SCOTT SIMON: Welcome to Need to Know, and thanks for joining us. At this time last year, in the heat of the 2012 presidential race, much of the nation’s attention was focused on a case before the Supreme Court. At issue, was the constitutionality of President Obama’s most significant piece of legislation: the Patient Protection and Affordable Care Act.
At the heart of the matter was the mandate. It requires individuals who aren’t insured to buy health insurance by 2014 or face penalties. Supporters of the plan say it provides a safety net to the nearly 50 million uninsured Americans and — eventually – will lower healthcare costs. Opponents say forcing anyone to buy medical insurance intrudes on personal freedom, costs will wildly increase, and deter employers from hiring. And even though the court upheld the constitutionality of the mandate, that doesn’t mean the debate is over. So just how might this federal healthcare plan work over time?
You don’t have to guess entirely. Because a very similar plan, including an individual mandate, was enacted seven years ago in Massachusetts under then-governor Mitt Romney.
Our medical correspondent, Dr. Emily Senay, traveled to Massachusetts last spring to see how healthcare reform is working there.
DR. SENAY [narration]: THOUGH THEY LIVE ON OPPOSITE SIDES OF BOSTON AND LEAD VERY DIFFERENT LIVES, 38-YEAR-OLD ALLIEA GROUPP AND 52-YEAR-OLD PETER BROOK HAVE SOMETHING VERY IMPORTANT IN COMMON: THEY BOTH KNOW WHAT IT’S LIKE TO BE SICK WITH LITTLE OR NO HEALTH INSURANCE. ALLIEA HAS EPILEPSY. AND IT CAUSED A PROBLEM WHEN SHE APPLIED FOR INSURANCE AT HER FIRST JOB OUT OF COLLEGE.
ALLIEA GROUPP: One week into the job I was notified by my employer that the insurance provider had denied me coverage. Because of my preexisting condition. And so, I was left alone to pay for my care on a very low salary.
DR. SENAY [narration]: AT THE TIME, SHE WAS A LOW-PAID COMMUNITY ORGANIZER, TAKING HOME LESS THAN A THOUSAND DOLLARS A MONTH AND HAD TO PAY ABOUT 200 OF IT OUT-OF-POCKET FOR HER DAILY ANTI-SEIZURE MEDICATION. IT WAS TOO BIG A BITE OUT OF HER CHECK.
ALLIEA GROUPP: So, I took it about every third day. Just to be able to eke out – make it more affordable for myself. Which meant that I had seizures on occasion.
DR. SENAY [narration]: EVEN WHEN SHE GOT INURANCE AT ANOTHER JOB A FEW YEARS LATER, ALLIEA SAYS THE PLAN WAS SO LIMITED, SHE STILL COULDN’T AFFORD THE CARE SHE NEEDED WHEN SHE CAME DOWN WITH A MINOR INFECTION.
ALLIEA GROUPP: When I went to go fill the prescription, I couldn’t afford it. Because it was so expensive and I had to pay for it out of pocket. So, I said, okay, well, you know, again I’ll make a choice to say I don’t need it. I’ll get better on my own.
DR. SENAY [narration]: SHE DIDN’T GET BETTER, SHE GOT WORSE … AND ENDED UP IN THE EMERGENCY ROOM WITH A KIDNEY INFECTION. IT ALL ADDED UP TO ABOUT $24,000 IN MEDICAL BILLS.
ALLIEA GROUPP: I wish that I’d been able to make a different choice. But I couldn’t.
DR. SENAY [narration]: ABOUT FIVE MILES AWAY IN SOUTH BOSTON, PETER BROOK ALSO KNOWS WHAT IT’S LIKE TO GO WITHOUT HEALTH CARE. HE’S HAD TYPE ONE DIABETES SINCE HE WAS 14. BUT AS A HANDYMAN WITHOUT STEADY WORK, HE SPENT YEARS UNINSURED AND HAD TROUBLE MANAGING HIS DISEASE.
