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
Tea Party Budgeting: Everyone Doesn’t Deserve A Fair Shot
Three lessons I’ve learned from Tea Party budgeting:
1. Charles Lightroller was a chump.
Lightroller was the second mate on the Titanic. Legend holds that no one enforced the command to allow women and children to board the lifeboats first more rigorously than he did. Some call him a hero. But not me. That’s because I, like Rush Limbaugh, think Paul Ryan’s budget is “wonderful.”
And how could you not? Ryan surveys the budget battlefield and here’s what he sees: on one side, an onrushing horde of seniors, working people, and the disabled. On the other, defenseless corporations and their affluent compatriots prancing like happy kittens amongst the flowers. In the face of such forbidding odds some might duck, but Ryan strides onto the field of play and bravely interposes himself between the conflicting parties, prepared to defend the defenseless come what may.
Here’s what that looks like: Medicare, the health program relied on by millions of seniors, is replaced with a benefit guaranteed to fall further and further behind the actual cost of healthcare. Medicaid (healthcare for people with low-incomes) sustains deep cuts. But tax rates on corporations and the highest earners are lowered, while subsidies for oil companies remain untouched. Truly a profile in courage.
2. Pell Grants are destroying America.
I feel badly for not recognizing it, but it seems so obvious now. Freeloaders figured out how to get free food, free housing, and free electricity years ago, but they’ve never been able to reach the Holy Grail: free Biology of the East African Mud Turtle 101. Until now. “You can go to school,” warns Rep. Denny Rehberg of Montana, “collect your Pell Grants, get food stamps, low-income energy assistance, Section 8 housing, and all of a sudden we find ourselves subsidizing people that don’t have to graduate from college.”
Welfare cheats scheming to take the college courses of their dreams? (And then not graduate!) It’s an outrage. How many of them are sitting in a college cafeteria right now snickering over a steaming plate of American Chop Suey? (Purchased with food stamps, natch.) “It’s turning out to be the welfare of the 21st century,” Rehberg says. Talk about getting schooled: that’s got to be one of the smartest theories I’ve ever heard.
Of course, it’s not just Pell Grants that are so nefarious. It’s Head Start too, and Medicare, and Medicaid, and …(hence, Lesson 1 above).
3. Better than Government? Fairies.
A signal question in American political life today is: when things go wrong, what role, if any, should government play in trying to make things right?
We seem to have settled on some answers. When we’re to blame for the bad things that happen, we’re on our own. The same is true when we do our best but lose fair and square. But what about when people encounter difficulties through no fault of their own and in a way that offends our sense of fairness? A kid who’s born into a family without the means to send him to a good school, or a mother who works hard every day but loses her employment because global economic forces are moving manufacturing jobs to other countries? Should government lend a hand in those kinds of cases?
The Ryans and the Rehbergs conceive of a government that does so less and less. They say the benefit of helping the disadvantaged is outweighed by its expense. What they don’t say is what happens to people who no longer can rely on needed government assistance. Perhaps magical fairies come along, wave their magic wands, and everyone who used to get a Pell Grant can still go to college, only this one is taught by chocolate bunnies! And all those people who can’t afford healthcare anymore? It’s OK. They’re now living in a cottage made entirely of gingerbread!
Let me be clear: there’s every reason to be serious about reducing the budget deficit. Political leaders on both sides of the aisle should be open to good faith ideas that emanate from anywhere on the political spectrum. But it’s reasonable to ask whether using concern over the deficit as an excuse to accomplish purely ideological goals can be considered serious.
Democrats agree that the private sector should be the engine that drives our economy and that we need the discipline to cut government programs that aren’t working. But there’s something else we believe that sets us apart from the Tea Partyers: there’s a promise inherent to the American free market system that says everyone deserves a fair shot, and that promise goes unfulfilled when people are disadvantaged by forces beyond their control and we all stand by and do nothing about it.
In other words, bring back Charles Lightroller. Boy, do we need him.
By: Anson Kaye, U.S. News and World Report, April 7, 2011
Government Shutdown: A Hostile Act Against A Civil Society By A “Band Of Rebels”
Shutting down the federal government is a hostile act against civil society.
The Civil War started 150 years ago in April 1861, and we are still getting over it, still talking about it, still writing about it. Some in the South have still not made peace with the end of the Civil War and hold fast to “heroes,” notably General Robert E. Lee. President Abraham Lincoln showed what he thought of Lee when he seized Arlington, Lee’s stately home and slave plantation across the Potomac River, and started burying the dead Union soldiers in the ground there.
