• Massachusetts coverage update

    The Massachusetts Division of Health Care Finance and Policy (MA DHCFP) has released the results of its 2010 household insurance survey. It’s very good news, and to tie it into current news, it continues to show the value of an individual mandate.

    [N]ot only does Massachusetts continue to have the highest health insurance coverage rate in the nation, but that our state has seen gains even through an economic recession.

    This year, more than 98 percent of Massachusetts residents have health insurance. These results are astonishing.

    Some of the most exciting news is related to children and elderly adults, as the survey found that virtually all Massachusetts children have health insurance (99.8 percent) and nearly all elderly adults are covered (99.6 percent).

    The survey, conducted by the independent Urban Institute on behalf of the Division, indicates that coverage is very strong for Massachusetts residents at all income levels, ranging from 96 percent for those with family income under 300 percent of the federal poverty level to over 99 percent of those with income above 500 percent of the federal poverty level.

    More about the survey and results can be found here and here. Links to other and older MA DHCPF survey documents are here.

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    • But premiums have gone up. Costs have gone up. Access has been reduced.Most surveys show Doctors are refusing new patients.

      I know you know about this column
      http://www.kaiserhealthnews.org/Columns/2010/July/072210Turner.aspx

      Mission Not Yet Accomplished? Massachusetts Contemplates Major Moves On Cost Containment
      http://content.healthaffairs.org/content/28/5/1373.full?sid=757e0779-d4e6-4ff4-bf92-708285aedee5

      • @Aaron G – You know that I do not deny the cost problems in the system. They need to be addressed. But I still support coverage expansion and the insurance reforms that make it possible.

    • @Aaron G

      So healthcare costs rose about 6% more than the national average (in Massachussets, which is one of the most expensive states in the country to begin with) but you are covering 99% of the people as opposed tothe national average of about 83%.

      Sounds like a downright bargain to me.

      99% of the people have insurance as opposed to 83% and healthcare facilities usage rose. What a shocker!

      Of course there will be a temporary rise in prices and reduction in availability of services. It takes a lot longer to train doctors than it does to sign on to an insurance form. But that will work itself out within a few years as more college kids become doctors, instead of “financial analysts”.

      Almost all the issues mentioned (like people gaming the short term insurance system) can easily be fixed by minor rule adjustments, and the new healthcare law provides for that through the healthcare board…

    • Massachusetts is not a good test bed to demonstrate the value of the individual mandate and comparisons with the national average of 85% are way out of line. 90% or more of the Massachusetts population has always been insured. Healthcare insurance was “invented” here.

      Depending on what statistics source you use the needle has moved from 90% to 95% (according to the U.S. census bureau) between 2000 and 2009 or from 97% to 98% (according to the survey referenced here) between 2008 and 2010. But all you are talking about — not even statistically significant in my opinion (read the fine print about two-tailed calculation of confidence level in the fine print of the cited report) — is a couple of hundred thousand people out of over 6,000,000.

      The “Mandate” results in Massachusetts are all about paper shuffling. The entire gain since the first full year of Romneycare was based on taking Uncompensated Care Pool money and using it to give free or highly subsidized insurance to uninsured people who would have just received the healthcare anyways paid for by the Uncompensated Pool The actual number of people really buying insurance (taking money out of their own pockets to pay premiums) in Massachusetts is down about 50,000 since 2007 (see the quarterly Key Indicators report on the Massachusetts government web site).

      But keep wishing it was otherwise.

    • Aaron G is right. What matters is not insurance coverage but access to actual care. What good is it to pay $15,000 per year on legally mandated insurance if I can’t find a doctor willing to see me?

      Addicted claims the “reduction in availability” is temporary, but our experiences here in BC (and elsewhere in Canada) show otherwise.

      • @Scott – Waiting times is another form of rationing. We could certainly make things work better on that margin. “Solving” it by maintaining a broken insurance market (the remedy of which is ACA’s main goal, as was Massachusetts’ law) seems like no solution at all.

    • @Austin: Thanks for replying. I agree that serious reforms are needed in the health insurance market, but PPACA and Massachusetts seem to go in the wrong direction. According to Aaron G’s first link, one-third of Massachusetts family doctors who were accepting new patients in 2005 no longer are. Here in BC (where we have our own version of the individual mandate), the waiting list to see a new family doctor is 2-3 years long. The alternative is to go to the ER and get in the way of people with real emergencies, or go to a lower-quality clinic.

      Wait times are more than a problem at the margin. They affect everyone who tries to get health care, and the only way to get around them is to go to the US. What will we do when the US has wait times just as bad as ours?

    • This is something I should probably know, but was there any chatter/attempt to legally challenge the individual mandate in Massachusetts? If it was definitively ruled that the federal mandate was unconstitutional and the federal government couldn’t compel citizens to buy health insurance, is there any corresponding legal principle at the state level? Obviously the Commerce Clause wouldn’t apply, but would there be any effect or anything that would need to be tweaked?

      My Massachusetts Politics professor would probably be disappointed that his lectures on the MA constitution didn’t fully sink in, but oh well…

    • The idea that the mandate violated the Massachusetts Constituion came to court shortly after the mandate went into place in 2008 and was settled in the state’s favor in 2009 (see http://revenue.blog.state.ma.us/blog/ ). It was never appealed to the state’s suprement court.

    • Thanks!