PETER BROOK: Before health care, I would use an insulin needle, I’d use it for a month, or a month and a half. I would just hole up in my little studio apartment here in Southie and I’d be sick for weeks on end. I wouldn’t– absolutely wouldn’t go to a doctor, even when I was sick, I wouldn’t go to a doctor. I would go there on an extreme when I was almost dead and, you know, a neighbor would call and I– they’d pick me up like a wet towel and put me on a cot and take me away in an ambulance and then I’d live in a hospital for a couple weeks.
DR. SENAY [narration]: HE EVEN TREATED HIS OWN FINGERS THAT HAD BEEN BROKEN ON THE JOB.
PETER BROOK: I’d just tape one finger to the other and immobilize it. Let it do its healing thing but of course you see then it doesn’t heal correctly. My hand doesn’t function like it used to function so. Saved me $300 in hospital bills.
DR. SENAY [narration]: THEIR EXPERIENCES LED BOTH ALLIEA AND PETER TO HELP LOBBY THE STATE LEGISLATURE FOR PASSAGE OF THE MASSACHUSETTS’ MANDATORY HEALTH CARE LAW IN 2006. BOTH SAY THE BILL MADE THINGS CHANGE FOR THE BETTER.
ALLIEA GROUPP: It improved my life drastically by ensuring that I can get the care that I need and make sure that my seizure disorder is cared for.
EMILY SENAY: Would you say your health is better now since reform?
PETER BROOK: Oh– oh, my health is much better now. I have conscientious very professional, what I call world class, health care now.
MITT ROMNEY: Massachusetts once again is taking a giant leap forward.
DR. SENAY [narration]: THE GOAL OF THE HEALTH REFORM BILL ENACTED UNDER THEN-GOVERNOR MITT ROMNEY WAS SIMPLE: HEALTH INSURANCE FOR EVERYONE.
MITT ROMNEY: Every citizen with affordable comprehensive health insurance, small businesses able to conveniently buy insurance for their employees at a cost that’s competitive with big businesses.
DR. SENAY [narration]: THE LAW WAS CONSIDERED SUCH AN ACHIEVEMENT, THAT IN ROMNEY’S OFFICIAL PORTRAIT HANGING IN THE STATEHOUSE IN BOSTON… THERE ON THE DESK NEXT TO HIM IS A BOUND VOLUME WITH THE MEDICAL SEAL, MEANT TO REPRESENT THE LAW.
THIS IS WHAT THE LAW REQUIRES OF THE STATE’S 6.5 MILLION RESIDENTS:
EVERY ADULT MUST HAVE INSURANCE OR PAY A FINE. EVERY EMPLOYER WITH 11 OR MORE EMPLOYEES MUST OFFER INSURANCE – OR ALSO PAY A FINE OF ABOUT $300 PER WORKER.
THE LAW REDIRECTED FUNDS PREVIOUSLY USED FOR CARE OF THE UNINSURED AND EXPANDED INSURANCE COVERAGE TO CHILDREN AND TO THE POOR. IT ALSO SET UP A NEW SYSTEM FOR INDIVIDUALS AND SMALL BUSINESSES TO BUY INSURANCE.
THE BILL PASSED ALMOST UNANIMOUSLY AND HAD THE SUPPORT OF EVERYONE FROM THE REPUBLICAN GOVERNOR TO LIBERAL DEMOCRAT SENATOR TED KENNEDY AND FROM UNIONS TO BUSINESS.
MITT ROMNEY: My son said that having Senator Kennedy and me together like this on this stage behind the same piece of landmark legislation will help slow global warming. That’s because hell is frozen over.
DR. SENAY [narration]: POLLS TODAY SHOW ALMOST TWO-THIRDS OF THE STATE’S RESIDENTS SUPPORT THE LAW, AND THERE HAVE BEEN NO SERIOUS LEGAL CHALLENGES TO IT. BUT, IT’S STILL PROVOKED SOME CONTROVERSY. THAT’S BECAUSE IT SERVED AS THE TEMPLATE FOR THE 2010 FEDERAL AFFORDABLE CARE ACT. AND JUST AS THE FEDERAL INDIVIDUAL MANDATE SPURRED A SUPREME COURT CHALLENGE AND FIERCE DEBATE. THE INDIVIDUAL MANDATE IN MASSACHUSSETS HAS SPARKED SOME CRITICSM, TOO.
