A packed Capitol Hill forum Feb. 25 heard a warning that national health care reform should steer clear of the problems Massachusetts has experienced with its state program.
Titled “National Lessons from State Health Reform: the Massachusetts Case Study,” the forum was convened by Rep. Eric Massa (D-N.Y.) and sponsored by the Leadership Conference for Guaranteed Health Care, a coalition of nurses and other health care providers, labor unions, and nonprofit organizations.
Panelists explained to the audience of health care advocates and congressional staffers the history, implementation, and current condition of Massachusetts’ much-discussed 2006 health care reform law.
Their core message was that the 2006 law is not working and should not be used by President Obama and his administration as a national model for health care reform.
The Massachusetts program has several components.
First, everyone in the state is required to have health insurance. Individuals living below 150 percent of the federal poverty line are eligible for fully subsidized public insurance through the Commonwealth Care program. Individuals who earn between 150 percent and 300 percent of the federal poverty level have sliding scale subsidies.
Employers are mandated to provide a portion of the health insurance premium to a percentage of their employees, or else they are fined $295 per employee per year. That is significantly less than the cost to insure an employee and her/his family.
If you do not qualify for publicly subsidized insurance and your employer does not offer you affordable coverage, then you are required to purchase a plan through the Massachusetts Health Connector, an independent state agency that links individuals to appropriate health insurance plans. If you do not purchase health insurance, you may be fined up to $912 per year.
Massachusetts state Sen. Jamie Eldridge told the forum that, since the law took effect, 440,000 more people in Massachusetts now have insurance — two-thirds of the previously uninsured. However, panelists pointed out deep flaws in the system.
The most important, and fatal, flaw is the continued reliance on the private insurance industry. According to Eldridge, the plan has not been able to produce the promised health care savings through decreased emergency room use (by linking every new enrollee to a primary care doctor) and increased participation of young, healthy people.
Dr. David Himmelstein, a Harvard medical professor and longtime leader of Physicians for a National Health Program, pointed out that if you do not remove the inefficiencies inherent in a private-insurance-based system, you cannot reduce costs through expanding coverage.
Himmelstein reported that the Connector and the rest of the Massachusetts plan has, in fact, made the whole system more complex, bureaucratic and expensive. Not only does the Connector charge an additional 4 percent in overhead, but hospitals have to learn new billing systems and hire more people to work on them.
Furthermore, purchasing health insurance does not guarantee actual access to care, panelists said. Many private plans have exorbitant “cost-sharing” co-pays and deductibles that prevent sick people from going to see their doctors. Individuals are being forced to purchase insurance instead of other necessities and they still cannot afford care. Also, the 2006 law shifted resources away from paying for free care in safety net hospitals and clinics to subsidizing private insurance products in Commonwealth Care. This has resulted in an across-the-board decrease in reimbursement for safety net facilities and huge windfalls for richer hospitals.
In fact, according to Dr. Himmelstein, six community health centers have shut down in Boston, and Cambridge Health Alliance, which he is affiliated with, was forced to institute drastic cuts in inpatient mental health care.
“Most of the new coverage,” he said, “has been from purchasing from private insurance plans with large overheads; we have taken money out of direct grants to safety net institutions which carried virtually no overhead and we put them into insurance plans with 12 to 16 percent overhead.” This has pushed up costs and put huge fiscal pressures on safety net institutions.
Other panelists included Sandy Eaton of the Massachusetts Nurses Association; United Electrical Workers Northeast Region head Peter Knowlton; former Northampton, Mass., Mayor Mary Ford; and Arthur MacEwan, a University of Massachusetts economics professor. Reps. John Conyers (D-Mich.) and Dennis Kucinich (D-Ohio), the original sponsors of HR 676, the single-payer “Medicare for All” plan, also addressed the forum.
Mary Carol Jennings, a legislative director for the American Medical Student Association, commented, “It was exciting to see a standing-room only session calling for consolidated funding of our health care system.” She noted that “30 congressional offices sent staffers to observe the forum.”
The resounding message of the panel was that the only way reform can work is if we take the private insurance companies out of the picture and institute a single, national, public health insurance program. Otherwise known as a “single-payer” system, such a program would improve real access to doctors and hospitals, save billions of dollars through decreased administrative costs, and promote an adequate safety net and public health infrastructure.
Rep. Kucinich said we are in a political moment with great opportunity, and it is critical to make sure that this proposal, the only viable proposal, stays on the health care reform debate table.
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