False promises

At a speech last night, Lynn Nicholas, head of the MA Hospital Association, summarized the up's and down's associated with the Massachusetts 2006 universal health care access legislation. She was kind enough to send me her slides.

There are clearly some significant results from Chapter 58, as outlined in the slide above. Near universal access to insurance has been achieved; a significant percentage of those are being covered by their employers; the individual mandate is successful; the public approves of the program; there has been a reduction in disparate care to minority communities; and the net cost to the state has been relatively modest, when viewed as a percentage of the $30 billion or so state budget.

But there is a problem in that the state promised to raise Medicaid rates to a level more closely approximating the cost of providing service. This did happen for a couple of years, but then things starting to go in the wrong direction.


The result is that Medicaid payments as a percent of the cost of service have been consistently falling.


This is clearly an unsustainable situation. When the state doesn't pay its fair share, either service is not delivered or hospitals face financial problems, or costs are transferred to employers and workers who are covered by commercial insurance.