Health Care Reform in Massachusetts: State Model for the Affordable Care Act Is Working And Broadly Popular
The Affordable Care Act was signed into law one year ago. It is modeled in large part on the landmark Massachusetts health reform law enacted four years earlier in 2006. Opponents of the Affordable Care Act often attack it by distorting the facts about the Massachusetts experience. They selectively alternate between snapshots of and trends in Massachusetts and comparisons between Massachusetts and the United States.
The most appropriate way to assess the impact of the Massachusetts law is to compare changes over time in things like health coverage and premium costs in Massachusetts to changes over time in the United States as a whole. We use that approach below to debunk many of the myths opponents propagate regarding Massachusetts’s experience with health care reform.
Massachusetts increased health coverage while coverage declined in the rest of the country.
Myth
The Massachusetts law failed to significantly reduce the ranks of the uninsured in the state.
Fact
The Massachusetts health reform law dramatically increased the insurance rate in the state over a period when the national health coverage rate declined. As of the end of 2010, 98.1 percent of the state’s residents were insured compared to 87.5 percent in 2006 when the law was enacted. Almost all children in the state were insured in 2010 (99.8 percent). In comparison, at the national level the health insurance rate dropped from 85.2 percent in 2006 to 84.6 percent in 2010.
Employers continued the same level of health coverage in Massachusetts while dropping people in the rest of the country.
Myth
The Massachusetts health reform law is eroding employer-sponsored health insurance.
Fact
The number of people in Massachusetts with employer-sponsored health insurance has not dipped below 2006 levels since passage of the health reform law. Approximately 4.3 million people in Massachusetts obtained health insurance through their employer in 2006. This figure increased to 4.5 million in 2008 before returning to 2006 levels in 2010. In comparison, the number of nonelderly people in the United States with employer-sponsored health coverage declined from 161.7 million in 2006 to 156.1 million in 2009.
Since passage of Massachusetts’s health reform law, a larger share of the state’s employers have offered health insurance to their workers when compared to the United States as a whole. At the national level only 60 percent of employers offered health coverage to their employees in 2005. This is significantly lower than Massachusetts’s rate of 70 percent at that time. The Massachusetts rate increased to 76 percent in 2009, which is 7 percentage points higher than the national figure for 2010.
People buying insurance on their own in Massachusetts are paying lower premiums. Premiums in the nongroup market have increased in the rest of the country.
Myth
Massachusetts residents are paying higher premiums in the nongroup market as a result of the health reform law.
Fact
Nongroup health insurance premiums in Massachusetts have fallen by as much as 40 percent since 2006 because health reform brought healthy people into the insurance market. In contrast, at the national level nongroup premiums have risen 14 percent over that period of time.
More than 98 percent of Bay Staters met the law’s individual insurance requirement.
Myth
A significant portion of Massachusetts residents are ignoring the mandate and only purchasing health insurance when they need care.
Fact
The size of Massachusetts’s individual market more than doubled after passage of the health reform law. This boost and the accompanying drop in the average cost of individual premiums were due in part to more healthy—and previously uninsured—individuals entering the market. Only 1.3 percent of the state’s 4 million tax filers who were required to and did report their coverage status were assessed a penalty for lacking coverage in 2008, the last year for which complete data are available. About 26,000 of these 56,000 people were actually in compliance for part of the year.
The cost of health care in Massachusetts is in line with expectations.
Myth
The Massachusetts law is bankrupting the state.
Fact
The fiscally conservative Massachusetts Taxpayers Foundation, or MTF, finds that under reform, “State spending is in line with what [the organization] expected.” An MTF report released in 2009 found that state spending on health reform increased from $1.041 billion in fiscal year 2006 to a projected $1.748 billion in fiscal year 2010—an increase of $707 million over the four-year period, half of which is covered by the federal government.
Higher-than-expected enrollment in Commonwealth Care, the state-subsidized health insurance program, initially raised fears that policymakers had dramatically underestimated the number of low-income uninsured in Massachusetts. These concerns, however, were unfounded. Commonwealth Care enrollment peaked in mid-2008 with 176,000 members. The MTF attributes the initial rapid growth in Commonwealth Care enrollment to the state’s early success in getting residents signed up for the program.
The majority of people in Massachusetts like the health reform law, and it has gotten more popular over time.
