What lessons Massachusetts holds for US healthcare reform

The Massachusetts law, passed by a Democratic legislature and signed by Republican then-Gov. Mitt Romney, has expanded the ranks of insured at all levels. Some 163,000 residents bought policies using new “Commonwealth Care” subsidies. Another 190,000 enrolled in employer plans or bought insurance privately, without subsidies. Even MassHealth, the Medicaid program for the poor, expanded its rolls by 76,000, as of the start of this year – in part by adding more children.

Bay State resident Carol Wideman, visiting the Whittier Street Health Center in Boston, says she’s glad that her great-nephew has access to care through MassHealth.

Such views are widely shared, judging by opinion polls last year showing solid public support for the program. Still, the system has cracks.

Subsidies remain a key question

Health coverage is hard for many residents here to afford, just as in other states. Ms. Wideman is stretching to keep her own insurance intact, after losing a job, by making payments under the federal COBRA program for the unemployed.

A key question in Massachusetts and the nation is how much to subsidize people who don’t qualify for Medicaid. For a Bay State family of four, for example, assistance is available up to an income of $66,000. Above that, many families enter a zone where they get no help from the state, and buying insurance on their own may cost more than the state considers affordable. Those families can either struggle to pay premiums and copayments, or use a state exemption and go without insurance.

That’s where cost control comes in. Massachusetts sees that as the next phase of reform, or else voters will face tough choices between rising taxes and squeezed coverage.

Already, budget woes have prompted the state to scale back on access – paring coverage for legal immigrants and ending automatic enrollment for people who qualify for subsidized care.

Critics on the left say the answer is a stronger government role as a payer or perhaps as the single provider of care. On the right, critics say more consumer choice and industry competition will reduce costs and allow more people to afford coverage.

State sets basic standards about what's covered

In Massachusetts, consumers choose from a range of plans, but the state sets basic standards about what care and procedures are covered. The Bay State’s reforms seek to occupy a middle ground.

“The big lesson is that the mandate works – we’ve dramatically increased our insurance coverage” without operational glitches or enforcement problems, says Jonathan Gruber, a healthcare economist who serves on the Connector’s board.

Another positive lesson, he says, is that setting up the exchange caused costs to fall for residents who buy insurance directly (rather than through an employer or government program).

Sarah Beth Glicksteen contributed to this report.

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Where in the world are they getting healthcare right?

As the US struggles to overhaul its system, nations from Taiwan to Germany offer a few lessons – and warnings. Click here to read.

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