Although the Obama administration Tuesday extended the original March 31 deadline to enroll in health insurance into April, a report out today provides some perspective on how there is more to health reform than simply getting everyone enrolled in health insurance.
Massachusetts is often seen as the guinea pig for how health reform may play out across the country. In 2006, then-Mass. governor Mitt Romney signed the Massachusetts health care bill into law, the first in the nation to require residents to obtain health insurance coverage.
A 2012 report by the Blue Cross Blue Shield of Massachusetts Foundation and the Robert Wood Johnson Foundation analyzed the 2006 Mass. health reform law’s impact on access to care, use of health care services, and cost. Despite the fact that nearly all of Massachusetts residents are insured (primarily through their employer), approximately 25 percent have financial problems because of high health care costs.
In 2012, 94.6 percent of non-elderly Mass. residents had health insurance compared to 79.7 percent of Americans. This is the highest rate of health insurance coverage for any state, a rate that has grown from 85.9 percent in 2006.
Overall, 37.1 percent of Mass. adults experienced problems with health care spending in 2012, while 16.4 percent have gone without receiving “needed care” because of the cost. (Nationwide, the nonprofit Kaiser Family Foundation has found similar statistics, reporting that 1 in 3 Americans have difficulty affording their medical expenses).
Here’s how we’re cutting back to pay up: 89 percent cut back on other spending (anything that’s not health-related, including groceries, clothing, daily expenses), 77 percent pull from savings, and 42.7 percent of state residents take on credit card debt or borrow money. Unfortunately, the report also found that more than 57 percent actually cut back on their use of health care because of the cost, putting off treatments or filling prescriptions until they can afford them.
“We need to finish the work of health reform by making high-quality care affordable as well as accessible,” said Phil Johnston, Chairman of the Board of the Blue Cross Blue Shield of Massachusetts Foundation, in a statement about the report. “There’s reason to be optimistic now that Massachusetts has a comprehensive cost containment law on the books, and I hope these findings will lead to a renewed sense of urgency—and action—by all sectors of the health care community.”
Interestingly enough, the survey measured the cost impact of health care right after the passage of the Massachusetts cost containment law in 2012, so it leaves out any potential effects the law has had since then.
“The cost containment law is still in the early implementation phase, and it may be having some kind of psychological impact on providers, because they know the limit is there, but there is nothing that has actually happened because of provisions of the law that has had any measurable impact,” said Dr. John McDonough, director of the Center for Public Health Leadership at the Harvard School of Public Health, in an email exchange.
Unfortunately, McDonough said that health care costs in Massachusetts “will not go down in any significant way—that we can be quite confident about. The question is how much the growth rate will continue to stay at this historically slow rate.”
The Affordable Care Act modeled its insurance requirements and universal mandate after the 2006 Massachusetts law, so it remains to be seen whether what we’re seeing in Massachusetts at this six year mark will reflect the rest of the country’s status in a few years.
“The persistence of such problems, several years into an era of near-universal coverage, amplifies the importance of the state’s current policy focus on affordability and cost containment,” said the report.
Despite the bad news around cost, the survey also found some positive trends that put Massachusetts ahead of the rest of the country. Nine out of 10 adults in the state have access to health care other than the hospital or emergency room, such as a primary care physician or community health clinic. Eight out of 10 adults in Mass. have had a doctor’s visit in the past year, the highest rate of using physician services nationally.
Massachusetts was behind the rest of the nation in terms of access to those physicians though. Nationwide, 11.6 percent of adults are unable to get new patient appointments at doctor’s offices in 2012, while in the same year for Massachusetts, 13 percent of adults were unable to get an appointment. Although this is an improvement from more than 16 percent in 2008, it’s still something the state is wrestling with.
Although the report said the findings in Massachusetts have meaning for the national-level policies like the individual mandate, expansion of Medicaid, and subsidizing insurance coverage, it remains to be seen exactly how this will all play out.
“One thing that’s clear is the Massachusetts reform did not have the major impact on our health system that many feared or wanted. Life goes on, and life will go on after full implementation of the ACA,” said McDonough. “The long-term cost trajectory is less related to the ACA, and more related to the decisions people make day by day to restrain spending growth or to relax controls.”