Massachusetts Health Care Reform — Near-Universal Coverage at What Cost?
| Title | Massachusetts Health Care Reform — Near-Universal Coverage at What Cost? |
| Year | 2009 |
| Author | J. S. Weissman and J. Bigby |
| DOI | doi:10.1056/NEJMp0909295 |
| URL | http://www.nejm.org/doi/full/10.1056/NEJMp0909295 |
| Journal | New England Journal of Medicine |
| Document Type | Journal Article |
| Document Availability | Full Text |
| Classification | Policy |
| Abstract | Massachusetts has long been known for its academic medical centers, biomedical research, high-quality health care, and perhaps not unrelatedly, high health care costs. In 2006, the state captured national attention when it passed a landmark health care reform bill, under which it has achieved near-universal coverage of state residents. Some observers, however, have questioned whether this reform has been too costly. The Massachusetts reform law expanded Medicaid coverage; created state-subsidized insurance, called Commonwealth Care, for low-income persons who are not eligible for Medicaid; merged the individual and small-group insurance markets; instituted an employer “fair share assessment” and an individual mandate; and created the Commonwealth Connector, an insurance exchange that also sets standards for coverage and affordability. Under this reform, nearly universal coverage has been achieved, with 97.3% of all residents covered as of the spring of 2009 by health plans that meet a “minimum creditable coverage” standard. There is no evidence of private insurance “crowd-out,” and access to care has increased, with fewer people encountering financial barriers to care. Nevertheless, under the microscope of the national health care reform debate, questions have been raised about the appropriateness of the Massachusetts model for the country as a whole, given the costs of the program for individuals, employers, and the state; some have also questioned whether recent actions to reduce costs represent a retrenchment as compared with the law’s original intent. |