Three years ago the Commonwealth of Massachusetts enacted a far-reaching health reform law that politicians and the media hailed as a model for other states and the federal government. Indeed that law has become the major blueprint for health system change on a national scale, and its advocates are aggressively marketing some variation of the Massachusetts plan as the reform of choice. Until recently, there has been little analysis of how the law has worked. Today we begin a series of posts that will explore the Massachusetts law with an eye toward helping the press and the public understand the flashpoints as legislation based on the Bay State’s experiment winds its way through Congress. The entire series is archived here.
In mid-February, the consumer advocacy group Public Citizen held a press conference alerting the media to the shortcomings of Massachusetts health reform. Familiar supporters of national health insurance—or a “single-payer system,” as it’s now euphemistically called—acknowledged that the law had had some success, but also pointed out several problems that up to that point had not been widely discussed. Dr. Rachel Nardin, who heads the Massachusetts chapter of Physicians for a National Health Program, noted that having health insurance was not the same as getting health care. Thirteen percent of people in the state who had insurance still could not pay for some health services, and 13 percent could not pay for their medicines, she said. Dr. Steffie Woolhandler, a professor at the Harvard Medical School, explained how the law encouraged the overuse of costly high-tech care while damaging the finances of safety-net hospitals.
The report—and an open letter to Senator Edward Kennedy, signed by 500 of the state’s doctors and urging Kennedy to push for a single-payer plan instead of a Massachusetts knock-off—got some press pick-up; but not as much as Public Citizen’s PR folks had hoped. The Boston Globe ran a short piece, and CBS gave it a mention. It was mostly specialized and trade pubs, though, like The Hill, Investor’s Business Daily, Health Plan Insider, and McKnight’s Long Term Care News, that carried the story.
Last week the Institute for America’s Future, a leftish advocacy group, released a similar report documenting what it considered failings in Massachusetts. Its key conclusion: “Since the Massachusetts plan does not contain any mechanisms for reining in the rapidly increasing cost of health care, the plan has limited potential for long-term sustainability.” Press coverage was still scant. Jonathan Cohn picked it up for his blog, Philip Klein posted on the American Spectator blog, and the Boston Herald ran a brief piece.
But the messengers of negative news, nevertheless, tried to put a positive spin on their poor-to-mediocre press showing. Angela Bradbery, Public Citizen’s communications director, said her staff had tried hard to generate interest at all the major news outlets, and that she was pleased that 250 journalists opened the press release. “We think it will greatly improve the coverage of this issue as the health debate unfolds.” And even good reporters are just “getting up to speed on health care choices,” said Diane Archer, a researcher at the Institute. She believes her group will have a long-term impact even if its report didn’t get next-day, nation-wide coverage.
The lack of media coverage that honestly looks at the successes and the failures of the Massachusetts plan, however, stands in stark contrast to the near-universal press enthusiasm that greeted the passage of the law in April 2006. Photos of Senator Kennedy, then-Governor Mitt Romney, and representatives of the state’s medical establishment and consumer organizations congratulating themselves—and headlines like “A Health Fix That Is Not A Fantasy” in The New York Times—seemed to say it all. Romney himself got a lot of ink when he proclaimed that “Massachusetts is leading the way with health insurance for everyone, without a government takeover and without raising taxes.”
In the article, the author states, "The law essentially left in place the existing health insurance structure and rearranged money within the system." I find this to be an excellent summary of what was done here in Massachusetts. With costs continuing to rise faster than inflation, those of us who are self-employed are stuck in a "damed if you do, damned if you don't" dilemma. My 'employer' can't chip in because I AM my employer. Either we pay exorbitantly high rates, per month, or be fined by the state at the end of the year. Follow the money and it ends up in the same pockets: big insurance companies, big hospital chains, big drug makers, medical device companies, etc. In my opinion, the system is headed for collapse. The more people are out of work the more are no longer covered by their employer and the faster they see how absurdly expensive so-called "coverage" really is. If enough can't pay, then the income stream, into the system, starts to dry up.
#1 Posted by Glenn Koenig, CJR on Fri 27 Mar 2009 at 12:43 AM
I am an uninsured Massachusetts resident.The true facts are the health law is discrimination based on income and age.The middle income pay double of a low income and younger person.The "affordable"insurance is not affordable.The high cost plans come with high cost deductables.From $2000.00 to $4000.00.This law encourages welfare because if a citizens income increases so does the cost of their insurance.This law is a rip-off and the only ones benefiting are insurance companies.
#2 Posted by Norma, CJR on Fri 27 Mar 2009 at 03:42 AM
The Mandated Mistake that is Massachusetts.
