insurance, the law reinforced the economic and political power of health insurance firms. Thus, the reform augments the already high administrative costs of health care. Moreover, the agency that administers the new law (the “Connector”) adds an extra 4 to 5 percentage points to the already high overhead of private health insurance policies.
The reform failed to reduce overreliance on expensive, high-technology services. Indeed, some of its provisions such as changes in Medicaid rates and cuts to safety-net providers (who do more primary care) have further tilted health spending toward expensive, high-technology care.
A single-payer system of non-profit national health insurance could save about $8-$10 billion annually in the state through reduced administrative costs. This money could be used to cover all of the state’s uninsured residents and to improve coverage for those who now have insurance, without any increase in total health care costs.
The Massachusetts reform law is not providing universal access to care, even in a state with highly favorable circumstances, including previously high levels of spending on health care for the poor, high personal incomes, and low rates of uninsurance. It is not a model for the nation.
Report: Massachusetts’ Plan: A Failed Model for Health Care Reform http://pnhp.org/mass_report/mass_report_Final.pdf
Press release: Massachusetts Is No Model for National Health Care Reform http://www.pnhp.org/news/2009/february/massachusetts_is_no_.php
Comment:
By Don McCanne, MD
Those supporting the leading Democratic model for reform frequently cite the Massachusetts plan as an example of how building on our current system of health care financing is the best path to success. Unfortunately, they use selected positive numbers to define success, while ignoring the fact that Massachusetts has failed in its efforts to achieve the real goals of reform. You can understand how pathological the politics of reform has become when they have to dig into the data of a failed reform effort in order to redefine failure as a success.
Let’s look at some of the goals, and how Massachusetts has fared:
Everyone should be included - We should quit being dishonest when we say universal, and start demanding that universal means absolutely everyone. The Massachusetts model has left perhaps five percent of individuals without any coverage whatsoever, and there is little likelihood that the numbers of uninsured will be reduced further because of serious flaws in their model.
The growth in health care costs must be slowed - The Massachusetts model has been ineffective in addressing the primary causes of excess cost escalation.
Health care must be affordable for each individual - Insurance premiums and cost sharing in private plans have remained unaffordable for many in Massachusetts, impairing access to care. Insurmountable debt or personal bankruptcy from medical bills remains a very real threat in Massachusetts.
Under-insurance must be eliminated - Massachusetts has expanded the problem of under-insurance in an attempt to make premiums affordable, failing to achieve either goal of adequate plans or affordable premiums.
Administrative waste must be reduced - Massachusetts has added complexity to an already complex financing system, significantly increasing the administrative waste in their system.
Coverage should be automatic, portable, and permanent - Massachusetts has provided further confirmation that no model built on our dysfunctional financing system can achieve these goals.
Health care must be accessible - The Massachusetts model has further exacerbated the deficiencies in the state’s primary care infrastructure, resulting in increased difficulty in accessing their system. Their fragmented financing model has very little capability of realigning resource allocation to improve access.
Private intermediaries that waste resources and impair access must be eliminated - But isn’t this what the Massachusetts plan is all about? Their view is that we must use our public agencies and tax funds in an all-out effort to protect the private insurance industry, regardless of the harm to patients in the form of physical suffering and financial hardship.
Suppose Congress and the administration accept the message that the Massachusetts plan is the wrong model for reform. Will they then move forward with a single payer national health program - a model that would actually achieve our goals? It is unlikely, based on all signals emitting from Washington. Instead, they will develop a uniquely American plan designed for Americans.
It will be a plan built on our uniquely American, dysfunctional, fragmented system of financing health care. But it won’t be like the Massachusetts plan that was developed in a wealthy state with greater health care resources, and with fewer financing problems than the rest of the nation. No, it won’t be like Massachusetts. It will be much worse… much, much worse.
Even Worse Ideas
Following is an excerpt of an unpublished, confidential report of which I received a copy:
“… He describes his plan as universal managed care run by “7 or 8” large insurance companies. All other smaller “mom and pop” insurance companies would no longer exist. Insurance companies would make medical decisions rather than doctors, who Emmanuel says “do a poor job in managing care, administering inappropriate, poor quality, costly treatments that do not increase longevity”. Americans would get vouchers and would “choose freely” from one of the 7 or 8 basic plans. Wealthy Americans could purchase higher quality care than ordinary citizens in the basic plans. This plan is funded through a “value-added tax” which is an extra sales tax, beginning at ten percent, but would increase over time as needed. He called this a “progressive tax”, because he theorized, “the wealthy would buy more, and therefore spend more, adding more money to tax revenues” than poorer, less fortunate citizens.”
Special Note
The Massachusetts plan is relatively new. The reports to tell the story of the failure, especially the failure for individual citizens, has not been fully told, such as on a PBS Frontline program or a website. The information provided at this web page and at the stories web page is intended to give you a brief glimpse. Much more will come later from other sources, especially if we do not stop this and Medicare’s wrong direction by getting Americans not only educated but also getting them to do the critical action of communications.
Additional Information
Grim Prognosis for Massachusetts Reform
Mational Lessons from State Health Reform: The Massachusetts Case Study – about 20 minutes of video presentation by Dr. David Himmelstein
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