Most conservative critics of the Massachusetts health reform have focused on any piece of bad news about the program they can find. After all, if this is the model for the federal legislation everyone calls “ObamaCare” it’s got to have a lot of defects. Right?
Not so fast. The real story coming out of Massachusetts is that the whole thing is a yawner. Health reform in the Bay State has been mainly about money: who writes the checks and who cashes them. That shouldn’t be a surprise. That’s usually what health reform is about. But what about the effect on patients? As it turns out, there has been very little change at all.
Does that mean that health reform at the federal level might also be benign? I wish. Unfortunately, ObamaCare introduces new and dangerous distortions that you don’t find in Massachusetts — partly because states don’t have the same powers as the federal government. More about that below.
On paper, it looks as though the state has made major progress in insuring the uninsured. From 6.4% of the population in 2006, the uninsured hover around 2% today. However, one study found that nearly all of the newly insured are either on Medicaid, in a state-subsidized plan or in an employer subsidized plan. Only 7% of the newly insured, or about 30,000 people, are directly paying their own way. It’s relatively easy to get people to sign up for insurance when coverage is free or almost free. And it’s not very expensive if you pay for the subsidies using money you would have spent anyway on free care for those who can’t pay their medical bills.
But aside from moving money from one bucket to another, have any real problems been solved? The evidence isn’t positive.
There are three major problems in health care all over the world: cost, quality and access. Since nothing in the Massachusetts reform addressed the problems of rising costs and less than adequate quality, those problems have remained more or less unchanged. What about access to care? Surely, newly insured people have more options in the medical marketplace.
The trouble is that almost all of the newly insured are in health plans that pay doctors and hospitals a lot less than what private insurance pays. Like other places around the country, Massachusetts Medicaid (called MassHealth) pays providers so little that patients often turn to hospital emergency rooms and community health centers for their care when they can’t find doctors who will see them. People in the newly subsidized private insurance plans aren’t faring much better because these plans pay only slightly more than what Medicaid pays.