Myth
The Massachusetts health reform law is highly unpopular among members of the public, the business community, and policymakers.
Fact
Support for the law is strong among members of the public. Sixty-one percent of the Massachusetts nonelderly population approved of the law when it passed in 2006. Two years later, 69 percent of nonelderly adults viewed the law favorably. In a survey of employers conducted in 2007—shortly after passage of the health reform law—a majority of Massachusetts firms surveyed agreed that “all employers bear some responsibility for providing health benefits to their workers.”20 A survey of employers conducted a year later—after the individual and employer mandates were implemented— found that a majority of firms believed the law was “good for Massachusetts.”
The Massachusetts health reform law was also a bipartisan achievement, drawing support from both sides of the aisle throughout the process. The law was passed by a Democratic legislature with support from its Republican members and then signed by GOP Gov. Mitt Romney.
Massachusetts is building on its 2006 reforms to promote better quality care at lower costs.
Myth
Current Gov. Deval Patrick is proposing to ration health care in Massachusetts.
Fact
Gov. Patrick’s proposal would make Massachusetts a leader in nationwide efforts to reform health care delivery and bring down costs. The governor has proposed new tools for achieving integrated care—by holding providers accountable for working with each other and their patients to coordinate and delivery higher-quality care at a lower cost.
These innovative tools encourage providers to deliver better care—replacing the current payment system’s set of incentives that provide more care regardless of value. Indeed, more care can sometimes be harmful to patients. Hospital-acquired infections and medical errors are among the most common causes of preventable deaths and injuries in U.S. hospitals. Medical errors accounted for 238,000 preventable deaths in Medicare and cost the program $8.8 billion from 2004 to 2006. A recent study found that sepsis and pneumonia caused by hospital-acquired infections resulted in 48,000 deaths in 2006 and cost the program $8.1 billion.
Conclusion
The Massachusetts health reform law is a success story from every perspective. The state has expanded health coverage to almost all of its residents, maintained a strong market for employer-sponsored health insurance, gained the support of the business community and the public, and is moving forward in containing costs. We can look forward to a similar positive experience across the nation as we implement the Affordable Care Act modeled in large part on the Massachusetts law.
By: Nichole Cafarella and Tony Clark, Center for American Progress, April 13, 2011
State Budget Crises And The New Language of Deceit
For most of history, we had undebatable definitions of words such as “bailout” and “bankruptcy.” We understood the former as an undeserved public grant, and the latter as an inability to pay existing bills. Whatever your particular beliefs about these concepts, their meanings were at least agreed upon.
Sadly, that’s not the case during a deficit crisis that is seeing language redefined on ideological terms.
“Bailout” was the first word thrown into the Orwellian fire. As some lawmakers recently proposed replenishing depleted state coffers with federal dollars, the American Conservative Union urged Congress to oppose states “seek(ing) a bailout” from the feds. Now, Rep. Paul Ryan, R-Wis., says, “Should taxpayers in Indiana who have paid their bills on time, who have done their job fiscally be bailing out Californians who haven’t? No.”
Ryan, mind you, voted for 2008’s TARP program — a bank bailout in the purest sense of the term. But one lawmaker’s rank hypocrisy is less significant than how the word “bailout” is being used — and abused. Suddenly, the term suggests that federal aid would force taxpayers in allegedly “fiscally responsible” Republican states to underwrite taxpayers in supposedly irresponsible Democratic ones.
Aside from stoking a detestable interstate enmity, this thesis ignores the fact that state-to-state wealth transfers are already happening. According to the Tax Foundation, most Republican-voting states receive more in federal funding than they pay in federal taxes, while most Democratic-voting states receive less federal money than they pay in federal taxes.
That means traditionally blue states like California are now perpetually subsidizing — or in Ryan’s parlance, “bailing out” — traditionally red states like Indiana. Thus, federal aid to states could actually reduce the state-to-state subsidies conservatives say they oppose.
Congressional Republicans will undoubtedly ignore these facts. Their proposed solution to the budget emergency could instead be a Newt Gingrich-backed initiative letting states default on outstanding obligations by declaring bankruptcy. Again, the word is fraught with new connotations.
Whereas sick or laid-off individuals occasionally claim a genuine inability to repay debts and thus a need for bankruptcy protections, states can never legitimately claim such a need because they are never actually “bankrupt.” Why? Because they always posses the power to raise revenue. The power is called taxation — and destroying that authority is what the new bankruptcy idea is really about. It would let states avoid tax increases on the wealthy, renege on contractual promises to public employees and destroy the country’s creditworthiness.
