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In Massachusetts, A Health Care Reform Preview

Fall in Franklin County, Mass. (Flickr Creative Commons/banspy)

A recent post-election poll confirmed the national split over health reform — 49 percent of respondents wanted to see the law repealed or rolled back, while 40 percent wanted to see it kept as is or expanded.

It was against that backdrop of uncertainty that my producer and I traveled to Franklin County, Mass. last week two days after the election. We were curious what we’d hear from people there about health care reform. This was, after all, the first state to pass a sweeping health care reform law in 2006, so Massachusetts residents have been living with reform for four years.

And the Massachusetts law is very similar to the Affordable Care Act.

It requires just about everybody to buy insurance, and the most recent data show that just about everybody has. Only about 2 percent of the state’s residents today don’t have health insurance.

When people don’t buy insurance they have to pay a penalty equal to 50 percent of the lowest-cost they would have been offered. That means the fines can go up to about $1,000 a year.

Employers with 11 or more workers have to provide insurance or pay what’s called a “Fair Share” fine of up to $295 per employee.

A key component of the law is the Commonwealth Health Insurance Connector, where people can go and choose between seven state-approved insurance plans .

Residents can sign up online or they go and get help in person from one of the many connector offices around the state.

And like the new federal law, Massachusetts provides subsidies to help low-income families purchase health insurance — the sliding scale subsidies are available to people who make up to about $32,000 per year for an individual or $66,000 for a family of four.
People who earn less than 150 percent of the federal poverty level pay no premiums at all.

More than 80,000 people have signed up for coverage this way.

The Massachusetts plan also dramatically expanded Medicaid for children whose families earn up to 300 percent of the federal poverty level. That increased enrollment by over 53,000 people.

Surprisingly, we didn’t hear a peep about the new federal law on our visit. And we found only one person who complained about the mandate there to buy health insurance.

But, as in the rest of the nation, health care costs in Massachusetts have continued to skyrocket.

And visits to emergency rooms have not decreased. Massachusetts Institute of Technology health economist Jon Gruber says that’s because there is a shortage of primary care physicians. So while more people have insurance coverage, there are not enough doctors to go around. And Gruber thinks that’s why visits to the ER around the state have not gone down.

Gruber also says that it is important for people to remember when comparing the Massachusetts version of reform with the national law that the goal of the Massachusetts law was never to contain costs.

“It was all about getting everybody insured,” he says.

Gruber and other supporters of reform say that’s what Americans need to stay focused on as Washington begins to implement the national health reform law. “One thing at a time,” he cautions.

But Gruber also admits no one, not even the experts, have found ways to bring down health care costs. “They’ve thrown a lot of spaghetti at the wall,” he says…referring to the many pilot programs around the country aimed at “bending the curve” downward. “But so far, nobody knows what’s going to stick.”

We’ll have much more on how health care reform is playing out four years later in Massachusetts on an upcoming NewsHour segment.

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