Columbia University Journalism Review of RomneyCare:
"Dr. Rachel Nardin, who heads the Massachusetts chapter of Physicians for a National Health Program, noted that having health insurance was not the same as getting health care.
Thirteen percent of people in the state who had insurance still could not pay for some health services, and 13 percent could not pay for their medicines, she said.
Dr. Steffie Woolhandler, a professor at the Harvard Medical School, explained how the law encouraged the overuse of costly high-tech care while damaging the finances of safety-net hospitals."
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The assumption was that, as more people—and, in particular, more young and relatively healthy people—joined the system, premiums would go down across the board.
There was also the assumption that as more people became insured, the number of people going to the emergency room would drop dramatically, saving the Commonwealth money. Neither of those things have happened—at least not enough to produce the cost savings we were told we would see.
In fact, health care reform has cost the Commonwealth much more than expected—-up to a record $1.3 billion this year. It is maddening that so many of our public health care dollars are diverted to HMOs and health insurance companies, under the current employer-based Massachusetts health care system.
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http://www.cjr.org/campaign_desk/health_reform_lessons_from_mas.php?page=2"......people still seek treatment at the state’s safety net hospitals and emergency rooms, which wasn’t supposed to happen as people became insured. The Globe just reported that more people are seeking care in emergency rooms, and that the cost of treating them increased by 17 percent from 2005 to 2007, a period that includes two years covered by the law. The problem, it seems, is more complicated than simply mandating insurance coverage.....
At the end of 2007, some 204,000 people remained uninsured. Nine thousand were exempt for religious reasons; 127,000 didn’t have to buy a policy because the state ruled that their incomes were too low to afford one; 68,000 paid the tax penalty.
Elisa McKernan, who spoke at a Boston forum last year, said that her family had lots of health problems but could not afford coverage. The state fined the family. Experts expect that these numbers will rise as the recession lingers, raising an unpleasant question that has been absent from the public discussion: Who is more deserving of insurance in a less-than universal system?
Undocumented immigrants and the mentally ill often fall through the cracks, as do the 20 percent of residents on Medicaid who cycle on and off the program. Medicaid, called Mass Health, is one of the state’s building blocks. ....
http://www.cjr.org/campaign_desk/health_reform_lessons_from_mas_1.php?page=2As more people gained insurance coverage and used it to obtain medical services (which was the point of the law), the care they received piled more costs onto the state’s already expensive system. It’s a simple mathematical proposition: more services lead to higher total expenditures.
Jon Kingsdale, who heads the state’s Health Insurance Connector Authority, is blunt: “The cost of health care needs to be under control to sustain the individual mandate or the whole thing unravels. If costs continue to soar, the enforceability of the mandate is in jeopardy.”
http://www.cjr.org/campaign_desk/health_reform_lessons_from_mas_2.phpThe Abrams’s story illustrates what many people in the state are beginning to realize—that affordable health insurance is beyond their reach even under the health reform law, and that the state’s much touted shopping/brokerage service, called the Connector, may not help much.
The Abrams’s income, about $63,000 per year, was a bit too high to qualify for subsidized coverage when the law took effect.
(The cutoff for state help was just over $60,000.) The state’s affordability schedule indicated that families with annual incomes of $63,000 a year should have been able to spend up to $352 a month on premiums. But Frontline reported that when the Abrams’s searched the state web site, the cheapest monthly premium available for them through the Connector cost $800.
They finally choose a policy costing around $1100, nearly twice the family’s mortgage and three times its food budget. Eventually Alison got a job with benefits.
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most adults must have a policy with coverage for inpatient hospital care, physician services, diagnostic tests, outpatient care, and prescription drugs. Deductibles cannot exceed $2000 for individuals and $4000 for families.
That still presents a huge out-of-pocket expense for middle-income wage earners, who have to pay those amounts for care before their Connector policies kick in. Preventive care is not subject to the deductible, and the most a family has to pay out-of pocket is $10,000 ($5000 for individuals).
Those, too, are high, but still offer some protection against catastrophic expenses. Outside of those parameters, insurers are free to design the policies anyway they like—with copayments and coinsurance applied to different kinds of services such as mental health, drugs, or hospital inpatient stays.
http://www.cjr.org/campaign_desk/health_reform_lessons_from_mas_4.phpMassachusetts embarked on its reform efforts with several advantages. The state’s number of uninsured residents was lower than most states, and a large percentage of employers offered coverage and still do.
Boasting a tradition of strong insurance regulation, the state already required insurers to cover sick people. The state’s Medicaid waiver was up for renewal, and politicians persuaded the federal government to recast the waiver and expand coverage to more poor people.
But recent Census Bureau statistics show that, in 2008, some 352,000 Massachusetts residents did not have coverage, even though the law requires that they do. That’s about 5.5 percent of the state’s population; up from the 2.6 percent who were uninsured in the years after reform took effect.
These numbers caused Dr. Steffie Woolhandler, a professor at the Harvard Medical School (and unabashed single-payer advocate), to remark: “Today’s numbers show that plans that require people to buy private insurance don’t work. Obama’s plan to replicate Massachusetts’ reform nationally risks failure on a massive scale....
http://www.cjr.org/campaign_desk/health_reform_lessons_from_mas_5.phphttp://www.cjr.org/campaign_desk/health_reform_lessons_from_mas_4.phpThe truth of “universal” health care in Massachusetts is that it is not true. I am one of the only physicians in my area who accepts the state health insurance. I actually pay to provide health care for these individuals. If no doctors accept this insurance, how does it provide health care to anyone? Please tell the truth about this.
http://www.cjr.org/campaign_desk/health_reform_lessons_from_mas_7.phpetc......
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