Blocking state “bailouts” and letting states declare “bankruptcy” are radical notions, especially in a bad economy. One would result in recession-exacerbating public layoffs; the other would institutionalize an anti-tax zealotry that destroys tomorrow’s middle class in order to protect today’s rich. That’s why advocates of these ideas have resorted to manipulating language. They know the only way to make such extremism a reality is to distort the vernacular — and if we aren’t cognizant of their scheme, they will succeed.
By: David Sirota, Creators.com, Originally Published 3/4/11
Few Heard At Wisconsin Budget “Hearing” In Milwaukee, But School Choice Advocate Denounces Walker’s Subsidy For Rich
At Monday’s public hearing in Milwaukee on Governor Walker’s budget, Wisconsin Republicans once again resorted to anti-participatory tactics to avoid criticism of their far-right agenda. Despite these efforts, strong criticisms were squeezed-in by longtime Milwaukee school choice advocate Howard Fuller, calling GOP efforts to lift income limits on school vouchers an “outrageous” program “that subsidizes rich people.”
Republicans Regulate Milwaukee Hearing
Milwaukee’s hearing at State Fair Park was the third of four statewide sessions on Walker’s proposed budget by the Republican-controlled Joint Finance Committee, and controversy arose well before the hearing began. According to the Milwaukee Journal-Sentinel, two of Milwaukee’s congresswomen, Rep. Tamara Grigsby and Sen. Lena Taylor, were concerned that many working people would be excluded because the hearing was scheduled to end at 6pm. The two arranged to hold informal sessions until 9pm to allow people to voice their opinion, then notified Joint Finance co-chairs Rep. Robin Vos (R-Burlington) and Sen. Alberta Darling (R- River Falls) about their plans.
Sen. Darling reportedly approved the Grigsby-Taylor informal hearing and Rep. Vos “said he would think about it.” However, Taylor soon received notice from State Fair Park that Vos had reserved the facility until midnight, meaning the Dems’ hearing could not take place, and Milwaukee’s working population could not have their voices heard.
According to Taylor, “This isn’t open government. This is not democracy. This is shameful.”
Beer City Blockage the Latest in a Series
Vos and Darling were unabashed about their intention to suppress opposition, with Darling telling the Journal-Sentinel “we had to take precautions so that what happened at the Capitol wouldn’t happen at State Fair Park.”
“The hearings are going to be done when we say they’re done,” Vos said.
This is only the latest in a series of Wisconsin GOP efforts to limit scrutiny and stifle dissent. On February 11, Governor Walker sought to limit deliberation on his budget repair bill by introducing it on a Friday and ordering a vote on a Tuesday (Senate Democrats thwarted these plans by leaving the state). The Walker Administration violated the constitutionally-guaranteed right of public access to the state capitol in late February, and a judge ordered it re-opened; the administration violated that order in March and a hearing on that violation is pending. On March 11, Republicans forced the union-busting budget repair bill through the Senate with minimal notice, breaking state Open Meetings laws and possibly violating the constitution’s public access guarantees.
Hearing Limits Input from Milwaukee’s Particularly-Affected Populations of Color
This latest step towards suppression is especially egregious considering Milwaukee is not only the state’s largest city, but has the most people of color, a population that will be particularly affected by Walker’s budget and budget repair bill. The plans eliminate funding for a new program to track and remedy racial profiling (the first step towards confronting Wisconsin’s atrocious record of racial disparities in incarceration); will limit eligibility for medical assistance; kicks legal immigrants off food assistance; and eliminates funding for a program that provided civil legal services to low income residents. Walker is also expected to cut $300 million from Milwaukee Public Schools (MPS), severely limiting education quality for the district teaching the greatest number of students (and students of color) in the state.
With Republican legislators keeping the Milwaukee hearing short, only speakers who signed up before 12:30pm had their voices heard. Hundreds of people were denied the ability to speak, and as the hearing ended at 6:30pm, there were shouts of “let us speak” and the now-familiar “shame” directed at those lawmakers.
Howard Fuller Heard on Education
While many Milwaukee residents were not heard on Monday, at least one prominent voice spoke strongly against Walker’s plans for Milwaukee schools.
