Massachusetts & Health Care Reform
While health care reform has stalled at the federal level, it’s interesting to look at what has been done. Three years after Massachusetts passed health care reform legislation, the legislature reports that 97% of residents have health insurance, the highest in the nation. Massachusetts Senator Richard Moore, chair of Health Care Financing Committee offers that “health care reform in Massachusetts was much more than expanding access to health insurance. It also addressed improving health care quality and containing costs. What else can we learn from the Massachusetts experience?
The basics under the Massachusetts reform include:
- All residents must purchase health insurance;
- All employers with 11 or more employees must provide employee health insurance coverage or contribute up to $295 a year per employee;
- The Medicaid program was expanded to cover more people;
- Another subsidized health insurance program for the poor was created;
- The state created a health insurance exchange for small businesses and individuals to purchase health insurance; and
- People can purchase individual policies through a merged individual and small group insurance market.
Although many residents are satisfied with the changes, there have been legal challenges. One resident challenged the state’s mandate for him to have health insurance. It has been reported that the case (George Fountas v. Navjeet K. Bal (representing the Department of Revenue for the Massachusetts Commonwealth) was dismissed in 2009 in favor of the state by the Massachusetts Supreme Court. It is currently under appeal. Other states have anticipated challenges by citizens and are considering legislating an opt out clause should federal reform include such a requirement. The Commonwealth of Virginia is the first state to pass an opt out provision.
The Massachusetts legislature has forged ahead with additional legislation designed to support health care reform measures. Examples include financial aid for those attending the University of Massachusetts Medical School and who agree to practice in primary care, as well as funds to expand health information technology. The legislature also commissioned a study of payment reform in the transition from fee for service to global payments. Recommendations from the study will be used to draft the next level of health care reform legislation, slated for this year.
This is an example of one state’s courage in pursuit of health care reform. Though evaluation is limited at this time, this is a reminder that states act when Congress doesn’t.
Janet Haebler, MSN, RN
