Thursday, June 26, 2008

Massachusetts 2 1/2 year old of Universal Coverage Pan

Observations about progress to date.

1. At its onset, Massachusetts was a state unusually positioned for universal coverage, a liberal populace, a low rate of uninsured (552,000 of 6.4 million, 8.6%) and the highest health premiums in the land, roughly 30% above the national average.
2. Other states are unlikely to follow Massachusetts because of different demographics, e.g., California has more uninsured, 6.7 million, than the entire Massachusetts population of 6.4 million.
3. Universal coverage is more expensive than originally projected and is growing faster than anticipated because of record and growing enrollments.
4. The plan has successfully newly insured 350,000 residents, 5.5% of the state population.
5. Universal coverage requires a large and complicated bureaucracy (The Connector, rules for tracking who gets subsidies and how much, tracking who is getting enrolled, and Medicaid tracking and adjustments).
6. Monthly costs per subsidized member are $352.43 per member.
7. The individual mandate is enforced through state income tax returns.
8. In 2008, the maximum penalty for not having insurance was $912.
9. In 2008, for most citizens health insurance is now considered affordable.
10. Universal insurance coverage is not the same as universal access, :many citizens are having difficulty finding a primary care physician and primary care practices are overloaded.
11. Cost control is an overriding issue (according to John Kingsdale, executive director of the Commonwealth Connector, “To maintain public and financial commitment. Controlling costs is 110% of the challenge over the next several years.”)
12. he legislature is considering new cost controls, and Blue Cross Blue Shield may initiate a plan combining payments combining pay-for-per-performance and capitation.
13. The Massachusetts experiment is a work in progress, is popular among the public and its politicians, and will continue as long as the State and the federal Medicaid program is willing to pay the ever-increasing bill
14. Universal health reform takes more time and more money than expected, evening an overwhelmingly liberal state with the best intentions of all participating parties.


Robert Stein brook, M.D. “Health Care Reform in Massachusetts – Expanding Coverage, Escalating Costs,” New England Journal of Medicine, June 26, 2008.

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