In addition to cutting $300 million from Milwaukee’s public schools (and eliminating teacher’s unions), Walker’s budget reinforces existing inequalities by expanding the “school choice” program, which allows students to opt-out of public schools and use a taxpayer-funded voucher for private school tuition. The voucher program has been criticized not only because it directs money away from public schools, but because private schools can pick-and-choose their students, often selecting those who come from an advantaged background and leaving the rest to suffer in under-funded public schools.
Milwaukee became the country’s first publicly-funded school voucher program in 1990, and it grew under the tenure of MPS Superintendent Howard Fuller. He currently directs an institute at Marquette University that authorizes schools trying to get into Milwaukee’s choice program. Howard has collaborated with Republican lawmakers in the past, many of whom support so-called “school choice” out of belief in free market principles of competition and privatization. While many on the left fear defunding public education, some urban advocates like Fuller have supported vouchers to give promising low-income students a better chance at long-term success by providing education options that would not otherwise be available.
But Fuller, who is now regarded as the nation’s most influential African-American spokesman for “school choice,” strongly criticized Walker’s plans to remove income eligibility caps for the private school voucher program. “Please don’t make it true that you were using the poor just to eventually make this available to the rich,” Fuller said. “If [lifting income eligibility] is done, I will become an opponent of this.”
“I never got into this to give someone like me $6,500 to send their kid to Marquette High School (tuition $15,000 per year). . . This is where I get off the train, I’m not going to go anywhere in America and fight for a program that subsidizes rich people.”
By: Brenda Fischer, Center for Media and Democracy, April 12, 2011
Wisconsin Supreme Court Election Needs Fraud Investigation
Partisans on both sides were ready to scream “fraud at polls” as the balloting wound down in Wisconsin in the recent state Supreme Court election.
Normally, the race would have been a snoozer. Incumbent Justice David Prosser, a former GOP state assembly speaker and failed congressional candidate, won 55 percent of the vote in the first round of balloting. His opponent, an ultra-liberal named Jo Anne Kloppenburg, ran a distant second. But that was before Wisconsin Republican Gov. Scott Walker proposed and won enactment of a series of reforms that change the rules for state government workers in a way that limited their collective bargaining power.
After that, the election was presented as a referendum on Walker’s reforms, one the unions opposed strongly, going so far as to occupy the state capitol building in an effort to block the legislature from doing its business.
Since the court will inevitably rule on the legality of Walker’s reforms, a victory by Kloppenburg would have been a major setback for the new governor since it would have shifted the 4-3 majority on the seven-member Supreme Court from 4-3 conservative to 4-3 liberal.
The morning after the election, the Associated Press was reporting Kloppenburg ahead by just over 200 votes, enough for her to declare victory, even though the margin was close enough to trigger an automatic recount. The GOP was concerned because the heavy presence of pro-union activists in the state from around the country may have been able to take advantage of weaknesses in the state’s election code to unfairly, perhaps even illegally, influence the election.
The GOP was ready to question the validity of the outcome when a reporting error in heavily-GOP Waukesha County was discovered that gave Prosser a lead of more than 7,000 votes.
Now it was the Democrats‘ turn to cry, “Foul!” and to raise the specter of vote fraud.
Both parties are right to be concerned. Elections in Wisconsin are a messy business, particularly because the state allows same-day registration on Election Day, and because of something known as “vouching,” in which voters who can prove who they are can attest to the identity of others seeking to vote.
Something needs to be done. It’s time for a bipartisan effort to look at the entire election. As the Wall Street Journal‘s John Fund wrote recently, “An independent investigation is called for, if for no other reason than to clear the air and to recommend procedures to ensure such errors don’t happen again. Just as many Wisconsin officials have ignored or downplayed evidence of vote fraud (see the Milwaukee Police Department’s 2008 detailed investigation) so too have sloppy election procedures been allowed to fester in some counties.”
He’s right. Too many people choose to look the other way when the issue of voter fraud is raised, especially if their party is the one that benefits. Elections are too important to not take these allegations seriously. Wisconsin has the reputation for being a “good government state.” If they want to keep it, Governor Walker should appoint an independent panel to review the election and use it as the basis for a set of electoral reforms that could be a model for the nation.
By: Peter Roff, U.S. News and World Report, April 11, 2011
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