Health insurance premiums going down in Massachusetts for individuals? State says end of federal subsidies will “challenge” this trend.

From the Massachusetts Center for Health Information: 

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PMPM: Payment per member per month

CHIA found that, overall, the individual purchaser market segment experienced decreases in average premiums (-3.4%) and cost-sharing (-8.0%) between 2015 and 2016. CHIA also found that unsubsidized plans experienced higher premium growth and larger cost-sharing increases than ConnectorCare Plan.  (State’s subsidized health insurance exchange.)

…Overall financial trends for individual purchasers were
driven, in large part, by enrollment growth in ConnectorCare plans with lower
premiums.Between 2015 and 2016, enrollment in unsubsidized individual
plans in Massachusetts increased by 6.5% to over 97,000 members, while
ConnectorCare enrollment grew by 51.4% to nearly 170,000 members

Enrollment and cost trends for individual plans purchased outside
the employer-sponsored insurance system reflect a combination of
individual purchasing decisions, population health characteristics, policy
and regulatory measures, and broader trends in health care spending.
Between 2015 and 2016, unsubsidized individual plan premiums grew
more slowly than the statewide average premium, and ConnectorCare
premiums actually decreased. For unsubsidized plan members, modest
premium growth was offset by increased cost-sharing obligations.
Members enrolled in ConnectorCare plans would have experienced higher
cost-sharing were it not for subsidies that preserved low out-of-pocket
spending. In the coming years these trends will be challenged by the
discontinuation of CSR subsidies in late 2017 and other potential changes
at the federal level. which may have a substantial effect on enrollment,
premiums, and cost-sharing for individual purchasers, depending on how
states offset these changes.

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Mass. single-payer advocates take on limits of state health reform

Before you write off these folks, note that a recent survey of doctors by the Massachusetts Medical Society found that a growing number of doctors support the idea of a single-payer system. More than 40 percent, up from  34 percent last year. So do a lot of folks at Occupy Boston.

Massachusetts Health Reform in Practice and The Future of National Health Reform

OVERVIEW: While the Massachusetts health reform law of 2006, widely regarded as the model for the new federal health law, reduced the uninsured population in the state, it did so at the cost of rapidly rising underinsurance, increased health care premiums, and a financial crisis among the state’s safety-net hospitals and community health centers. And the financial burden of the reform has fallen disproportionately on lower-middle-class families.

Those are some of the findings in a new, exhaustively documented report on the outcomes of the Massachusetts reform law released by Mass-Care and Massachusetts Physicians for a National Health Program. The report draws on hundreds of sources, including academic studies, government statistics and scientific surveys, in the first compilation of its kind.

EXECUTIVE SUMMARY

The Massachusetts Health Reform Law of 2006 expanded Medicaid coverage for the poor and made available publicly subsidized private health insurance for additional low-income residents of the state. It also mandated that all but the poorest uninsured residents either purchase private health insurance or pay a substantial fine (up to $1,212 in 2011). Smaller fines (up to $295 per employee) were also levied on employers who fail to offer insurance.

Four years after full implementation of the law, Massachusetts has not achieved universal coverage, although one-half to two-thirds of the previously uninsured now have some type of insurance policy. Most of the gains in coverage have come from expansions in publicly subsidized insurance. This largely represented a shift of patients from the state’s former Free Care Pool, which compensated hospitals and community health centers directly for care of the uninsured, to private insurance plans, which is a more costly way to provide care. The reform did not lead to a sustained increase in employer-sponsored coverage, but did slow declining employer coverage. Instead of dropping coverage, employers in Massachusetts have increased cost sharing, shifting costs on to employees, leading to rapidly rising underinsurance after health reform. The use of high-deductible plans more than tripled for residents with private insurance, and good insurance coverage at small businesses all but disappeared over a few short years after reform.

