Strong success: Massachusetts health reform at 5 years

Massachusetts' 5 year old health reform law is the subject of fierce contention on the national stage, since it formed the foundation for the much-debated Patient Protection and Affordable Care Act (PPACA).But within Massachusetts there's a lot less rancor. Discussion of repeal or defunding is not even on the table despite the challenging budget climate. A new comprehensive chart pack from the Blue Cross Blue Shield of Massachusetts Foundation (Assessing the Results) summarizes the law and presents findings on progress. Key takeaways, which are illustrated with extensive charts and graphs include:

• An increase of 400,000 state residents with insurance coverage, leading to the highest coverage rate in the US, with 98% covered
• Percent of employers offering coverage rising from 70 to 76% even as government subsidized options have increased
• Moderately high and stable support for reform among consumers, employers, and physicians
• No real progress on cost containment

The report emphasizes that the groundwork for near-universal coverage had been laid in the years leading up to 2006. That has made a big difference in reform's success and demonstrates why results in Massachusetts aren't so easily achievable in the country as a whole. (And although Republican primary voters may or may not buy in to it, it does mean Mitt Romney is not necessarily hypocritical in his support of MA reform and opposition to PPACA.) The key enabling factors for Massachusetts cited in the report include:

• Low rate of uninsurance. We already had many people covered through employment and a generous, effective Medicaid program
• An existing funding mechanism to pay facilities to take care of the uninsured, which could be redirected to subsidize the purchase of insurance
• A heavily regulated insurance market with guaranteed issue and community rating

I would add some other factors that the report omits. These are elements that the rest of the country could usefully emulate:

• Strong investment in public education that has led to a well educated workforce that attracts high-wage employers willing and able to provide health insurance. It's a lot easier for an employer to afford $10,000 of health insurance for a worker making $100,000 than for one making $20,000
• A spirit of collaboration among key stakeholders --employers, providers, consumers, health plans-- who worked toward a solution everyone could agree to, and accepted the need for compromise
• A willingness of Democrats and Republicans to work together on a key issue for the state

As the document notes, Massachusetts health reform did not contain costs. That's hardly surprising because it wasn't designed to do so.I'm cautiously optimistic that Massachusetts is now ready to tackle the cost problem. Now that almost everyone has health insurance, there's a willingness to address the affordability challenge in order to preserve what has been achieved.I would argue that addressing costs on a serious scale requires near-universal coverage to be in place. That's a lesson the country as a whole may have to learn, too, and so I'm a lot less optimistic about cost containment at the national level than I am in Massachusetts.