More Questions About Massachusetts Health Care

And some fine coverage from the State House News Service

Kudos to Kyle Cheney of the State House News Service for a wicked good piece published in the Belmont (Mass.) Citizen-Herald. The article, which discussed the future of the Massachusetts health reform plan, is reminiscent of the good state house reporting many newspapers did before the Great Axe began to fall on the news gatherers. Cheney’s piece, valuable to Massachusetts residents and health reform legislators alike, is an example of the good, nitty-gritty health policy reporting that we need more of.

First, a quick refresher: Two years ago, the state passed a landmark law which mandates health insurance for all residents and imposes a tax penalty on those who don’t purchase coverage. The law subsidized residents who had trouble paying for insurance on their own. Employers balked at the idea of having to cover their workers and, instead, got away with putting $295 per worker per year into a special pot to help pay for the subsidies—a much cheaper alternative. Financing came from a variety of sources, including general revenues and money from the state’s free care pool. The state paid hospitals to treat the poor (who now theoretically had insurance), thus providing a payment stream to the hospitals, so they wouldn’t need to dip into the pool. A big chunk also came from the federal government through the Medicaid waiver program, which allows all states to expand coverage by leveraging federal dollars.
Today, the free care pool is still dipped into regularly by hospitals, and the Medicaid waiver, which provides most of the third-year financing, is up for renewal. State officials and the feds are in intense negotiations before the waiver expires on July 1.

Cheney’s piece captured all that’s at stake. The feds have been cool to the state’s pleas for more money, the State News reported, but Cheney did enough digging to tell readers that the feds, concerned about Massachusetts’s failure to quickly reduce the amount of “free care” that hospitals had been giving, wanted to change the state’s eligibility rules so fewer people would qualify for Medicaid. That, of course, means those people would then be forced to seek subsidized insurance from the state, in order to avoid the tax penalty—which would put further pressure on an already shaky financing scheme. Bad news for the state and for all those required to buy their own coverage.

From Massachusetts Senate Minority Leader Richard Tisei came more ominous news. Tisei told Cheney that, in order to reduce costs, state officials must consider capping enrollment in the subsidized program. While that may well be an option down the road for policymakers, a cap would destroy the law’s basic premise — universality, achieved partly by helping people pay for insurance they couldn’t otherwise afford.

It’s no secret that money is Massachusetts’s biggest problem, one that could well doom the state’s effort—as noble as it is. But you wouldn’t know it from the spin of the positive headlines, earlier this month, on stories reporting the results of a study from the Urban Institute, the Washington think tank that helped shape the law in the first place with a report funded by the state’s Blue Cross Blue Shield organization and its big hospital system, Partners HealthCare. The new Urban Institute report found that Massachusetts’s law had, indeed, brought more coverage to residents. The number of uninsured folks dropped by almost half last year. In the meantime, the state revenue department revealed that 86,000 people paid fines rather than buy insurance, most likely because they didn’t qualify for subsidies but still couldn’t afford coverage (or didn’t want it). The state let another 62,000 off the hook after determining that insurance was too expensive for them.

Stories in the Washington Post—“Study Praises Mass. Health-Care Program,” Marketplace—“Mass. Insurance law passes check-up,” and the Boston Globe—“Health insurance gains detailed” made passing references to the financing pickle, but didn’t offer much depth or insight. This from Marketplace: “But the Massachusetts plan isn’t entirely the picture of health. The research suggests there may not be enough primary care doctors to service all the newly insured and the program costs at least $150 million more than expected.”

To learn what’s really going on, we still need good solid state house reporting—the kind that the State News just provided for the people of Massachusetts.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.