Lincoln’s message could not be clearer: Leading an assault on the Union was not a Sunday picnic in the country. Serious consequences followed, hitting home.
Now we have a band of rebels—87 of them newcomers—in the House Republican majority, who are fixin’ for a fight. Spoiling to see the Capitol Dome go dark. Acting as if that’s the mission, the reason they crossed lines to come into the heart of the enemy. Washington is a staging ground for their defiant anger at the Union. The republic is under a new kind of siege.
If they have their way, the federal government will be closed this time next week, not what we need right now with so many American households hanging by a thread.
Now a few facts to concentrate the mind. First, the Tea Party is part of the problem. But hold the whole lot of House Republicans and their leaders responsible. If there are any grown-ups in the House, they are allowing their most radical element, unschooled freshmen, to dominate in a delicate showdown looming with the Senate and the White House.
Second, remember the Senate is controlled by a Democratic majority, a fact conveniently forgotten by the lower chamber, whose members often brag about the last election. The 2010 outcome was actually an evenly divided government, with a Democratic president to play his part in final outcomes, laws, and budgets. That’s the way it should be, if Senate Democrats and President Obama will only stand up to the rebels.
Third, the scope of the House Republican “defunding” demands is tantamount to waging war on our civil society as we know it. I don’t mean just NPR. Some of the priceless “commons” are at risk, in the proposed degradation of environmental programs. Social programs like family planning and women’s health are on the chopping block in an offensive against women’s health and reproductive rights. Chris Van Hollen, a House Democrat from Maryland, reads it right: Across the aisle is an extreme agenda to impose a right-wing ideology on town and country, using budget cuts as a vehicle.
Fourth and finally, whether $33 billion or $60 billion is cut from the budget, it will be too much. For the collective health of the nation, either number is like going on a diet when you’re starving. It’s really no use the two congressional chambers meeting in the middle, because the rebels can say they won the day—and they might be “right” in more ways than one. They skewed the debate by passing their draconian budget early and talking it up every day since.
What the GOP House freshmen lack in knowledge, they make up with sophomoric enthusiasm. They are so gung ho to camp out in the dark. Remembering Lincoln, don’t let the rebels take over and turn the lights out on us.
By: Jamie Stiehm, U.S. News and World Report, April 4, 2011
Teaparty, More Dumb Than Clever
Although I’m not part of the Tea Party movement and I don’t share its values, I usually understand what its followers are trying to do. But their latest gambit on health care has me genuinely baffled.
The idea is to oppose the Affordable Care Act not in the Congress or the courts, where they’ve been fighting so far, but in the state legislatures. As you may recall, the Act calls upon states to create the new “exchanges,” through which individuals and small businesses will be able to buy regulated insurance policies at affordable prices. The simplest way to do that is for state legislatures to pass laws creating exchanges that conform to the Act’s standards. Several states have started that process already–and a few, like California, are well along in their efforts.
But Tea Party activists have been lobbying state lawmakers to vote against such measures and, in a few states, it looks like they’re succeeding. Politico’s Sarah Kliff has the story:
In South Carolina, tea party activists have been picking off Republican co-sponsors of a health exchange bill, getting even the committee chairman who would oversee the bill to turn against it.
A Montana legislator who ran on a tea party platform has successfully blocked multiple health exchange bills, persuading his colleagues to instead move forward with legislation that would specifically bar the state from setting up a marketplace.
And in Georgia, tea party protests forced Gov. Nathan Deal to shelve exchange legislation that the Legislature had worked on for months.
It’s a great idea for blocking the law, except for one small problem: The Affordable Care Act anticipates that some states might not create adequate exchanges. And the law is quite clear about what happens in those cases. The federal government takes over, creating and then, as necessary, managing the exchanges itself. In other words, if state lawmakers in Columbia, Helena, and Atlanta don’t build the exchanges, bureaucrats in Washington are going to do it for them.
I realize that blocking the exchange votes may have certain symbolic value–and, at least in the early going, it could complicate implementation simply by generating more chaos. (Georgia lawmakers, as the article suggests, had already put in a lot of time on theirs.) I also gather that some Tea Party activists believe that blocking state exchanges will strengthen the constitutional case against the law. Still, if even part of the law withstands both congressional repeal and court challenges, as seems likely, the long-term effect of this Tea Party effort seems pretty clear: It will mean even more, not less, federal control.
