Massachusetts’ Health Reform Plan: Miracle or Muddle?

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Executive Summary

Interest in the Massachusetts health reform plan remains high as observers at the federal and state levels monitor its progress toward achieving universal health insurance coverage and controlling rising health costs. Many of the features of the Massachusetts plan are contained in legislation under consideration in Congress, including a bill offered by Massachusetts Sen. Edward Kennedy’s Health, Education, Labor, and Pensions Committee. Therefore, it is worth assessing the experience with the Bay State’s reform initiative so far for lessons that may be useful for federal lawmakers.

When the state’s reform plan was enacted in 2006, then-Massachusetts Gov. Mitt Romney was hailed for achieving what no other political leader has been able to accomplish: Developing a broad health reform plan with strong bipartisan support. By enacting sweeping health reform legislation, Massachusetts sought to be the first state in the nation to have all of its citizens covered by health insurance.

Since then, state officials, including Gov. Deval Patrick, as well as many others in the health sector and business community, continue to advance the reform experiment. But implementation continues to pose many challenges — both in access and costs — and observers are cautious about the outcome.

For example, more than half of those newly enrolled in health coverage in Massachusetts are in free or heavily subsidized plans, causing significant budget pressures for the state. Rising costs for health coverage and health care pose the biggest challenge to the success of the reform effort. And physician and medical workforce shortages have been exacerbated, with half of the state’s internists and family physicians closing their practices to new patients.

Architects of the plan are confident it will succeed. Jon Kingsdale, head of the Commonwealth Health Insurance Connector Authority, and others implementing the plan say support remains strong among political leaders and the business community. Gov. Deval Patrick cites 439,000 newly insured residents in the state as evidence of its success. But major problems remain, and duplicating the Massachusetts experiment would be a significant challenge for any other state, much less the federal government.

Massachusetts’ reform initiatives that are being considered by Congress include an individual mandate, employer play-or-pay mandate, a national health insurance exchange, strict regulation of private health insurance, expansion of Medicaid, and establishing a government-mandated health benefits package. Before proceeding to implement this experiment on a nationwide scale, it would be wise to learn more about how the reform plan in this sophisticated, highly-motivated state is developing.

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Download the full paper

Executive Summary

Interest in the Massachusetts health reform plan remains high as observers at the federal and state levels monitor its progress toward achieving universal health insurance coverage and controlling rising health costs. Many of the features of the Massachusetts plan are contained in legislation under consideration in Congress, including a bill offered by Massachusetts Sen. Edward Kennedy’s Health, Education, Labor, and Pensions Committee. Therefore, it is worth assessing the experience with the Bay State’s reform initiative so far for lessons that may be useful for federal lawmakers.

When the state’s reform plan was enacted in 2006, then-Massachusetts Gov. Mitt Romney was hailed for achieving what no other political leader has been able to accomplish: Developing a broad health reform plan with strong bipartisan support. By enacting sweeping health reform legislation, Massachusetts sought to be the first state in the nation to have all of its citizens covered by health insurance.

Since then, state officials, including Gov. Deval Patrick, as well as many others in the health sector and business community, continue to advance the reform experiment. But implementation continues to pose many challenges — both in access and costs — and observers are cautious about the outcome.

For example, more than half of those newly enrolled in health coverage in Massachusetts are in free or heavily subsidized plans, causing significant budget pressures for the state. Rising costs for health coverage and health care pose the biggest challenge to the success of the reform effort. And physician and medical workforce shortages have been exacerbated, with half of the state’s internists and family physicians closing their practices to new patients.

Architects of the plan are confident it will succeed. Jon Kingsdale, head of the Commonwealth Health Insurance Connector Authority, and others implementing the plan say support remains strong among political leaders and the business community. Gov. Deval Patrick cites 439,000 newly insured residents in the state as evidence of its success. But major problems remain, and duplicating the Massachusetts experiment would be a significant challenge for any other state, much less the federal government.

Massachusetts’ reform initiatives that are being considered by Congress include an individual mandate, employer play-or-pay mandate, a national health insurance exchange, strict regulation of private health insurance, expansion of Medicaid, and establishing a government-mandated health benefits package. Before proceeding to implement this experiment on a nationwide scale, it would be wise to learn more about how the reform plan in this sophisticated, highly-motivated state is developing.

Download the full paper

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About the author