In 2006, Massachusetts passed health care legislation that is remarkably similar to the Affordable Care Act (ACA). Like the ACA, the Massachusetts law focused on expanding health insurance for all the state’s 6.5 million residents.
Key provisions of the law included:
- Expanding public programs that are affordable
- Requiring adults to buy insurance or pay a fine
- Requiring employers with 11 or more full time employees to meet a minimum standard of coverage or pay an annual assessment of up to $295 per employee to help fund costs of uncompensated care. This has now been amended to apply to companies with 21 or more fulltime employees in 2013.
- Creating an insurance exchange—the Health Connector—making it easy for individuals and small businesses to find affordable insurance.
The arguments against this bill echo what is being said now—that small businesses cannot afford the reform; that businesses would pay the fine rather than offer insurance; that small employers would dump insurance. This is not what happened. Since the law passed in 2006:
- Nearly 2/3rd of Massachusetts residents continue to support the law
- Physician support is even higher at 70%
- Physicians say the quality of care has improved—19%; while 66% are neutral about the impact on quality; only 6% think the law has a negative impact
- Massachusetts has the lowest rate of uninsured in the country
- In 2006, 6.4% Massachusetts residents were uninsured, compared to 1.9% in 2010
- More employers offer insurance—77% today vs. 70% in 2005.
Some Consequences of health care reform:
- Rapid adoption of “global or bundled” contracts that reward physicians and hospitals for quality and efficiency
- Health insurance products allow employers and consumers to use certain lower cost providers
- Stronger incentives exist for hospital systems and physician groups to reduce cost while improving care
- Premiums in the non-group market fell considerably and employer premium rates have risen more slowly in Massachusetts than in the rest of the country
- Employers did not drop their insurance coverage as feared. Since reform, employer sponsored coverage has grown from 64% to 68%.
What the Massachusetts experience tells us is that reform can work, and that it is more likely to work if groups work together. The law was passed when Mitt Romney (R) was governor, but he faced a 2/3 majority of Democrats in both the House and Senate.
There were also several coalitions in Massachusetts at the time, including Massachusetts Business Leaders for Quality Affordable Health Care and Affordable Care Today Coalition of business, labor, faith communities and consumer groups.
In King County, County Executive Dow Constantine has just appointed a Leadership Circle to help with outreach and education for the Affordable Care Act. The three co-chairs are Maud Daudon, CEO, Metropolitan Seattle Chamber of Commerce; Tom Gibbon, MD, External Affairs and Manager, Swedish Community Specialty Clinic; and Gordon McHenry. Executive Director, Solid Ground, a non-profit organization working with low income communities.
Information for this article came from a presentation at Seattle CityClub with presenters including Maud Daudon, CEO Metropolitan Seattle Chamber of Commerce and Phil Edmondson, CEO, William Gallagher Associates and co-founder of Massachusetts’ Affordable Care Today Coalition, and Business Community Participation in Health Reform: The Massachusetts Experience, 2013, pamphlet prepared by Associated Industries of Massachusetts, Massachusetts Business Roundtable, Greater Boston Chamber of Commerce and Massachusetts Taxpayer Foundation.
Price Transparency and Drug Companies
We will be doing a series on one of the initiatives coming out of the Affordable Care Act—price transparency. Under some of the new ‘sunshine’ laws, as reported in The Financial Times, the pharmaceutical industry must start reporting the amount of their spending directed at doctors. The figures were complied by PharmaShine (www.pharmashine.com) for the Financial Times and focus on pharmaceutical companies that paid over 500,000 doctors for entertainment, consulting and research. It does not include the cost of free samples of drugs for patients, or payment to doctors for giving speeches at accredited continuing medical education courses.
These are only preliminary figures as the sunshine law does not require reporting until this August, to be made public by September 2014. Preliminary reports include:
- Payments by medical device companies: $188 million to physicians
- $130 million to physicians in royalties for drugs they helped develop
- Merck paid $27 million to physicians in 2011 and $226 million in 2012
- Eli Lilly paid $225 million in 2011 and $219 million in 2012
- Pfizer paid $170 million in 2011 and $162 million in 2012
Price transparency and hospital bills. And why do the same procedure costs vary so greatly? AARP reported differences in costs, for example, for ER visits. Reported on PLOS ONE—ER for sprained ankle–$4 to $24,110; headache–$15 to $17,797; kidney stone–$128 to $39,408. We will continue to look into this.
Rush Right Out and Read!!
Switch: How to Change Things by Chip Heath and Dan Heath. Why? Because it offers the only compelling case for how we can garner support for health care reform.
Their point is exactly what we heard in our years working with the public on health care reform. Over and over again, we asked people in focus groups, online surveys and in group discussions: “What will it take you to act on health care reform?” To a person their answer was: “Show us what it will look like!”
As a nation we have never done that. We have been locked in dead end ideological debates without offering a vision of what health care could look like that serves families and businesses.
What does Switch advocate: you can’t get change without changing people’s hearts and minds. They use the analogy of riding an elephant—the rational mind trying to harness our emotional responses.
“When people try to change things, they’re usually tinkering with behaviors that have become automatic, and changing those behaviors requires careful supervision by the Rider. The bigger the change you are suggesting, the more it will sap people’s self control. The bigger the change….the more it will sap people’s self control.
“And when people exhaust their self-control, what they’re exhausting are the mental muscles needed to think creatively, to focus, to inhibit their impulses, and to persist in the face of frustration or failure. In other words, they are exhausting precisely the mental muscle needed to make a big change.”
Other points the book makes:
- What looks like laziness is often exhaustion
- When you break to feeling, things change
- Resistance is often a result of lack of clarity
- If you want people to change you need crystal clear direction
As I am fond of saying, no one would have followed Moses unless they were convinced there was a land of milk and honey on the other side. Martin Luther King had a dream, a very specific dream. There was no ‘how’ in his dream. Neither man said how we were going to get there.
Now we have Massachusetts as an example. And guess who is running for Governor? Dan Berwick.
Berwick to Run for Governor of Massachusetts
All we fight about in health care is ‘how.’ What we need is a picture of the possible. We have that now in Massachusetts. We need to reframe the debate around core American values of fair play, equal opportunity, self-reliance and accountability.
Tim Egan on Health Care Reform