Consumers’ Experience in Massachusetts: Lessons for National Health Reform
By Carol Pryor and Andrew Cohen
Kaiser Family Foundation
The Access Project
September 2009
In developing its health reform initiative, designers of the Massachusetts system tried to ensure that programs were available to help almost everyone get either insurance coverage or assistance in paying for health care. MassHealth continues to serve traditional populations, such as low-income families with children. Commonwealth Care plans are designed for low-income adults without access to other sources of coverage. People with employer-sponsored coverage are expected to keep that coverage. For higher income people without access to employer-sponsored coverage, non-subsidized Commonwealth Choice plans were created to provide what was considered affordable non-group coverage. And for people who still “fell through the cracks,” the Health Safety Net subsidizes certain costs for uninsured people or people with inadequate insurance.
One issue for consumers is that the protections provided to Commonwealth Care and MassHealth enrollees regarding limits on premium and out-of-pocket health care costs were not extended to all lower and moderate income people. As a result, workers in employer-sponsored coverage, especially those with lower incomes, may end up with insurance premiums and out-of-pocket costs that are unmanageable given their incomes. For moderate income workers without access to employer-sponsored coverage, especially those just over the limits for Commonwealth Care eligibility, the options available to them may be an improvement on what was available prior to health reform but still unaffordable. Although the HSN (Health Safety Net) provides some back up coverage, it does not cover everything and the support it provides may not be adequate for everyone.
These problems in part reflect affordability decisions that set coverage limits based on the state resources available. They may also reflect misconceptions about the costs that people at various income levels are able to absorb. People generally think of financial problems resulting from health care costs as the result of catastrophic bills people incur because of major illness. However, a recent study found that most people who reported problems paying medical bills had relatively modest levels of out-of-pocket spending.
The second issue is that the reformed system is complicated for consumers to navigate, which may lead to gaps in coverage as people move among different types of insurance, both public and private.
The Massachusetts experience shows that to make affordable health care accessible to consumers, it is not sufficient to ensure that programs are available to cover everyone. The quality of the coverage provided and the interrelationships between the programs are also important.
http://www.kff.org/healthreform/upload/7976.pdf
Although there are many reports on the deficiencies of the Massachusetts reforms, this report stresses two serious design flaws that impair affordability and access for low and middle income patients: 1) both public and private plans often fail to provide adequate financial protection even for those with only modest health care needs, and 2) the complex maze of programs and plans are very difficult to navigate with ever changing eligibility for the various programs, leading to frequent unavoidable lapses in coverage or no coverage at all.
Many have recommended that we use the Massachusetts model as the basis for national health reform. Basically, that is what Congress is doing. If you read this full report to see what the authors believe are the lessons for national reform, you will see that they recommend yet another half dozen or so patches to be applied to this system with a failing financing infrastructure – failing because it began as a patched together system in the first place.
Perhaps the most telling of their recommendations: “Even in a reformed health system, a health care safety net will be needed.” They assume that we will always have significant numbers of uninsured and underinsured individuals. Providing everyone adequate health care is not possible, that is unless we adopt an improved Medicare program for everyone. But that isn’t feasible.
That last line reminds me of a comment Andy Rooney once made after noting that so many people were told by a doctor that they had only six months to live and yet they lived on for years or decades longer. He said that we should conduct a national manhunt to find that doctor and arrest him.
Likewise, we need to find the person who is telling everyone that the one health care reform program that would actually work isn’t feasible, and then arrest him. At least the people who went to the doctor Andy Rooney mentioned survived his bad advice. This guy who is blocking reform because of some “feasibility” nonsense is killing people wholesale. We have to stop him.