RICK LIVINGSTONE: It was appalling to me. Because I was told, I had to have insurance. It was taking freedoms away from me. I’m not one that expects someone else to pay for my health care. The system has developed where, people are paying for other people’s health care. That’s not right either.
ZUZANA LIVINGSTONE: I’d rather have a choice. I just want to have a choice.
DR. SENAY [narration]: RICK AND ZUZANA LIVINGSTONE OF ANDOVER MASSACHUSETTS ARE SELF—DESCRIBED CONSERVATIVES. THEY ARE AMONG THE 30 PERCENT OF THE STATE’S RESIDENTS WHO OPPOSE THE HEALTHCARE PLAN.
RICK LIVINGSTONE: This country was founded on freedom of choice. And, you know, you live and die by those choices. Same thing with health care. If you choose not to have health care, then you’re going to live and die by that decision.
DR. SENAY [narration]: AND THAT’S THE DECISION THEY MADE. WHILE THEIR THREE CHILDREN – AND ALL CHILDREN IN THE STATE – ARE INSURED EITHER PRIVATELY OR PUBLICLY, ZUZANA AND RICK ARE PART OF THE TWO PERCENT WHO DON’T HAVE MEDICAL INSURANCE. SOME CAN’T AFFORD IT. OTHERS SIMPLY REFUSE TO PAY FOR IT AND CAN BE FINED UP TO $1200 A YEAR.
THE LIVINGSTONES’ DECISION WAS ABOUT BOTH POLITICS AND COST. THEY SAY THE SEVERAL HUNDRED DOLLARS A MONTH IT WOULD TAKE TO BUY INSURANCE IS A HARDSHIP SINCE RICK’S HOME BUILDING BUSINESS DRIED UP, AND THE FAMILY IS LIVING ON ZUZANA’S INCOME OF JUST OVER 80,000 DOLLARS A YEAR.
ZUZANA LIVINGSTONE: That pays the mortgage, that feeds the kids, pays the cars. Pays the gas. We’re dipping into the savings all the time. All the time
RICK LIVINGSTONE: We had to really had to get rigid with wants, needs and desires. And you know, needs is, have a roof over your head. You know. A desire is to have health care. It’s not a need. Fortunately, we are all healthy. We haven’t taxed the system.
ZUZANA LIVINGSTONE: I can go to the doctor. Of course, I can go to the doctor. I shell out 150 bucks, and I go home. You know, I pay it. It’s much cheaper to do it that way, then to have insurance.
DR. SENAY [narration]: IN A WAY, THE LIVINGSTONES, PETER BROOK AND ALLIEA GROUPP AREN’T TYPICAL AT ALL. WHAT MAKES THEM DIFFERENT THAN MOST IS HOW DIRECTLY THEY’VE BEEN AFFECTED BY THE HEALTHCARE REFORM. WHAT’S NOT REPORTED AS OFTEN IS HOW LITTLE HEALTHCARE HAS CHANGED FOR THE MAJORITY OF PEOPLE IN MASSACHUSETTS. DOCTORS LIKE RICHARD DUPEE, AN INTERNIST AND GERIATRICIAN IN THE AFFLUENT BOSTON SUBURB OF WELLESLEY HILLS, ARE STILL PRACTICING MEDICINE MUCH AS THEY DID BEFORE THE REFORMS.
EMILY SENAY: How big an impact did health reform have on your practice?
DR. DUPEE: You know it’s interesting. It really has not had a huge impact.
EMILY SENAY: And would say that’s the case for the vast majority of physicians like yourself
DR. DUPEE: In private practice, yes.