The irony here is that, throughout the health care debate, liberals like me wanted federal exchanges, in part because we feared states with reluctant or hostile elected officials would do a lousy job. That’s the way exchanges were set up in the House health care reform bill and, in January of 2010, many of us hoped the House version would prevail when the two chambers negotiated the final language in conference committee. But the conference negotiation never took place, because Scott Brown’s election eliminated the Democrats’ filibuster-proof majority. The House ended up passing the more conservative Senate bill, which had state exchanges, and that became the law.
Of course, not all Republicans agree with the Tea Party’s approach. In a previous article, for Politico Pro, Kliff interviewed several state officials who said they were setting up exchanges, notwithstanding their opposition to the law, precisely because it is the surest way to keep out the feds.
Len Nichols, the health care policy expert at George Mason University, thinks that approach makes a lot more sense, given their priorities:
Ironically, the only way to make PPACA a “federal takeover” is for states to do nothing. There is much state flexibility in the law, and much more could be sensibly negotiated and amended before 2014, but the strategy of repeal, do nothing and “get the government out of health care” will have exactly the opposite effect in those states that follow this path.
Maybe the Tea Party activists know something that neither Nichols nor I do. My bet, though, is that this effort is the policy equivalent of a temper tantrum, one that opponents of federalizing health care may come to regret.
By: Jonathan Cohn, The New Republic, March 31, 2011
GOP Wants To Pay For Health Care After All
Well, well, well.
Remember how Republicans have been whining that using federal tax dollars to pay for health care is some kind of evil Hitlerian Kenyan socialism that has all our Founding Fathers spinning in their graves? Turns out it’s bullshit.
Kate Sheppard at Mother Jones reports:
A bill that Rep. Cliff Stearns (R-Fla.) introduced in January would provide federal funds for the purchase of sonogram machines at organizations that counsel women against having an abortion (the American Independent reported on this bill last week). These crisis pregnancy outfits, sometimes called “pregnancy resource centers,” are often run by religious groups; many have been found to provide women with false and misleading information to dissuade them from having an abortion.
The bill, H.R. 165, laughably called the Informed Choice Act, appears quite simple:
To authorize the Secretary of Health and Human Services to make grants to nonprofit tax-exempt organizations for the purchase of ultrasound equipment to provide free examinations to pregnant women needing such services, and for other purposes.
But of course it doesn’t allow all organizations to apply for funding. There are a few restrictions, according to Mother Jones.
To be eligible for this grant, a facility would have to show every woman seeking services the ultrasound image and describe to them the “general anatomical and physiological description of the characteristics of the fetus.” The facility would be required to provide women with “alternatives to abortion such as childbirth and adoption and information concerning public and private agencies that will assist in those alternatives.” It also must offer its services free of charge. That last condition would disqualify abortion providers, such as Planned Parenthood, which charges on a sliding scale based on a woman’s income.
Crisis pregnancy centers are nothing more than religious centers that try to dissuade women from obtaining abortions by using false and misleading information.To review:
Such centers have repeatedly been found to give women false medical information for the explicit purpose of preventing them from obtaining, or even learning about, abortions.A 2006 Congressional report, False and Misleading Health Information Provided by Federally Funded Pregnancy Resource Centers, concluded:
Pregnant teenagers and women turn to federally funded pregnancy resource centers for advice and counseling at a difficult time in their lives. These centers, however, frequently fail to provide medically accurate information. The vast majority of pregnancy centers contacted in this investigation misrepresented the medical consequences of abortion, often grossly exaggerating the risks. This tactic may be effective in frightening pregnant teenagers and women and discouraging abortion. But it denies the teenagers and women vital health information, prevents them from making an informed decision, and is not an accepted public health practice.
The bill’s sponsor is the same Cliff Stearns who wanted to investigate Planned Parenthood over the O’Keefe-style sting videos that tried to show Planned Parenthood covering up a prostitution ring. That would be the same Cliff Stearns who last month said that “defunding Planned Parenthood should be a fiscal and moral priority for Congress, and for the American people.” Why?
Our national debt exceeds $14 trillion and after running a federal deficit of $1.3 trillion last year, we will see a $1.5 trillion deficit this year. I get one clear message in talking with the American people – promote job growth and control government spending.The federal government funds thousands of programs and projects, and Congress must look at all federal expenditures and reduce or eliminate those that do not meet the needs of the American people.
So while Rep. Stearns and his fellow Republicans think there’s just no room in our budget for the nation’s largest women’s reproductive health care provider, there is, apparently, $5 million a year to fund fake health care clinics run by religious zealots.
No word yet from Stearns on how this will “promote job growth and control government spending.”
By: Kaili Joy Gray, Daily Kos, March 29, 2011
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