Outcomes
From 2006, the number of uninsured Massachusetts residents dropped from about 6% to about 2% in 2010 according to the Massachusetts Department of Healthcare Finance and Policy (DHCFP), depending on the methodology used, The United States Census Department shows a higher percentage of uninsured for the same years but a similar trend line. That trend line mirrors the approximately 400,000 Massachusetts residents added to the rolls of the insured in 2006/2007 via an expansion in Medicaid eligibility rules and the subsidization of the Commonwealth Care insurance program. A separate view also prepared by the DHCFP in June 2011 (and released in March 2012 with a date of February 2012) shows the number of privately insured individuals in Massachusetts down almost 100,000 between December 2006 and December 2010. According to the same report (latest data available), the decline in the number of privately insured was down only 50,000 as of March 2011 versus December 2006 but there is no indication if that improvement over December 2010 is a seasonal adjustment or a permanent trend based on an improving economy (the state of Massachusetts stopped issuing statistically consistent quarterly Key Indicators reports after the report dated May 2011).
In early years of the implementation of the law, approximately 2% of those eligible were determined not to have had access to affordable insurance, and a small number opted for a religious exemption to the mandate. Approximately 1% of taxpayers were determined by the Commonwealth to have had access to affordable insurance during tax year 2009 (latest data available) and had to pay an income tax penalty instead.
Comparing the first half of 2007 to the first half of 2009, spending from the Health Safety Net Fund dropped 38%–40% as more people became insured. The Fund—which replaced the Uncompensated Care Pool or Free Care—pays for medically necessary health care for those who do not have access to health insurance, and the underinsured. According to the DHCFP in a report dated September 2011, "Total Health Safety Net (HSN) payments increased by 7% in the first six months of Health Safety Net fiscal year 2011 (HSN11) compared to the same period in the prior year while demand increased by 10%. Demand represents the amount that providers would have been paid in the absence of a funding shortfall. Because HSN11 demand is expected to exceed HSN11 funding, hospital providers experienced a $38 million shortfall during the first six months of HSN11." Versus the same period two years earlier, HSN spending plus demand has increased 20%
The reduced state HSN payments anticipated (but not realized) that by reducing the number of uninsured people Commonwealth Care would reduce the amount of charity care provided by hospitals. In a subsequent story that same month the Globe reported that Commonwealth Care faced a short-term funding gap of $100 million and the need to obtain a new three-year funding commitment from the federal government of $1.5 billion. By June 2011 enrollment is projected to grow to 342,000 people at an annual expense of $1.35 billion. The original projections were for the program to ultimately cover approximately 215,000 people at a cost of $725 million.
Enrollment in the Commonwealth Choice Plans, offered through the Commonwealth Health Insurance Connector, fluctuates between 15,000-20,000 according to the state.. According to the DHCFP's quarterly Key Indicator reports, 89,000 people bought healthcare insurance directly as of June 2009, up from 40,000 in June 2006. The number of people with group insurance in Massachusetts has held steady at around 4,400,000 since passage of the health care reform law, according to the DHCFP's quarterly Key Indicators reports available on its website. One outcome has been the unavailability of coverage by many insurers previously doing business in Massachusetts and the inability of anyone who has been uninsured for more than 62 days except in a short window in part of August and September each year. It is possible to be refused insurance by any carrier in the State's Connector plans for up to 11 months, leaving some people uninsured for extensive periods of time.
A study published in The American Journal of Medicine, "Medical Bankruptcy in Massachusetts: Has Health Reform Made a Difference?", compared bankruptcy filers from 2007, before reforms were implemented, to those filing in the post-reform 2009 environment to see what role medical costs played. The study found that: 1) From 2007 to 2009, the total number of medical bankruptcies (defined as due to unpaid medical bills or to loss of income due to illness, with no distinction between those causes) in Massachusetts increased by more than one third, from 7,504 to 10,093; and 2) Illness and medical costs contributed to 59.3% of bankruptcies in 2007 and 52.9% in 2009. The researchers note that the financial crisis beginning in 2008 likely contributed to the increased number of bankruptcies, and Massachusetts' increase in medical bankruptcies over the 2007–2009 period was nevertheless below the national average rate of increase. Still, the researchers explain that health costs continued to go up over the period in question, and their overall findings are “incompatible with claims that health reform has cut medical bankruptcy filings significantly.”
