Massachusetts Health Care Reform - Access and Cost

Measured by access, Massachusetts Health Care Reform is doing very well. But unless the state can get a grip on costs the reform effort will go down the tubes.

As of its second birthday in April, 340,000 - 52% of the formerly uninsured - now have insurance. One third are enrolled in private insurance - 17,000 in the non-subsidized "Commonwealth Choice" program, and the rest through their employers. 174,000 are in subsidized "Commonwealth Care," with half being fully subsidized and half paying between $35 - $105 (for individuals - correspondingly more for families). The rest are newly enrolled in Medicaid.

This year was budgeted at $472 million, but because of higher than expected enrollment in the subsidized program, a supplemental allocation of $153 million was required. For next fiscal year the Governor has requested $869 million instead of the $725 million originally projected. (Details are available in the April report from the Massachusetts Health Connector.)

Unfortunately, progress in dealing with cost has not matched progress on access. The Annual Report of Quality and Cost Council, a key part of the reform program, details an ambitious plan, but shows few accomplishments. A cost/quality website for consumers central to the strategy. Assessing quality is obviously crucial for a health system, but if the website turns Massachusetts citizens into discerning consumers who drive cost down and quality up I'll eat the report.

The most promising idea in the Quality and Cost Council plan is to aggregate claims data from all Massachusetts insurers. If this is accomplished, and if Massachusetts leadership chooses to use the comparisons such a data base would allow (two big "ifs"), Massachusetts would be able to get serious about managing costs.

We can't realistically expect political candidates to talk seriously about cost containment and making tough choices. If we had a nickel for every invocation of the market's invisible hand, acting through individual consumers who shop prudently for care, armed with new information, we could pay for the uninsured.

As I said in the May 4 post, the most promising sources of educative leadership are large businesses and the states. Massachusetts is proud of what it is accomplishing for access. Knowing that all that it has gained will be for naught without serious grappling with cost could trigger some real leadership. Let's hope so!