DR. SENAY [narration]: HIS PATIENTS AND MILLIONS OF OTHERS ARE STILL ELIGIBLE FOR THE SAME CARE. ABOUT 90 PERCENT OF THE STATE’S RESIDENTS HAD INSURANCE EVEN BEFORE THE LAW WAS PASSED – MOST OF THEM THROUGH EMPLOYERS — AND THEY’RE STILL COVERED TODAY. JUST LIKE DANIELLE ESJUNIN, DR. DUPEE’S ASSISTANT AND A PATIENT IN HIS PRACTICE .
EMILY SENAY: Did you experience any change after the passage of the law?
DANIELLE ESJUNIN: No.
DR. SENAY [narration]: OF COURSE, THOSE OLD ENOUGH TO QUALIFY FOR MEDICARE BEFORE 2006, LIKE BOB AND JUNE MACDONALD, ARE STILL COVERED AS WELL.
JUNE MACDONALD: It didn’t affect us at all because we already had health insurance.
EMILY SENAY: So you didn’t feel a thing?
JUNE MACDONALD: No.
DR. SENAY [narration]: JUST LIKE WHAT’S INTENDED AT THE FEDERAL LEVEL, THE BIGGEST IMPACT OF THE STATE LAW WAS ON THOSE WHO WEREN’T INSURED.
MICHAEL DOONAN: It didn’t change how the whole system worked. It just filled in the gaps
DR. SENAY [narration]: MICHAEL DOONAN, A POLITICAL SCIENCE PROFESSOR AT BRANDEIS UNIVERSITY, HAS STUDIED THE IMPACT OF THE STATE’S HEALTH REFORM.
MICHAEL DOONAN: It’s like Swiss cheese. And what Massachusetts did is it filled in the holes.
DR. SENAY [narration]: FILLING THOSE HOLES MEANT COMING UP WITH NEW PROGRAMS AND SYSTEMS TO COVER THE UNINSURED. SINCE THE MASSACHUSETTS LAW WAS PASSED, ABOUT 439,000 OF THEM GOT COVERAGE. THE CHIEF BENEFICIARIES HAVE BEEN LOW INCOME WORKERS, LIKE PETER BROOK, WHO EARNS LESS THAN 10 THOUSAND DOLLARS A YEAR DOING ODD JOBS.
PETER BROOK: That’s just to keep the dogs off of there. That’s the only reason…
DR. SENAY [narration]: NOW, HE IS INSURED THANKS TO THE STATE’S EXPANDED MEDICAID PROGRAM – PART OF THE 2006 REFORM BILL. HE PAYS NO MONTHLY PREMIUM, BUT STILL SEES HIS DOCTORS REGULARLY AND GETS HIS PRESCRIPTIONS FOR JUST A FEW DOLLARS EACH.
PETER BROOK: It’s like all of a sudden you’re driving around in a Maserati or a Porsche all the time and everyone’s ‘oh you have such a beautiful car. Oh you must have a good job. You must have this. But that’s not the real truth of it.’
DR. SENAY [narration]: PETER BROOK IS ACTUALLY THE EXCEPTION.
ONLY ABOUT 20 PERCENT OF ALL MASSACHUSETTS RESIDENTS HAVE MEDICAL
INSURANCE SUBSIDIZED BY THE STATE. NEARLY 80 PERCENT GET THEIR
INSURANCE FROM THEIR EMPLOYERS. ALLIEA GROUPP IS PART OF THE SLIVER WHO BUY THEIR INSURANCE ON A WEB SITE CALLED THE HEALTH CONNECTOR. IT’S PART OF THE STATE’S NEW HEALTH INSURANCE EXCHANGE – A PLACE FOR THOSE NOT COVERED BY AN EMPLOYER TO GO SHOPPING FOR INSURANCE.
ALLIEA GROUPP: So, what’s your family size. As an individual, I clicked one. Is your household income more than $33,516 a year? Yes.