The MA. mandated insurance is an absolute abomination-period. See http://www.hr676.org/index.html to learn how America could do much better than the MA. mandate. Did you know the architects of the Massachusetts mandated healthcare and similar plans have done studies showing that government provided insurance would be far more equitable and efficient, yet in every case have opted for MA. style mandates citing “political feasibility”? It’s a polite way of saying the insurance companies own our politicians-completely. Did you know the far right think tank, The Heritage Foundation, was invited into Romneys office to devise our mandated healthcare plan for this, the most Democratic of the states? Or that the Ma. mandate plan, all 80 pages of it, landed on legislators desks the day before they were to vote on it? Now big insurance hopes to do to the nation what they’ve done to MA. residents. If successful, it will be the single greatest redistribution of citizenry cash into private industry pockets ever, and to assure sycophantic Senatorial complicity we have this : http://news.yahoo.com/s/ap/20090324/ap_on_he_me/insurers_sick_people
Supporters of the MA. mandate here and elsewhere are part of a well financed spin machine and do a great job. It’s all rather obvious- this machine will sell the American public out to the highest bidder while hiding behind shameful “coverage for all” antics. The irony is they are all Luddites advocating an anti-American anti-progress agenda on behalf of their big money insurance masters. I’m a Massachusetts resident living under the MANDATED healthcare that our “elected” health insurance foot soldiers in Boston rolled out across us all. Now Washington hopes to do the same to all of America. In MA. a healthy 49 y.o. couple with $42,500 GROSS, not net, redistributes around $7000 yearly to insurance companies profit lines with 20% co-pays, $2000 deductible and a policy full of holes. There is no middle ground when you so blandly go about destroying the financial future of those you purport to protect.
I do not want something for nothing-we bought our own coverage for years-but what has been foisted upon MA. residents here is extortion and on the grandest of scales. I know what coverage both cost and covered when purchased with the negligible bargaining powers of an individual. When you consider MA. Mandated insurance was negotiated thru collective bargaining as coverage for millions it can ONLY be viewed as an absolute disgrace in depth and cost. Look around the globe and you’ll see comparatively what a disaster our healthcare system is, that our own leaders would toss us into this abyss as they have in MA. is unconscionable. Mandated insurance is a scam and you are part of the heist.
#3 Posted by Scott Carlo, CJR on Fri 27 Mar 2009 at 10:42 AM
Thanks for looking at media coverage of the Massachusetts health reform law. You are providing a valuable service to the press and public as lawmakers in Washington embark on a national health reform effort.
In that spirit, I would like to clarify what the work of the Blue Cross Blue Shield of Massachusetts Foundation has been in relation to the Massachusetts health reform law. We are a private foundation with the mission of expanding access to health care for low income and vulnerable Massachusetts residents. Toward that end, the Foundation has spent more than $4.1 million since 2001 in a grant program area called “Strengthening the Voice for Access,” which awards money to organizations working to give voice to the uninsured and those who advocate on their behalf. You mentioned two of these organizations in your piece, Community Partners and Health Care for All.
In writing that the Foundation “has spread its money around” to organizations like Health Care for All, the “state’s premier health advocacy group, which has been a strong supporter of reform,” readers might have been given the misimpression that the Foundation only awards grants to groups that support the state’s health reform effort. In fact, the Foundation awards grants to organizations with sound, constructive strategies around enacting change that will result in greater access to health care. This includes organizations critical of the state’s health reform effort, such as the Mass Health Care Education Fund and the Alliance to Defend Health Care.
You are correct to observe that there is a lot to write about with regard to the ongoing Massachusetts health reform effort. As the press turns its collective lens on Massachusetts, I hope that it is careful to present the state’s historic efforts on health care reform in the proper context. One important consideration is to understand that the road to reform in Massachusetts took place over 25 years, beginning in the 1980s with the run-up to the Bay State’s first health reform law, which was passed in 1988. For the full story, read “Funding Makes a Difference: The Role of Philanthropy in Massachusetts’s Journey To Health Care Reform,” available at bcbsmafoundation.org.
Jarrett T. Barrios
President, Blue Cross Blue Shield of Massachusetts Foundation
#4 Posted by Jarrett T. Barrios, CJR on Fri 27 Mar 2009 at 04:04 PM
Yes, I agree with Jarrett Barrios - ex-MA senator who voted for the MA mandated health insurance law and then moved on to become President of BCBS-MA Foundation - that Trudy Liebermann is providing a valuable service to the press and public as she is willing to connect the dots and tell the unreported truth about the MA give-a-way of its residents to the private insurance industry. BCBS and Health Care for All-MA seem to have serious issues regarding the grave harm the MA plan has caused to hundreds of thousands of hard-working MA residents and small- to-medium businesses - both insured and still-uninsured.