Reform has had a positive impact on access to care in the state, but this impact has affected a modest share of residents, and for some patients has been negative. For example, some low-income patients who previously received completely free care under the state’s prior free care program faced new co-payments and premiums after becoming insured, which impeded their access to care. Reform has not reduced the burden of medical bills and medical bankruptcy on Massachusetts’ families.

The growth of residents with insurance coverage has exacerbated a primary care shortage in Massachusetts by increasing wait times for appointments and decreasing the portion of physicians accepting new patients, creating access problems even for those with coverage. Reform did not reverse growing use of the state’s emergency departments for care, despite expectations that expanding insurance coverage would reroute patients through primary care offices. There is no evidence as of yet that expanding insurance coverage has had an impact on health outcomes or disparities in health outcomes. Reform has also created a financial crisis for safety net providers that specialize in care for low-income communities and the uninsured, by shifting resources away from safety net providers while patient demand for safety net care has actually increased.

The public cost of reform has been high, exceeding $800 million in fiscal 2009 for a state with a total budget of $32.5 billion.  However, federal taxpayers paid for the bulk of the law’s public expenses. The state has made a broad range of cuts to the original law in order to its keep costs down, cutting back coverage for over 30,000 documented immigrants, curtailing some benefits, increasing cost sharing, and increasing the share of enrollees required to pay premiums. Substantial funds from the federal stimulus bill were also used to sustain the reform law, but this was a short-term fix only.

Public payments account for only a portion of the reform law’s costs. A central premise of the law was that the state, employers, and individuals would all have to sacrifice financially to approach the goal of universal coverage. This premise of “shared responsibility” for the costs of the reform was in many ways disingenuous. Although employers, individuals, state and federal government have shared the burden of increased costs roughly equally, this overlooks the fact that governments pass on their spending to taxpayers, and employers pass on their costs to employees.  The actual burden of health reform was regressive, with increased spending after health reform falling disproportionately on lower-middle income residents.

The reform failed to “bend the cost curve” in Massachusetts because it contained no significant cost-control provisions. Health care costs in Massachusetts are higher than in any other state in the nation, and reform has been found to accelerate the rising costs of employer-sponsored health care. There is general agreement that the Massachusetts reform is itself not sustainable without effective cost control.

Massachusetts enjoyed favorable circumstances at the outset of reform, such as previously high levels of spending on health care for the poor, high personal incomes, and relatively low rates of uninsurance. Without controlling costs, national reform will run up against the same difficulties as Massachusetts: growth in public insurance coverage will prove unsustainable and will accompany the rapid erosion of private insurance benefits, while modest gains in access to care will be threatened in the short term by unsustainably high costs that are increasingly shifted on to patients.

While Massachusetts health reform has enjoyed support from a majority of residents in the state, that support has declined since national health reform instigated a broader debate over alternatives to the Massachusetts plan. Moreover, while residents support the Massachusetts reform law over no change at all, they have expressed increasing skepticism that the law is working for vulnerable communities, and more residents report that the law is hurting them than helping them.

We believe that the data in this report should give pause to those concerned with national health care reform. Although not without its successes, the Massachusetts reform has not addressed the fundamental deficiencies in the health care system – treating symptoms rather than causes – and even its modest successes are unsustainable for the state and Massachusetts residents.

New Yorker: How Mitt Romney came around to Massachusetts style health reform

Watching New Yorker writer Ryan Lizza on MSNBC on Wednesday night got us thinking – is this a repeat? Since we recently watched four innings of a rain-delay repeat of a Red Sox game before realizing
we had already seen it, we were suspect.

 Lizza struggled through his explanation of Health Reform 101 — we all do — without offering much news. The same can almost be said of his story on Mitt Romney’s role in the Mass plan in this week’s New Yorker.

One angle he did nail was – the approach embraced by Mitt and Obama is a Republicans idea. And contrary to the argument that this is a government takeover of health care, it’s actually an attempt at providing universal coverage while maintaining the private health insurance industry.

For government-run health care, see the UK. For government-run insurance, aka single payer, see Medicare
or Canada or Vermont. Find support for the latter approach at Mass Care or Physicians for a National Health Plan.