DR. SENAY [narration]: THE CONNECTOR TELLS ALLIEA – NOW A DIRECTOR OF A SMALL NONPROFIT – THAT HER INCOME IS TOO HIGH TO QUALIFY FOR A PLAN SUBSIDIZED BY THE STATE. SO IT SHOWS HER THE UNSUBSIDIZED OPTIONS, AND ALLOWS HER TO COMPARE PRICES AND BENEFITS TO CHOOSE THE ONE THAT BEST FITS HER NEEDS.
ALLIEA GROUPP: These are the seven companies that provide a gold plan. And you can see, each one of their monthly payments, and what their co-pays are.
DR. SENAY [narration]: ALLIEA CHOSE A MORE EXPENSIVE “GOLD” PLAN BECAUSE SHE HAS TO SEE HER NEUROLOGIST TWICE A YEAR, REQUIRES REGULAR TESTING TO MONITOR HER EPILEPSY, AND TAKES MEDICATION EVERY DAY. HER EMPLOYER PAYS THE BULK OF HER INSURANCE BILL — NEARLY 700 HUNDRED DOLLARS A MONTH — EVEN THOUGH IT’S NOT REQUIRED TO BECAUSE IT HAS SO FEW EMPLOYEES.
ALLIEA GROUPP: So this is my plan. I have no annual deductible.
DR. SENAY [narration]: NOWADAYS, ALLIEA IS TREATED BY DOCTORS IN THEIR PRIVATE OFFICES. BUT MANY OF THE NEWLY INSURED, LOW EARNERS LIKE PETER BROOK, ARE CARED FOR AT THE STATE’S 200-PLUS COMMUNITY HEALTH CENTERS, WHICH SAW A SURGE OF NEW PATIENTS WHEN THE LAW WENT INTO EFFECT. DOCTORS AT THE REVERE FAMILY HEALTH CENTER NORTH OF BOSTON WERE ON THE FRONT LINES.
SOMAVA STOUT: We suddenly saw this tremendous demand for health care services, especially in primary care.
DR. SENAY [narration]: DR. SOMAVA STOUT IS A PRIMARY CARE PHYSICIAN IN CHARGE OF IMPROVING THE DELIVERY OF CARE AT A NETWORK OF HOSPITALS AND CLINICS FOR THE UNDERSERVED. A FEW DAYS A WEEK, SHE ALSO PRACTICES AT THE REVERE FAMILY HEALTH CENTER.
SOMAVA STOUT: Before health care reform happened we had started with 500 patients. And now, we’re at about 10,000 patients. The wait time for our new patient appointment in Revere before was about nine months.
EMILY SENAY: So, was it overwhelming at first?
SOMAVA STOUT: Yes. And at the same time there was actually tremendous relief in knowing that your patients could get access to care. When you’re a doctor and you see somebody in front of you who has something totally treatable and preventable that you know will kill them and you have no way of getting that person the care they need, that is the worst feeling in the world.
DR. SENAY [narration]: BEFORE REFORM, STOUT SAYS SHE AND OTHER DOCTORS OFTEN HAD TO IMPROVISE TO GET PATIENTS THE HELP THEY NEEDED.
SOMAVA STOUT: We were doing all these crazy things. Like, we would call up special programs for drug companies to try to get people medicines. Or you know, try to ask favors of people-
EMILY SENAY: It was catch as catch can.
SOMAVA STOUT: It was catch as catch can and often the care couldn’t be as good because of that.
DR. SENAY [narration]: AFTER REFORM, THE SHEER NUMBER OF NEW PATIENTS NEEDING CARE MEANT THE SYSTEM HAD TO ADAPT.
SOMAVA STOUT: It required fundamental change in how we design, how we provide care.
DR. SENAY [narration]: THESE DAYS, THE EMPHASIS IS ON STREAMLINING AND COORDINATING CARE – DOING THINGS LIKE COMMUNICATING WITH PATIENTS ONLINE AND KEEPING CLOSER TRACK OF PATIENTS BETWEEN VISITS.
ADA: And then he’s follow-up bronchitis and asthma, also.
SOMAVA STOUT: Yeah.