The MA law was rammed through by special interests and state legislators under the pretext of an emergency. In fact, the national rhetoric that mainstream media and politicians are currently spitting out seems to be following the MA playbook word for word. Health Care for All, the 'state's premier health advocacy group' has been unwilling from the get-go to acknowledge the adverse effects the MA law has (and still is) causing to a large part of the targeted population. This is a great disservice to the general public across the nation who deserve to know both sides of the story in detail. A law that benefits some of the population but exploits a greater part cannot be called a success.
I know many individuals who could not afford the so-called “affordable” Commonwealth Choice or Commonwealth Care (subsidized) plans, or, for that matter, to upgrade their coverage in 2008 to meet state-approved standards - yet another gift to your vested-interest friends. Nor, for that matter, can any of these folks afford the penalties. People in MA are faced with choosing between heating, eating, paying property taxes or health insurance or penalties. The flat enrollment since January 2008 to the present time in Plan Types 2b and 3, the higher-cost premiums in the subsidized plans, attests to affordability issues while 72 percent get the insurance for free. Others cannot afford the copays which translates to not having access to care, not to mention those who must keep their income low in order to stay in a plan or be eligible for a subsidized premium. How does this help the economy, pray tell?
There are residents who want to see the doctors they had prior to this law and must pay out-of-pocket to do this b/c their docs aren’t in the network OR won’t take subsidized patients due to the state's low reimbursement rates. In some areas, there aren’t any doctors who will take these patients or the only choice is a community health care center which must become the “medical home,” and is not where that person wants to be treated. Therefore, in order to save money to see their choice of doctor, it’s not possible to also pay for an unaffordable monthly premium that buys them NO CHOICE.
The costs for residents were too high in 2007 according to a statewide survey conducted by Community Partners, yet, the Connector increased the premiums 10 percent and the copays from 50 to 100 percent in 2008. The Connector calls this cost-sharing. We call it cost-shifting. And quite frankly, an average reduction in 2009 of $2.44 for some but not all Commonwealth Care subsidized plans is a joke - especially in this economy - it doesn’t even make up for the 2008 increase. No mention yet of copays for the subsidized. Of note, the Commonwealth Choice plans will increase.
All of this is not only oppressive, it is a violation of human rights. Living in MA for the past three years has been a stress-filled nightmare. I wake up every day wondering what country to move to if the MA model is going to be the health care fix for America.
Congress handed seniors to Big Pharma with Medicare Part D. Now they want to sell us all to the highest bidder as MA has done with the continued blessing of MA Gov. Deval Patrick who knows full well that this model is not only harming far too many residents and businesses, it is also unsustain
#5 Posted by Dianne, CJR on Sat 28 Mar 2009 at 11:53 AM
Excellent comment Dianne. Another big issue in this story is how a state senator -- like Barrios -- can help get laws passed that work to the best interest of the industry and against the interests of the public, and then end up with a cushy job with the companies they helped. I'm reminded of Big Pharma giving Billy Tauzin a $2 million job after he pushed through the law that gave the industry $780 billion in the Medicare D program.
#6 Posted by Jack, CJR on Fri 15 May 2009 at 06:19 AM
The fact that 204,000 Massachusetts residents didn’t have health insurance on Dec. 31, 2007, is neither surprising nor unexpected. The Bay State’s landmark healthcare reform effort makes no claims that it will require everyone to have insurance. Those who must buy are those who can afford it. That is why the goal is near-universal coverage. With the percentage of uninsured the lowest in the country at 2.6 percent, Massachusetts now finds itself virtually on par with countries such as Holland and Switzerland, where the goal is to insure everyone. Those countries have uninsured rates of between 1 and 1.5 percent.
Shared responsibility among government, employers and individuals is the cornerstone of our effort. We subsidize insurance for about 170,000 low-income workers not to keep them entrapped in poverty, but to help them get the preventive care that has eluded them for years. And as they earn more, they pay more. Would the writer have them pay less or have everyone pay nothing at all?
The writer is also disappointed that NBC would choose to highlight the case of a 28-year-old woman whose new coverage helped her fight breast cancer. She expresses her dismay by noting that the young lady’s story had already been told in a healthcare reform progress report. The press run for that report was a grand total of 5,000. Does that mean that the 303,824,635 Americans who didn’t get a copy should not hear about it?
In her two postings, the writer likes to point out important facts that are being left out of media reports on our success. She is guilty of that, too. She refers to a newspaper story that highlighted a 17 percent increase in emergency room usage and concluded that the problem is more complicated than “simply mandating insurance.” What she didn’t tell anyone is that the penalty for not having insurance didn’t kick in until three months after the time period used in that study.
We agree that those who are looking under the hood of Massachusetts healthcare reform should put it under a microscope. There are plenty of lessons to be learned, but we will only learn if we have all the facts.
#7 Posted by Richard Powers, Director of Public Affairs, Massachusetts Health Connector, CJR on Fri 22 May 2009 at 03:20 PM