• Massachusetts’ high health care burden

    Zirui Song and Bruce Landon summarize the state of Massachusetts’ health care costs (high) and what state officials are attempting to do about it (a lot). Their short NEJM piece is ungated, so you can read it for yourself. The following two statistics caught me by surprise:

    1. The five organizations in the eastern part of the state that are participating in the Pioneer ACO program account for 75% of Medicare beneficiaries in the Boston area. Is the Medicare population associated with ACOs anywhere near that level in any other city? I doubt it. Boston is the ACO capital.
    2. In 2012, health care will consume a majority (54%) of the state’s budget. Among the states, is that the highest proportion? It believe so. Massachusetts is the health spending king.

    How do other states compare to Massachusetts in terms of health spending? Accounting only for Medicaid spending, Massachusetts still has the highest proportion of its state budget devoted to health spending. The chart below, made from statehealthfacts.org data, shows this (click to enlarge). But Massachusetts’ health spending is on more than just Medicaid. It also pays for subsidized health insurance through Commonwealth Care. No other state does that.

    Yeah, Massachusetts has a big time health spending problem.

    IMPORTANT NOTE: A number of good questions about the data underlying the above graph have been raised in the comments and on Twitter. If someone produces a more credible chart, I will post it. For now, take the above with a pound of salt.


    • Something does not seem right here, and it just may be categorization of numbers. In NY where I am from, we are not so proud to say we have the highest per capita cost for Medicaid in the nation. However, difft metric than graph above. However, it still did not resonate–as NYS listed above as 12% or so.

      Just did a quick google, see NYT oped, and in 2011: “Medicaid costs are a quarter of the state’s operating budget.”


      • More info at the statehealthfacts.org link in the post. In particular, the original source is NASBO: http://web.archive.org/web/20130603144247/http://www.nasbo.org/sites/default/files/2010%20State%20Expenditure%20Report.pdf

        The numerator here is “Medicaid: exclude administrative costs, while including spending from state funds, federal matching funds and other funds and revenue sources used as Medicaid match such as provider taxes, fees, assessments, donations, and local funds. Medicaid general funds include all funds appropriated to the Medicaid agency and any other agency which are used for direct Medicaid matching purposes under Title XIX. All other general funds include state functions not tracked individually, such as hospitals, economic development, housing, environmental programs, health programs (including the State Child Health Insurance Program), parks and recreation, natural resources, air transportation, and water transportation and terminals.”

        The denominator is “General Fund: the predominant fund for financing a states operations. Revenues are received from broad-based state taxes. There are differences in how specific functions are financed from state to state.”

        So, this is one, specific and consistent measure, but certainly not the whole ball of wax.

        • Another factor: Medicaid in NY is unique in that the counties pay for a portion of it. Something like 15-20% of NYS Medicaid costs are born by the counties. That is changing starting this year, but the data are from 2010. http://www.cbcny.org/sites/default/files/NEWS_NYN_01152012.pdf

          So when you say Medicaid as a share of state government budget is highest in MA that may be right, but in NY health care as a share of state and local government combined is much higher than indicated in the chart. At the very least, NY gives MA a run for its money.

    • IIRC, most of this difference occurs due to eligibility levels. The ACA should tighten this up some.


    • And Massachusetts is held out there as a model for the ACA? Whoa, Nelly. We have all the evidence for where this is going with ACA and no one wants to stop this?

    • MA covers higher % of citizens than any other, but at time of Romneycare, did not enact sufficient cost management/control measures.

      This year, ” Governor Patrick filed legislation that encourages the creation of “integrated care organizations” comprised of groups of providers that work together to achieve improved health outcomes for patients at lower costs; provides benchmarks, standards and guidance for the transition to integrated care and global payments; and allows the Division of Insurance (DOI) to consider more criteria when making the decision to either approve or reject rate increase requests from both carriers and providers. Other state initiatives include the development of patient-centered medical homes, bundled payments, and accountable care organizations (ACOs).”

      and has received Federal grant to implement:

      • Even though most studies on ACO’s and etc. are quite mixed in their results, with most studies showing no real change in overall healthcare costs?

        Pie in the sky thinking only can be shown what it is in retropect, I guess.

    • Is the story of the chart really about Massachusetts (highest Medicaid spending level, but only 5% uninsured – see http://www.statehealthfacts.org/comparetable.jsp?ind=125&cat=3 ), or is it about the VERY close competitors at #2 and #3: Ohio (14% uninsured) and CT (11% uninsured)?