Healthcare lessons for Washington
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IT'S BEEN two-and-a-half years since we began to implement our landmark healthcare reform law. Some 440,000 are newly insured and the state has by far the highest rate of coverage in the country. As President-elect Barack Obama and Senator Edward Kennedy prepare a new healthcare agenda for the country, people often ask what the nation can learn from the Massachusetts experience.
Truthfully, it is hard to say whether Massachusetts can serve as a national model. The state had many advantages as it began - a relatively high percentage of insured residents, a robust economy and higher-than-average personal income, relatively generous employer-sponsored coverage, generous Medicaid and "safety-net" funding, a progressive electorate, and the invaluable efforts of a diverse and committed coalition of supporters who helped pass the law and have stood steadfastly behind it since.
Whether the Massachusetts experience can serve as a blueprint or simply a point of comparison in the extraordinary challenge of crafting a national bill, there are lessons we can share with Washington. Here are a few:
The individual mandate worked in Massachusetts. An overwhelming 98.6 percent of taxpayers filed correctly and 97.4 percent now have insurance. The mandate spurred enrollment across the board, in employer-sponsored, government-subsidized, and individually purchased insurance.
Even a modest assessment on noncontributing employers, combined with a flexible requirement for individual coverage, has boosted enrollment by some 150,000 in employer-sponsored plans alone while generating broad business support for reform. Employers report a 75 percent favorability rating for the state's healthcare reform.
Building broad support is as critical in the implementation phase as it was for the law's passage. The Connector's diverse board voted unanimously on all its most controversial decisions. Exploring and incorporating ideas from multiple viewpoints is an ongoing process.
One reason for building broad support is the need for a massive, multifaceted public education campaign to reach the uninsured. The Connector decided the more ways the better, so it utilized advertising, partnerships with the Red Sox,
"Credible choice" is critically important to purchasers of health insurance - be they individuals or employers. Choice is one of the most important benefits that a Connector can bring to the market, and offering plans that carry the state's Seal of Approval for quality and value has brought peace of mind to the newly insured.
Simplicity also helps. Modern website tools for comparison shopping have proven surprisingly effective: On the Connector's website, shoppers need only about 20-30 minutes to compare plans and enroll - and 80 percent of them enroll online.
Generous subsidies in the Commonwealth Care program for the needy are critical to reaching near-universal status. The states alone cannot do this without federal financial support.
A merger of the nongroup and small-group markets enabled the state to rein in costs. Before reform, the options for the typical uninsured - a 37-year-old Bostonian - were very few and expensive. Now, the Connector offers that individual some 19 options, including plans that provide twice the benefits at half the premium previously available.
Challenges certainly lie ahead in Massachusetts, particularly around cost containment, and the cost of a national bill will be a major factor in the Washington debate. But, in the end, it is the economic impact of healthcare that may provide the impetus for passage of national legislation. Healthcare spending now accounts for 16 percent of the gross national product, exceeding manufacturing at 12 percent and far outstripping construction at 4 percent.
Increasing healthcare costs are burdening employers and the economy. As incoming Health and Human Services Secretary Tom Daschle said: "There is no question that the economic health of this country is directly related to our ability to reform our healthcare system."
Jon Kingsdale is executive director of the Commonwealth Health Insurance Connector Authority.