During the week of April 5, 2010, the Boston Globe reported that more than a thousand people in Massachusetts had "gamed" the mandate/penalty provision of the law since implementation by choosing to be insured only a few months a year, typically when in need of a specific medical procedure. On the average, the Globe reported, these part-time enrolees were paying $1,200–$1,600 in premiums over a few months and receiving $10,000 or more in healthcare services before again dropping coverage.
A study conducted by the Urban Institute and released in December 2010 by the Massachusetts Division of Health Care Finance and Policy stated that as of June 2010, 98.1 percent of state residents had coverage. This compared to 97.3 percent having coverage in the state in 2009 and 83.3 percent having coverage nationwide. Among children and seniors the 2010 coverage rate was even higher, at 99.8 percent and 99.6 percent respectively. The breakdown of insurance coverage consisted of that 65.1 percent of state residents being covered by employers, 16.4 percent by Medicare, and 16.6 percent via public plans such as Commonwealth Care. The state's Secretary of Health and Human Services, JudyAnn Bigby, said, “Massachusetts' achievements in health care reform have been nothing short of extraordinary. With employers, government and individuals all sharing the responsibility of reform, we continue to have the highest insurance rate in the nation.”
In June 2011, a Boston Globe review concluded that the healthcare overhaul "has, after five years, worked as well as or better than expected." A study by the fiscally conservative Beacon Hill Institute was of the view that the reform was "responsible for a dramatic increase in health care spending," however.
In March 2012, the National Bureau of Economic research released a working paper claiming "that health care reform in Massachusetts led to better overall self-assessed health... improvements in several determinants of overall health, including physical health, mental health, functional limitations, joint disorders, body mass index, and moderate physical activity."
In 2012, the Blue Cross Foundation of Massachusetts funded and released in April research that showed that the 2006 law and its subsequent amendments – simply in terms of measuring the state-budget effect on the uncompensated care pool and funding subsidized insurance (see Background section above) had cost approximately $2 billion in fiscal year 2011 versus approximately $1 billion in fiscal year 2006. Some of this doubling in cost was funded by temporary grants and waivers from the United States federal government.
The Blue Cross funded research did not address the increased costs in premiums for employers and individuals or other market dynamics – such as increased providers' costs and increased co-pays/deductibles – necessary to meet minimum creditable coverage standards that were introduced in Massachusetts by other parts of the 2006 legislature and its resulting regulations. Separate research on Premiums and Expenditures released by the Massachusetts DHCFP in May 2012 found that fully adjusted premiums per member per month (PPMPM) for Massachusetts residents covered by comprehensive private insurance policies (approximately two thirds of the state population) increased approximately 9% in both 2009 and 2010 (latest data available) for subscribers in the "merged market," 7% in the midsized group market, and 5.4% in the large group market. These premium increase do not reflect actual resident experience particularly in the merged market because Massachusetts regulations allow age and other rating factors (e.g., even if premiums were held flat for 55 year olds living on Cape Cod in construction work from year to year, the 55 year old in 2009 would pay 10% more in 2010 for the same policy, possibly with lesser benefits).
Because of this combination of a larger than anticipated effect on the state budget (see 2012 Blue Cross research compared to Governor Romney's proposal to the Medicaid Commission in 2006) because of the 2006 Massachusetts health care reform and continued growth above inflation for private insurance (see DHCFP research), the legislature is considering strict provider price controls as of May 2012 with expected passage by July 2012.
It is estimated that emergency room visits have declined by 5–8% as a result of the health reform. The reduction in emergency room visits is most pronounced during regular office hours when physician's offices are likely to be open.
Read more about this topic: Massachusetts Health Care Reform