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So far, Massachusetts' bold health care initiative is showing mixed results. The state has made great strides in covering the uninsured, but it is struggling with soaring costs. When the state passed its comprehensive plan for universal health coverage in 2006, the legislation was hailed for its bipartisan backing and viewed as a likely model for nationwide health care reform. It contained some novel ideas on how to achieve universal coverage, such as requiring all individuals to have health insurance. Employers must either provide coverage to their employees or pay $295 per worker into a state fund. Those who can't afford insurance are subsidized by the state.
More than half of the state's previously uninsured are now covered -- about 340,000 of the state's 600,000 uninsured. Of those, 175,000 are in the state's subsidized program, Commonwealth Care. That's about 30,000 more than state officials expected, and it's a big reason why the program will cost Massachusetts $153 million beyond what was budgeted ($472 million).
About 85,000 additional people are covered through their employers, mostly because they no longer turn down the insurance offered by companies. The percentage of employers offering health care coverage to workers also went up, from 70% to 72%, going against the national trend.
But higher than expected costs raise questions about the program's future. In addition to this year's $153-million shortfall, next year's request is for $869 million. The state is looking at increasing the tobacco tax by $1 a pack to help pay for the growing price tag and at other legislation to constrain cost growth. Such actions might include hiking contributions by employers, providers and insurers to the fund.
The subsidized program's premiums also will go up 10%, along with higher cost sharing, leading many to wonder if it will continue to be affordable for lower income people and whether benefits will have to eventually be cut.
One hope is that costs will come down through an effort by the Health Care Quality and Cost Council, a state panel, which was assigned to get information to consumers on provider cost and quality, so they can be better shoppers. A Web site will be launched in June with the data on obstetrical services, physician office visits, high-volume surgical procedures and diagnostic tests. The jury is still out on how well the individual mandate is working. Individuals had to indicate on their 2007 tax returns if they had insurance, and the results are still being tallied. Those who didn't have insurance faced a $219 fine, but starting this year, the fine increases to half the price of the lowest-cost health insurance plan available, up to a maximum penalty of $912.
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