Friday, October 2, 2009

MA universal health coverage (in brief)

Today at work, I was asked to provide some background for the 2006 Massachusetts state law, Chapter 58: An Act Providing Access to Affordable, Quality, Accountable Health Care. After the fact, I thought I'd post a portion of my communication on my blog.

Background on the MA Universal Healthcare Bill
Massachusetts' Universal Healthcare bill was signed into law in 2006 and MA remains the only state which provides health insurance coverage to all it's residents. When MA drafted this legislation they did it with the state's insurers sitting around the table as a stake holder so unlike the public option which you hear so much about in D.C., Massachusetts created a Public/Private option blend. The result has been fairly positive for the state's health insurers who have bucked a national trend by adding members; something unheard of nationally.

Why universal care works
The MA universal healthcare bill contained both a corporate and individual mandate. This has forced businesses to provide health insurance and encouraged residents to buy insurance or face fines. Nearly all but the state's smallest companies must offer health insurance that meets 'minimal creditable coverage', or they are forced to pay a fee based on the number of uninsured employees as well as any costs incurred by the State if their employees use free care (go to a clinic or ER). Residents also shoulder responsibility and have an individual mandate requiring they have insurance. 

Even though there was a lot of negative press about these mandates infringing on individual liberties and making the state 'unfriendly' to business, it did not prevent the MA from keeping this in the bill and it is in my opinion one of the reasons MA achieved universal coverage so quickly. The state made a strong case by saying that since every resident at some point uses the healthcare system, everyone should be expected to have some form of health coverage.

So what's the problem and what is/are the solution(s)?
Despite a significant downturn in the economy, universal healthcare remains popular in MA. An article published last month in The Boston Globe points out that residents still support the bill which brought universal care to MA by a 2-to-1 ratio (State's Health System Popular). However, the program does have many detractors and there are many problems; cost control and access to primary care physicians being the top two probably.

The state made news back in July when it announced that they would scrap the current "fee-for-service"; a system in which insurers pay doctors and hospitals a negotiated fee for individual procedures or visits (NE Journal of Medicine Article). A state commission has recommended that within the next 5 years the state move to have a yearly fee for each patient. In theory, this will eliminate any financial incentive to overtreat patients and encourage greater efficiencies. Additional monies could be earned through pay-for-performance initiatives.

Now that coverage is avavailable through private employer-based insurance and the state run "Commonwealth Connector" the next step is tackling the jams in the system to ensure better access and  decreasing medical cost trends.  Ideas like ending fee-for-service and implementing pay-for-performance models are innovative approaches that have yet to be tested so it can not be said if they will fail or succeed and the law of unintended consequences can never be discounted, but I am pleased that the state continues to take this issue seriously and errs on the side of innovation and action.

1 comment:

orucab said...

Hi mate!
I'm a Spanish doctor moving to Boston fairly soon for clinical training. I´ve been following your blog for a while without posting, but this entry well deserves a funny (but critical) song about this issue. You are number 37!!