Thursday, March 04, 2010

Pioneer speaks about MA health reform

The Pioneer Institute is a public policy research center in Massachusetts. On the political spectrum, most people would call it conservative, or a least free-market oriented. In my opinion, regardless of your particular position along that spectrum, the institute's work is worth reading.

Last month, it issued
a paper about the Massachusetts health care reform experiment that serves as a report card on a number of factors, with particular focus on the question of the equity and sustainability of the financing of the health care insurance access system put in place by Chapter 58 of the Acts of 2006.

For those interested in the possible applicability of the Massachusetts model to the national scene, authors Amy M. Lischko and Kristin Manzolillo say:

It is undeniably premature to enact a reasoned national-level solution based on Massachusetts’ or other state experiments. . . .

[We give Massachusetts'] health care reform financing an overall grade of “C” based on the following findings:

Metric 1: Is the funding for healthcare distributed equitably across various funding sources? The data indicate good performance in this area in the early phases of reform; however, without more recent data available, there is only a moderate level of certainty that this has been sustained. Grade: B.

Metric 2: How have per capita health care expenditures changed for the newly insured and the health safety net? Reform’s sustainability relies upon a continuing decrease in the use of the Health Safety Net Trust Fund (HSNTF) as more individuals gain access to insurance. With funding going towards both the HSNTF and Commonwealth Care, along with increased per capita spending on the newly insured, it remains unclear if this model is sustainable. Grade: C

Metric 3: Has the reform altered relative health care cost trends?There is no evidence to suggest that the reform has changed the general health care cost growth trend that was estimated based on 2004 data; however, it is inappropriate to rely on older data for evaluation of this metric. Grade: Incomplete.

Metric 4: Are premiums going up and if so for whom? The reform has to date succeeded at reducing the rate of increase for people purchasing in the nongroup market, but costs in Massachusetts still exceed national averages. Furthermore, the recent cost increases experienced by small groups need to be understood and quickly addressed if the reform is to be sustainable. Grade: C

Metric 5: Are residents able to afford coverage, or do they seek exemptions to the individual mandate? Based on the available data, the initial number of individuals deemed unable to afford coverage is minimal. However, with rising health care costs, the sustainability of this area of reform is questionable. Grade: B

Metric 6: How do Massachusetts’ medical bankruptcy rates compare to those in other states? While Massachusetts residents reported a decrease in the difficulty of paying medical bills since 2006, one in five adults indicated that they were paying off medical bills over time in 2008. When looking at adults earning more than 300% of the federal poverty level, over one in four are still carrying medical debt. Grade: C

1 comment:

Anonymous said...

Paul, The report you mention is the second report card on health reform by Pioneer. The first, available at, focused on increasing access, and was written by Amy Lischko and Anand Gopalsami. Results:

Metric 1: Number of Uninsured and Change Over time: A

Metric 2: Size and Growth of CommCare and Measure of Crowd-Out: B

Metric 3: Employee Take-Up Rate of Health Insurance: B

Metric 4: Use of Preventive Services: Inconclusive

Since the focus of the law was expanding access, and not controlling costs, the results aren't surprising. As Amy and her colleagues, and many others, have noted, our ability to sustain the coverage expansions, let alone expand them, will depend fundamentally on our ability to control rising health care costs. The US and state track record on that front doesn't give much cause for optimism but we will see if we can harness the political resolve to do what needs to be done. Nancy