So, it you need to catch up and don’t want to dish out $5.99  or subscribe to The New Yorker,  just scroll down or click on the story in last week’s Globe, the first in a series On Romney and health and not yet behind a pay wall. We recycled the headline.

Tipping point for health costs in Mass?

BHN is not a fan of the overused term “tipping point.”  But, it works here.

Let’s connect the dots. 

The Globe‘s reports on back room deals at Partners, the hospital giant that helps fuels the regions high health care costs high. The ever-looming high costs of care in Mass.  The state’s – and now the public’s –– stake in high health costs. The insurance industry attempt to raise some rates for small businesses by, in some cases, more than 30 percent.

 Tipping point?

 The state says no to high rates.  Insurers sue – and lose — but some start dropping high-cost hospitals. Partners — facing pressure for running thos high-costs hospitals — chips in $40 million for small businesses insurers.  And the state has a plan to cut waste by rewarding docs for who cure patients, not those who order lots of tests.

 BHN  was going to put all these pieces together. But the New York Time did it in yesterday’s staff editorial.

  When Massachusetts’s politicians designed their reform, they calculated that achieving near-universal coverage first would then give all participants in the health care system an incentive to help rein in costs. There are encouraging signs that that is starting to happen.

 

Massachusetts: Push Back on Health Reform

More on the single-payer folks retrenching and talking about state-level change. This via email:

Last week Mass-Care joined over 100 activists, unions, legislators, and community organizations at a spirited organizing meeting in downtown Boston to launch a Massachusetts Campaign for Health Care Justice. Given the faltering efforts at national health reform, the campaign will attempt to organize a renewed push for Medicare-for-All legislation particularly at the state level, while building a mobilization network capable of supporting workers, patients, and communities struggling to maintain access to health care.

Adding to the Debate Over the Mass model

From The Wall Street Journal:

A Debate in Massachusetts

Has the state’s plan succeeded? The two sides square off.

Here, arguing that the state program is a success, is Michael J. Widmer, president of the Massachusetts Taxpayers Foundation, a Boston-based, nonpartisan public-policy group that researches financial, tax and economic issues. The group is also part of the Massachusetts Health Care Reform Coalition, a nonprofit that promotes the state plan.

Arguing that the plan is a failure is Grace-Marie Turner, president of the Galen Institute, a nonprofit public-policy group based in Alexandria, Va., that conducts research to advance market-based solutions to health reform. The institute is funded by private donors, philanthropic organizations and companies that include health-care-related businesses.

 The single payer supporters also offer an analysis of the Mass Model that differs from these two. Mass Care has a full page on it. They argue that the plan “has significant weaknesses that prevent it from living up to its hype and is widely recognized as an unsustainable effort over the medium-term.”  

In October, MassCare, Physicians for a National Health Plan and others testified at the on Beacon Hill that the state health system is a non-functional corporate giveaway. Instead, they are pushing a bill that would establish a single payer system for the state: This from the Oct. 21 Belmont (Mass.) Citizen-Herald:

A quarter of the Legislature has signed onto a proposal to scrap the state’s landmark health care system, which still relies on private insurance companies to cover millions of residents, in favor of a single-payer system, publicly run and available to all residents.

Backers of the single-payer plan (H 2127) argued Tuesday that the state’s current system has failed to control costs, prevented even insured residents from obtaining needed care and left as much as 5 percent of the population without coverage.

Minnesota looks at the Massachusetts mandate

star journalGreetings fellow lab rats. Read on from the Minneapolis Star-Tribune:

Democrats highlight the expansion of coverage; about 97 percent of Massachusetts residents have insurance, compared with 85 percent nationally. Republicans, including Minnesota Gov. Tim Pawlenty, ding it for spending too much; Massachusetts had to scale back its coverage goals this year in the face of a big state budget deficit.

Health experts, meanwhile, consider it a useful laboratory to study the effects of revamping the health care system.