Study questions impact of health proposals

Efforts to cut the number of uninsured people in Massachusetts merely by changing the rules in the regulated insurance market are unlikely to have much impact, according to a draft study commissioned by the Massachusetts Association of Health Plans, a trade group for health maintenance organizations.

The draft study obtained by the Globe found neither the healthcare changes proposed by Governor Mitt Romney nor a competing proposal by Senate President Robert E. Traviglini would significantly reduce the number of uninsured over the next five years, when only considering how the plans would change regulations for insurers selling coverage to individuals and small employers.

But the study does not consider the more sweeping elements of the governor's proposal, such as an ''individual mandate" that would require all those who can afford health insurance to purchase coverage or face financial penalties.

''You can have limited impact on the problem of the uninsured by changing the regulatory structure for health insurance alone," said Nancy Turnbull, a lecturer at the Harvard School of Public Health and executive director of the Massachusetts Medicaid Policy Institute. ''We need to adopt approaches that are more far-reaching if we're going to have a significant impact." Turnbull said she hadn't reviewed the entire draft study.

Tim Murphy, Romney's secretary of health and human services, said the study didn't consider key innovations in the administration's plan. For instance, it doesn't include a proposal to enroll all qualified people into Medicaid, the joint state-federal program to provide healthcare for low-income people. That could remove more than 100,000 people from the rolls of the uninsured, the administration estimates.

''They missed a lot of the points of the Romney bill," he said. ''I'm looking forward to looking at the final analysis."

Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans, cautioned against drawing conclusions from what she called an incomplete and inconclusive study.

''This is a work in progress," she said, adding that the finished report should be released next month.

The draft study looked at how the competing plans would change the ways health insurance companies develop and sell plans for individuals and so-called small group employers with fewer than 50 workers. Buyse said insurers are concerned about measures that could make health coverage more expensive to those customers.

''We don't think the individual market or the group market can bear much more in rate increases," she said.

The preliminary findings come at a crucial time in the effort to extend insurance coverage to the roughly 500,000 uninsured people in the commonwealth.

Today, Massachusetts politicians, healthcare advocates and academics will meet in what is billed as the culmination of the ''Roadmap to Coverage." The Urban Institute, a nonprofit, nonpartisan research group in based in Washington, D.C., that has led the research, is expected to sum up the project's findings and recommend steps to achieve universal health coverage in Massachusetts.

In addition, Massachusetts House Speaker Salvatore F. DiMasi is expected to present parts of his own bill laying out a competing vision for extending health care coverage to all in the Bay State.

Romney's plan would take the $1 billion spent annually on healthcare for the uninsured to create a subsidized insurance plan with comprehensive individual health policies for about $200 a month.

Still, some wonder whether it will be possible to make serious reductions in the uninsured without additional money into the effort.

''You can't have an individual mandate requiring people to have health insurance unless you make affordable insurance available," said Michael Doonan, executive director of the Massachusetts Health Policy Forum and a professor at Brandeis University's Heller School for Social Policy and Management. ''The onus is on the governor or anyone who proposes a mandate to make sure it's affordable and available to everyone. It's hard to see how we can do that with any plan without putting additional money into the system."

Jeffrey Krasner can be reached at krasner@globe.com.