Rising Health Care Costs Challenge Massachusetts Health Insurance Law

Two years after the Massachusetts health insurance law was signed, the state's "biggest challenge is rising costs," the AP/Boston Globe reports. Since the law took effect, the number of insured state residents increased by nearly 350,000 people. A legislative committee in 2006 estimated that the law would cost about $725 million in fiscal year 2009. Gov. Deval Patrick (D) has allocated $869 million for the program in this year's budget, but state officials overseeing the program say costs will rise even higher. Lawmakers are considering a $1-per-pack increase in the state cigarette tax to help pay for the higher-than-expected enrollment. The tax increase would generate about $154 million annually, the AP/Globe reports.

According to the AP/Globe, the program's cost "hasn't dampened enthusiasm" among some lawmakers. Patrick said, "It's the very first question I get when I'm with other governors," adding, "I don't think anybody is prepared to say that what we have done here in Massachusetts is necessarily the formula for the rest of the country or for a national reform, but at least we are trying." Alan Weil, head of the National Academy for State Health Policy, said, "The Massachusetts reform law remains the focal point for other states and the nation in trying to figure out if state-based reform is possible," adding, "It's the biggest game in town."

The law also has "become a key talking point in the presidential race," the AP/Globe reports. Democratic presidential candidate Sen. Hillary Rodham Clinton (N.Y.) has made an individual mandate -- which is a component of the Massachusetts approach -- a main provision of her health care plan, according to the AP/Globe. Candidate Sen. Barack Obama (D-Ill.) would require all children to obtain health coverage, while Sen. John McCain's (R-Ariz.) proposal does not include any coverage mandates. Drew Altman, president and CEO of the Kaiser Family Foundation, said, "Everyone looks at the individual mandate because it is the first real-world test of the idea that everyone should be required to have health insurance," adding, "Everyone will be watching to see if (Massachusetts) can sustain the plan at a time when the economy is faltering" (LeBlanc, AP/Boston Globe, 4/12).

Women's Care
In related news, state-subsidized health care programs have not provided adequate, of affordable health care for women in Massachusetts, according to a recent study by Suffolk University researchers, the Boston Herald reports. The report found that although women in the state earn an average of 77 cents for every dollar earned by men, women visit physicians 58% more than men and spend more on health care. In addition, women are less likely than men to be covered by employer-sponsored coverage and are more likely to be covered under their spouse's plan.

Lead researcher Susan Sered said, "Women use the health care system far more than men do," adding, "They use it on behalf of their families, their children, their elderly family members, etc. As we began to interview women, we found that some of them couldn't use their insurance because they couldn't afford their copays." She added that middle-income women, undocumented immigrant women, older women under the age of 65 and young adult females often are unable to qualify for or afford the costs of the programs (Wolchover, Boston Herald, 4/13).

The report is available online (.pdf).

Editorial, Opinion Piece
Summaries of an editorial and an opinion piece about the Massachusetts health insurance law appear below.

• Washington Times: It is a "significant gain" that about 340,000 of the estimated 600,000 uninsured state residents obtained health coverage in 2007, but "the dramatic rise in health care demand has not been met with a co-equal rise in supply of physicians," a Times editorial states. According to the Times, "This has fueled a rise in costs, a resort to nurse practitioners and other non-M.D.s; it has made waits for appointments longer and resulted in other unwanted effects." The Times writes that it may be "possible to mitigate these circumstances with the right 'supply' incentives" (Washington Times, 4/9).
  
  
• State Rep. Rachel Kaprielian (D) and the Rev. Herman Hamilton, Boston Globe: A "basic component" to the law's "success is in its inclusion of prevention measures that seek to improve the overall public health -- today and down the road," Kaprielian and Hamilton, president of the Greater Boston Interfaith Organization and pastor of Roxbury Presbyterian Church, write in a Globe opinion piece. According to Kaprielian and Hamilton, state lawmakers are considering legislation that would increase the cigarette tax by $1 per pack and generate about $150 million, "which would enable the Legislature to continue health care reform, as well as reduce the incidence of smoking rates overall." They continue, "Perhaps more compelling, raising the price of smoking will discourage children ... from picking up the habit in the first place. That will lower future health care costs and help break the cycle of addition." Kaprielian, lead sponsor of the bill, and Hamilton write that "an increase in the tobacco levy simply makes sense" (Kaprielian/ Hamilton, Boston Globe, 4/10).

Letters to the Editor
The New York Times on Sunday published two letters responding to an April 5 Times article regarding the 2007 Massachusetts health insurance law. While the law has resulted in about 340,000 of the state's estimated 600,000 uninsured residents obtaining coverage, many newly insured residents are having difficulty finding available physicians because the number of doctors in the state has not increased (Kaiser Daily Health Policy Report, 4/7).

Summaries of the letters appear below.

• Georganne Chapin: One of the doctors, Patricia Sereno, in the Times article "unconsciously reveals the fallacy" and the "false hopes" of efforts to require residents to purchase health insurance, Chapin writes. Sereno said, "It's great that people have access to health care, but now we've got to find a way to give them access to preventive services." Chapin, president and CEO of the not-for-profit managed care organization Hudson Health Plan, notes that "[i]nsurance is not health care." Chapin concludes, "What Massachusetts has done successfully is to provide a new revenue stream for the private insurance system. What remains elusive is health care for all" (Chapin, New York Times, 4/13).
  
  
• Carla Kakutani: Disregarding the problem of the primary care physician shortage "would derail any attempt to provide universal health care," Kakutani, president of the California Academy of Family Physicians, writes. Kakutani cites a February Government Accountability Office study that found "primary care improves health outcomes and lowers health care costs," adding that patients who wait to see primary care physicians or seek treatment in emergency departments raise costs. Kakutani writes that primary care physicians in California "support universal coverage and comprehensive health care reform that addresses the primary care doctor shortage." However, to address the shortage, lawmakers must change the "lopsided payment system that richly rewards doctors who treat progressed illnesses but expects family physicians to subsidize the care that keeps America healthy" (Kakutani, New York Times, 4/13).