ADA: And then, she’s follow-up neck pain. I know she didn’t come for her last appointment. She missed her last appointment.
DR. SENAY [narration]: WAIT TIMES FOR NEW PATIENTS TO BOOK AN APPOINTMENT, WHICH WERE ONCE NINE MONTHS, ARE NOW NO LONGER THAN TWO WEEKS. AND THE AFTERNOON WE VISITED, THE WAITING ROOM WAS NEVER VERY FULL.
EMILY SENAY: Are people getting good care as a result?
SOMAVA STOUT: Well, we think so. So if you look at the community of Revere just as an example — we’ve been able to increase the colorectal screening rate for that population of patients from 30 percent up to 70 percent or pap smear rate, similarly, from about 40 percent to 90 percent.
DR. SENAY [narration]: MEREDITH ROSENTHAL – A PROFESSOR AT THE HARVARD SCHOOL OF PUBLIC HEALTH – SAYS THIS IS AN IMPORTANT OUTCOME OF REFORM.
MEREDITH ROSENTHAL: In Massachusetts, we know for example that after the reforms were passed and people took up new coverage that individuals were much more likely to have a regular source of care.
DR. SENAY [narration]: BUT ACROSS MASSACHUSETTS, THERE STILL AREN’T ENOUGH PRIMARY CARE DOCTORS. AND THAT MAY BE THE REASON WHY VISITS TO EMERGENCY ROOMS HAVE NOT DROPPED SHARPLY, DESPITE IMPROVED ACCESS TO HEALTH CARE. AND EVERY CONVERSATION ABOUT THE STATE’S PLAN ULTIMATELY LEADS TO THIS QUESTION: HOW WILL IT ALL GET PAID FOR?
SIX YEARS AFTER HEALTHCARE REFORM WAS ENACTED IN MASSACHUSETTS, THE HIGH COST OF HEALTH INSURANCE IS STILL A CONCERN FOR MANY IN THE STATE, ESPECIALLY SMALL BUSINESS OWNERS.
DAVE RATNER: This just got me really upset! I’m just looking at how much more I’m spending for how much less!
DR. SENAY [narration]: DAVE RATNER OWNS A SMALL CHAIN OF PET SUPPLY STORES IN WESTERN MASSACHUSETTS. HE’S BEEN IN BUSINESS FOR MORE THAN 30 YEARS AND HAS ALWAYS OFFERED HIS FULLTIME EMPLOYEES HEALTH INSURANCE, BUT THESE DAYS, HE SAYS, THAT’S GETTING MUCH MORE DIFFICULT TO DO.
DAVE RATNER: We have my monthly check to my health care provider. 9,996 dollars every month.
DR. SENAY [narration]: OVER THE LAST SEVERAL YEARS, DAVE’S INSURANCE PREMIUMS HAVE RISEN STEADILY – SOMETIMES BY DOUBLE-DIGITS IN A SINGLE YEAR.
DAVE RATNER: 2007, I don’t know what happened. The rate was going to go up 20%.
DR. SENAY [narration]: TO PROTECT THE BOTTOMLINE, DAVE HAS REPEATEDLY SWITCHED INSURANCE PLANS. THAT, HE SAYS, TURNS INTO AN ADMINISTRATIVE NIGHTMARE.
DAVE RATNER: It’s a huge amount of bookwork in the office. It’s- it’s new meetings with the employees to explain to them this is what’s happening this year. Here’s the plusses, here’s the minuses.
DR. SENAY [narration]: ALL THIS, HE SAYS, MAKES HIM LESS LIKELY TO HIRE.
DAVE RATNER: So, when I look to say, “Do I need another employee?” I have to figure out how much extra is it going to cost me per hour for- for the health insurance, right? Well, aren’t I just better off getting a regular employee more hours and even if I have to pay him overtime? Duh. Yeah. I’m way better off. So, yes, that absolutely affects our new hires.
