Massachusetts has become such a bellwether for health reform that every report analyzing the program’s outcomes is eagerly anticipated. A survey reported in a recent Health Affairs issue (Health Affairs Article) looks at some of the results as of the fall of 2008. The results were based on interviews with adults from just before implementation, in the fall of 2007 and in the fall of 2008. The authors acknowledged being unable to separate the influence of the reform measures from the general economic conditions during this period of time. Notwithstanding the severe recession, the number of uninsured persons in Massachusetts continues to be extremely low, around 2.5%. That is a major and important accomplishment.
More respondents had a regular place to go for medical advice and care after reform and more were likely to have had a doctor visit in the previous year. On the other hand, more people, especially low income individuals, reported having difficulty getting an appointment with a physician. Consequently, emergency rooms continued to be used frequently for non-emergency purposes. In addition, although they now have coverage, many adults continue to report difficulty in paying for medical care, again particularly low income adults. Even modest copays or deductibles can apparently be a significant problem for many individuals and families.
The report does not discuss the cost issues related to the reform program. The costs have been much higher than the state originally anticipated and especially with the recession in full swing, difficult efforts are being made to close the funding gap. The state is considering substantial changes to how providers are paid as a method of not only handling the current deficit but limiting costs in the future. The consequences of such changes are truly unknown; they might cause even more difficulty in finding physicians to work in the state or they may change how physicians and hospitals treat patients in unanticipated ways. As the article points out, the critical lesson for national reform efforts is that while you can get more people covered, figuring out how to pay the costs and to keep them under control is not easy.