Report on Mass Health Care
A new paper [gated, but with summary] by Sharon Long about the Massachusetts experience was published in Health Affairs. It is quite a nice look at how things changed from the fall of 2006 and the fall of 2007. The state did indeed reduce the numbers of uninsured and secured better access to health care services for it residents. Curiously, though, the improvement in access to services was not as dramatic as the reduction in uninsured.
The percentage of the uninsured population dropped from 13.0% to 7.1% in one year (this is all based on an independent telephone survey of some 3,000 people). But most of the access measures were far more modest. The percentage reporting they had a "usual source of care" increased from 86.5% in 2006 to 88.7% in 2007, "had a doctor visit in the past year" went from 80.0% to 81.6%, and so on. Out-of-pocket spending for services (not premiums) dropped somewhat. So, an honest reading would have to say that Massachusetts has had some success.
But an honest reading would also have to say that it has picked the low-hanging fruit and the rest will be far more difficult. For instance, all population segments have grown in support of the program – except the uninsured themselves. Their support has dropped from about 63% to 44%. The remaining uninsured tend to be young, low-income males in good health. 80% say they would have trouble paying for health insurance, 41% say they have had trouble paying other bills in the past year, and one-third are not even aware that there is a mandate.
The Heath Affairs study didn't deal with the cost of the program, but other articles have. The New York Times reported that 340,000 of the states residents have gained coverage, including 174,000 in Commonwealth Care (the subsidized program) and the governor "has requested $869 million for Commonwealth Care, but his aides have already conceded that will not be enough." Let's see, that is $4,994 per person in Commonwealth Care, exclusive of any premiums paid by enrollees. I suppose any state could lower its numbers of uninsured if it is willing to spend $5,000 per enrollee. Interestingly, the most expensive policy available next door in Hartford, Connecticut for a 35-year old male costs just $2,744 a year. This is for a zero deductible, zero coinsurance HMO. Other plans cost half of that or less. Massachusetts would have been better served if it simply allowed its residents to buy coverage next door and paid all of their premiums.