DR. SENAY [narration]: BUT SOME SAY THERE’S ANOTHER WAY TO LOOK AT HOW THE STATE’S
HEALTH CARE REFORMS HAVE AFFECTED JOB CREATION: ENTREPRENEURS ARE
NOW ABLE TO SEEK OUT NEW OPPORTUNITIES WITHOUT WORRYING ABOUT HOW TO STAY INSURED.
ARLEN PLOTKIN: Oh, I think it’s hugely empowering.
DR. SENAY [narration]: IN 2010, ARLEN PLOTKIN LEFT A FIRM WITH A BENEFIT PLAN AND IS NOW THE BUSINESS DIRECTOR OF “CONNECTED BITS,” A COMPANY THAT DEVELOPS MOBILE APPS. AFTER HIS COBRA BENEFITS RAN OUT, HE BOUGHT AN INDIVIDUAL PLAN THROUGH THE HEALTH CONNECTOR THAT COSTS ABOUT $200/MONTH.
ARLEN PLOTKIN: I have the flexibility to pursue whatever I want to pursue. I don’t have to rely on an employer to- to literally to live. And be- and maintain my health. You know. And a lot of jobs are created through start-ups and small organizations. And that’s an important part of driving the economy.
DR. SENAY [narration]: STILL, EVEN THOSE WHO NOW HAVE ACCESS TO HEALTH INSURANCE – SOME FOR THE FIRST TIME – WORRY ABOUT HOW MUCH THE PLAN IS COSTING THE STATE.
PETER BROOK: I still haven’t figured out, like, how it’s– how it’s all being paid for. I feel guilty because I– I’m not kind of pulling my weight.
ALLIEA GROUPP: The second phase of health reform needs to be how do we reduce the overall costs of care, while providing increase in quality?
DR. SENAY [narration]: ALLIEA GROUPP HAS NOW TAKEN UP COST AS A CAUSE – SHE’S LEADING A LOCAL INTERFAITH GROUP’S ADVOCACY WORK ON THE ISSUE.
ALLIEA GROUPP: While we have some of the best health care available, it’s still too expensive and it’s getting worse.
DR. SENAY [narration]: MASSACHUSETTS HAD SOME OF THE HIGHEST HEALTH CARE COSTS IN THE COUNTRY BEFORE REFORM, AND STILL DOES TODAY. SINCE THE STATE EMBRACED MANDATORY HEALTHCARE IN 2006, ANNUAL PREMIUMS CONTINUED TO CLIMB: UP AN AVERAGE OF 6 PERCENT A YEAR. EVEN SO, THE NATIONAL ANNUAL INCREASE HAS BEEN 7 PERCENT DURING THE SAME PERIOD.
MEREDITH ROSENTHAL: Massachusetts is struggling with the same thing every other state in the nation is struggling with. Which is the- these forces that are causing health care spending to increase more rapidly than the rest of our economy and causing this dilemma that we have now with the federal deficit, with the state budget deficits as well. But that crisis pre-dates coverage reform.
EMILY SENAY: And is not cured by coverage reform.
MEREDITH ROSENTHAL: And is not cured by coverage reform.
EMILY SENAY: Is it something though that is sustainable?
MICHAEL DOONAN: No. It’s not sustainable. And it’s not sustainable for the nation either. We can’t have premiums growing at six, seven, eight, ten percent a year when wages are stagnant. Some– something’s gotta give.
DR. SENAY [narration]: TACKLING THE COST OF HEALTH CARE HAS BEEN A PRIORITY FOR MASSACHUSETTS GOVERNOR DEVAL PATRICK, WHO CAME INTO OFFICE IN 2007 – THE YEAR AFTER HEALTH REFORM WAS ENACTED.
DEVAL PATRICK: When the- when the folks created our health care reform six years ago, they purposefully focused on access and put cost off for another day. So, we’re turning to cost containment now.
