Mitt Romney may not like to hear it, but if you want to know what health reform will look like for the United States, look to what’s happening in Massachusetts, a team of experts said on Wednesday.
An analysis in the journal Health Affairs shows the 2006 Massachusetts health reform initiative has, not unexpectedly, gotten health insurance coverage to most of the state’s residents. It has cut emergency-room visits and people say they feel they are healthier than before the law passed.
But costs are rising, and the national debate about the 2010 health reform law has hardened positions. Massachusetts residents who were once neutral about the law now say they oppose it, the study found.
“Just as Massachusetts’ 2006 health reform legislation provided the template for the Affordable Care Act, so the state’s experience under that legislation provides an example of the potential gains under federal health reform. It is likely that the path to near-universal coverage nationally will be slower and bumpier than it was for Massachusetts in 2006,” Sharon Long of the University of Minnesota and two graduate student colleagues wrote. “Yet the findings for Massachusetts are a reminder that major gains in coverage and associated benefits are possible.”
In 2005, an estimated 11.4 percent of Massachusetts adults under the age of 65 went without health insurance – below the national estimate of 15 percent. But the health reform law then-governor Mitt Romney signed in 2006 helped more people get covered. “Health insurance coverage among nonelderly adults in Massachusetts was at 94.2 percent in 2010,” Long’s team reported.
Long’s team used the Massachusetts Health Reform Survey, which collects information from 3,000 new adults ages 19 to 64.5 every year. They found the Massachusetts legislation met its two main goals of increasing access to health insurance and creating a new standard that health plans must meet to count as coverage under the individual mandate.
“The ‘minimum creditable coverage’ standard includes coverage for a comprehensive set of services (including prescription drugs); doctor visits for preventive care, without a deductible; limits on out-of-pocket spending; and no caps on total benefits for a particular illness or a single year. Both paths were expected to lower the costs of health care to individuals and, thereby, increase access to and use of care,” they wrote.
And this did happen. “For example, in 2010 compared to 2006, nonelderly adults were more likely to have a usual place to go when they were sick or needed advice about their health (up 4.7 percentage points), and were more likely to have had a preventive care visit (up 5.9 percentage points), a specialist visit (up 3.7 percentage points), multiple doctor visits (up 5 percentage points; and a dental care visit (up 5 percentage points),” they wrote.
There was a small drop in emergency room visits as well. But all was not rosy.
“Despite the 2010 gains in access relative to 2006, 22.8 percent of nonelderly adults in Massachusetts reported that they did not get needed care in 2010,” Long’s team wrote. “It is likely that the economic downturn and the continuing increase in health care costs, in particular, dampened any gains in coverage and affordability that might otherwise have been achieved under health reform in the state.”
Opposition to reform hardened, likely as a result of the national debate. Republicans have kept up a constant drumbeat of criticism of the national health reform law, with even Romney promising to work to repeal it if elected.
“And although nearly two-thirds of adults continue to support reform, among nonsupporters there has been a marked shift from a neutral position toward opposition (17 percent opposed to reform in 2006 compared with 26.9 percent in 2010),” Long’s team wrote.
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