Monday, August 3, 2009

Trouble in Massachusetts

The Massachusetts 2006 health reform is a model for national reformers: Implement an individual obligation to get insurance, expand the social safety net for low-income people, develop a mechanism for making it easier for people to compare plans and purchase insurance on the individual market, and pay for it all with new taxes.

It has succeeded in its basic objective of lowering to near zero its rate of uninsured citizens. It's struggling on every other measure. And now one of Boston's major providers of care to the poor is suing the state, arguing it is owed $127 million.

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One problem: There are too few physicians in the state to provide services effectively to all of the newly insured, even though Massachusetts is one the most physician-dense states in the union and it's pre-reform uninsured rate was among the nation's lowest.

Second problem: A plurality of the state's formerly uninsured say they've been more harmed by the mandates and expenses of the new system than helped by its services and subsidies. Something's amiss when the main beneficiaries of a new service say they were better before.

Third problem: The state is now having trouble paying for its largesse and has been looking for cuts. Hence the lawsuit by Boston Medical Center, a major provider of services to Medicaid patients.

Massachusetts got most everyone covered. Now it is finding that access to insurance is not the same thing as access to healthcare.

1 comment:

  1. So in the pre-reform era you are uninsured and develop abdominal pain. You go to an ED, get a CT and find you have a bad gallbladder, have surgery, get some nice narcotics and food for a week and sent home feeling better than you ever have felt. You ignore every bill (how in the world could you possibly pay a $2,000 surgeon bill or $18,000 hospital bill and a $50 a month payment plan will be laughed at.) Same thing for a headache, sore toe, trouble sleeping, erectile dysfunction, etc because the law says the ED can't turn you away.
    Now post-reform you have to pay monthly for insurance, you can't just walk in the ED and get care ("You mean I have to actually call ahead to get my sore throat checked???") and you have to pay $5 to be seen (that's a pack of smokes!).
    Along comes a survey guy..."are you better off now?" "Heck no!"