This is the next chapter in my Wednesday is Student Day series. Students, you have been slow in submitting other questions. If you don't have any, I'll have to make some up . . .
Rocky, a medical student, asks below: "Do you see the new Massachusetts Healthcare Plan having the potential to increase access to good quality care? How will undocumented residents and current free care recipients be affected by the new healthcare reform bill. Will large hospitals retain their freecare pool?"
I have not spent much, if any time, discussing the new Massachusetts legislation on this blog, mainly because the topic is very well covered on John McDonough's blog and WBUR's. I suggest you read those.
I think it is important to remember what the new law is designed to do and what it does not do. It is designed to provide as many people as possible with insurance. An underlying premise and hope is that people with insurance will have better and more appropriate health care. For example, they are more likely to have a primary care doctor -- assuming they can find one -- and go to that doctor for preventative care and low-level emergent issues, instead of showing up at a hospital emergency room. Although hard work remains on this front, the law has already been successful in providing insurance to tens of thousands of people who previously had none.
The law does not do much about the cost and quality of care in the state, except to the extent that insured people will have a better chance of earlier diagnosis and treatment. Although a Quality and Cost Council is established, as far as I can see, it has little authority. Perhaps, though, it will exercise its moral authority to push hospitals along.
Finally, on your question about the free care pool, which is designed to support care for people below a certain income level, we expect to see a transition of patients from that category to Medicaid or to the insurance plans offered through the Connector Authority. Whether that is a net plus or minus financially for a hospital is unclear: The free care pool has never fully compensated many hospitals for their care of uninsured people, but the payment schedules under the new state insurance plans -- just like Medicaid -- do not fully compensate hospitals either.
Just to be clear, none of this affects how we treat patients, which is to do our best to provide excellent care regardless of a patient's income or insurance status. The financial impact is made up by private insurance company payments from other patients and by philanthropy.