Despite economic hard times, Massachusetts still shows gains in insurance coverage and access to care as a result of its 2006 state health reform. However, some of the early gains in reducing barriers to health care and improving affordability had eroded by the fall of 2008, according to Urban Institute researchers in a new study published last week on the Health Affairs Web site [2-week free access.]

Lead author Sharon Long, a senior fellow at Urban, told the Boston Globe that the affordability problems that have started to resurface cannot be blamed on the state’s overhaul, but on a much larger and troubling national trend. “Health care costs, in general, are increasing faster than inflation,” she said.

About one in five of the over 4000 adults surveyed in fall 2008 in the state reported that a doctor’s office or clinic informed them that they were not accepting patients with their type of coverage or were not accepting any new patients. And lower-income residents faced more difficulties finding a physician than higher-income residents (24% of residents enrolled in state-subsidized health plans said they were told that a physician did not accept their insurance versus 7% of residents with private coverage). Overall, 17.9% of Massachusetts residents in 2008 reported having difficulty paying their medical bills, compared with 16.5% in 2007.

Lessons for health reformers in Washington

  1. “Although major expansions in coverage can be achieved without addressing health care costs, cost pressures have the potential to undermine the gains under reform,” write authors Long and Paul Masi.
  2. “In preparing for health reform at the national level, it will be important to ensure that the care delivery systems in communities across the country are ready to support the planned expansion in coverage. As was true in Massachusetts, it is likely that existing constraints on provider supply across the country would be exacerbated by an influx of newly insured people. There will no doubt be much debate as to whether this means increasing the supply of physicians, as some argue, or more fundamental changes in the health care system that address the organization and delivery of health care, as others contend,” conclude the authors.
  3. Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority in Boston, suggests that the Massachusetts experience shows the political wisdom of sequencing health reform, beginning with coverage expansion and then dealing with other challenges, particularly cost control. In a Perspective published by Health Affairs, he writes: “only by controlling costs can Massachusetts sustain near-universal coverage.” He argues that trying simultaneously to reform all aspects of the nearly one-fifth of the U.S. economy represented by health care would be an impossible challenge.