DR. SENAY [narration]: THE PATRICK ADMINISTRATION CRACKED DOWN ON INSURANCE RATE INCREASES, AND ENACTED A LAW TO HELP SMALL BUSINESSES OWNERS – LIKE DAVE RATNER – BAND TOGETHER TO NEGOTIATE BETTER RATES. IT’S ALSO BEEN WORKING WITH THE STATE’S INSURANCE COMPANIES ON NEW WAYS TO PAY DOCTORS AND HOSPITALS.
ANDREW DREYFUS: We designed a new payment model.
DR. SENAY [narration]: ANDREW DREYFUS IS THE PRESIDENT AND CEO OF BLUE CROSS BLUE SHIELD OF MASSACHUESETTS, THE LARGEST INSURANCE COMPANY IN THE STATE.
ANDREW DREYFUS: The old payment model, essentially rewards volume, it rewards admissions and tests and visits and treatments and the more complex and technological those interventions, the more we pay. Instead we wanted to create a system that would reward quality in outcomes and value.
RICHARD DUPEE: Now we must meet quality measures.
DR. SENAY [narration]: DR. RICHARD DUPEE IN WELLESLEY HILLS, WHOM WE MET EARLIER, HAS STARTED OPERATING UNDER THIS NEW BLUE CROSS MODEL. INSTEAD OF CHARGING FOR EVERY VISIT AND EVERY TEST, HE’S GIVEN A BUDGET FOR EACH PATIENT, AND IS REWARDED IF HE KEEPS THE PATIENTS HEALTHY. MORE THAN A MILLION MASSACHUSETTS RESIDENTS ARE NOW BEING TREATED BY DOCTORS PARTICIPATING IN THE BLUE CROSS OR OTHER SIMILAR PLANS.
RICHARD DUPEE: Thinking it through and spending a little more time in what we call a cognitive service you can save a whole lot of money by avoiding unnecessary testing.
DEVAL PATRICK: Every business, every municipality, certainly state government – is focused on health care cost. That issue doesn’t go away if you don’t have a universal care system. That issue has to be dealt with.
EMILY SENAY: So, Massachusetts is- is not collapsing under the weight of-
DEVAL PATRICK: No, no. It’s- it’s been a great, great, great success.
DR. SENAY [narration]: IN FACT, THE GOVERNOR SAYS PREMIUMS THAT HAD BEEN RISING BY DOUBLE-DIGITS A FEW YEARS AGO ARE NOW INCREASING LESS THAN TWO PERCENT A YEAR. AND A STUDY SHOWS ADDITIONAL STATE SPENDING RELATED TO HEALTH CARE REFORM ACCOUNTED FOR ONLY 1.4 PERCENT OF THE OVERALL STATE BUDGET LAST YEAR.
DEVAL PATRICK: And because we have focused not just on the access, but now on cost containment, which as I say, is a- is a national challenge, I think we’re going to be the ones here in Massachusetts to crack that code, too.
DR. SENAY [narration]: THE MASSACHUSETTS LEGISLATURE IS ON THE VERGE OF PASSING HEALTH REFORM PART TWO TO CRACK DOWN ON HEALTH CARE COSTS. EVEN SO, THE DEBATE ABOUT HEALTH CARE REFORM – BOTH PHILOSOPHICAL AND PRACTICAL – CONTINUES.
RICK LIVINGSTONE: I certainly think that we have a major issue and a major problem in this country. But this is certainly not the answer to it.
SOMAVA STOUT: From the perspective as a doctor, it’s been tremendously valuable. From the patients’ perspective, it’s been incredibly important.
DAVE RATNER: Yes, I believe everyone should have health care – no ifs, ands, or buts. But you know what? My guys and I shouldn’t be paying for somebody else’s.
ALLIEA GROUPP: Every year, we do polls to make sure that people in Massachusetts are still happy about this. We are. People still support this and it’s an experiment that worked.
SCOTT SIMON: Last summer, Massachusetts continued the experiment and passed healthcare reform “part two” – a historic cost-containment bill that aims to save around 200 billion dollars over 15 years. Supporters say they hope that bill will also serve as a model for other states tackling the high costs of health care. That’s it for another edition of Need to Know. I’m Scott Simon. Thanks for watching.