Massachusetts' 2006 Health Insurance Law Not A Good Model for National Health Care System Reform, Physicians Say
Kaiser Daily Health Policy Report
Feb 23, 2009
Modeling the U.S. health care system after Massachusetts’ health insurance law would leave many residents without affordable health coverage, according to analysis by three Harvard Medical School physicians and a letter signed by 500 state physicians sent to Sen. Edward Kennedy (D-Mass.), the Boston Globe’s “Political Intelligence” blog reports. According to “Political Intelligence,” portions of the insurance law — which requires most state residents to obtain health coverage and provides subsidies for some residents who cannot afford coverage — have been praised by President Obama and Senate Finance Committee Chair Max Baucus (D-Mont.), “making it likely to influence any effort to overhaul the national system.”
While the letter urges Kennedy to consider proposing a Medicare-for-all style national health care system, the Globe reports that this “something Congressional leaders and the White House have rejected as politically unworkable.” According to the letter, “Any plan that retains private insurers will add layers of bureaucracy and fail to control costs, dooming the noble effort to assure good care for all.”
In an analysis, Rachel Nardin, a neurologist and an assistant professor, and Steffie Woolhandler and David Himmelstein, both primary care physicians and associate professors, question the quality of state data that show all but 2.6% of Massachusetts’ residents are insured, saying that the number is probably 5% or more. In addition, they claim that insurance coverage under the new law has created unaffordable out-of-pocket costs for lower- and middle-class residents, particularly those with chronic illnesses. The new law also is more costly than expected, which has resulted in reductions to state funding of “safety net” providers that offer no-cost care to low-income residents, the physicians said.
Jonathan Gruber — an MIT economist and a board member of the Commonwealth Health Insurance Connector Authority, which administers the Massachusetts law — said the physicians “let the perfect be the enemy of the good.” Gruber said the Connector has capped out-of-pocket costs and premiums for low-income residents with annual incomes up to three times the poverty level at 10% of their income. However, those who earn between three and five times the poverty level may have more difficulty finding affordable health coverage, he said.
Jon Kingsdale, executive director of the Connector, also said that the physicians’ analysis did not accurately portray the cost of subsidized health coverage in fiscal year 2008, which was $800 million, not more than $1 billion (Wangsness, “Political Intelligence,” Boston Globe, 2/18).
Online The analysis is available online (.pdf). The letter also is available online (.pdf).
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