Insurance

News on the state's largest health insurers; the effects of health care reform on coverage; rising premium costs.

RECENT POSTS

What Analysts Say About The Mass. Health Law That’s Turning 10

WBUR first started CommonHealth to track a law that had an ambitious goal: health coverage for virtually every Massachusetts resident. It’s been 10 years since that reform effort. To mark the anniversary, we asked a number of health experts to offer their takes on the law. A handful of the commentaries are excerpted below, and links to all the analyses are at the bottom of this post.

Jonathan Gruber, MIT economist (full post here): 

Growth in insurance coverage has been shown repeatedly to lead to improved health outcomes in Massachusetts.

John McDonough, former director, Health Care for All (full post):

Massachusetts carved the path. Still, the work of advancing affordable and quality coverage to all Americans is unfinished.

Nancy Turnbull, associate dean, Harvard T.H. Chan School of Public Health (full post):

You’ve made life better, healthier and more financially secure for hundreds of thousands of people. So celebrate your successes.

But get ready for the challenges ahead: Being a tween is a wild ride!

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On Mass. Health Law’s 10th Anniversary, Here Are 12 Things To Know

Then-Gov. Mitt Romney shakes hands with other political leaders at Faneuil Hall in Boston after signing into law the state's landmark health reform bill on April 12, 2006. (Elise Amendola/AP)

Then-Gov. Mitt Romney shakes hands with other political leaders at Faneuil Hall in Boston after signing into law the state’s landmark health reform bill on April 12, 2006. (Elise Amendola/AP)

Ten years ago today, then-Gov. Mitt Romney signed into law a bill with an ambitious goal: health coverage for virtually every Massachusetts resident. To mark the 10th anniversary, we asked health experts of all stripes to assess the law’s first decade. Links to the commentaries are gathered here and at the bottom of this post. But first, 12 facts and figures:

1. The total number of Massachusetts residents with health insurance grew by somewhere between 441,251 and 590,195 from 2005 to 2015.

The lower estimate, from Nancy Turnbull at the Harvard T.H. Chan School of Public Health, is for residents under the age of 65. The higher estimate, from Sharon Long at the Urban Institute, includes all residents. The last official estimate from the state showed a gain of 439,000 between 2006 and 2011.

2. The percentage of state residents without insurance dropped from 9.6 percent in 2006 to 4.4 percent in 2014, according to the Census Bureau’s Current Population Survey.

The only continuous state-based survey of the uninsured tracks the rate for 19- to 64-year-olds. It dropped from 14 percent in 2006 to 4.3 percent in 2015.

The uninsured rate varies a lot by age (see page 7), including: 0.8 percent for residents 65 and older, 1.6 percent for children and 7.2 percent for 19- to 25-year-olds.

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Mass. Small Business Owners Dropping Health Coverage That’s Become Unaffordable

Ryan Cook wanted to help. The office manager at his small Raynham real estate office needed health insurance; her husband had lost his job and with it, the family’s coverage.

So Cook looked into adding the woman and her family to his self-employed plan. “And I was seeing prices at about $1,800 a month. That cost was ridiculous, quite frankly,” said Cook, president of FCRG, Inc.

Ridiculous, but not a complete surprise, as Cook’s own premiums have increased 50 percent in the last three years.

His office manager tried another option. She applied for subsidized coverage through the state Health Connector and was told she qualified. Her monthly contribution would be $250 a month.

“It just made no sense at that point for me to provide that benefit to my employee,” Cook said.

Cook says many small business owners he talks to at Chamber of Commerce luncheons and other meetings are struggling to stay competitive with larger firms when it comes to benefits.

“The one that everyone is choking on is the cost of health care,” Cook said. “They’d love to be able to offer it but it just becomes so cost prohibitive to the business that you can’t do it.” Continue reading

Ballot Initiative Seeks To Limit Cost Ranges For Medical Care At Mass. Hospitals

In Massachusetts, it can cost you or your insurance company two or three times more to deliver a baby at one of the big Boston teaching hospitals than at small- or medium-size facilities outside the city.

Is this a problem? Should the state try to fix it? That’s what you may have to decide when you vote in the fall. WBUR’s Martha Bebinger explains the issue for Morning Edition.

Related:

Price Of User-Friendly Form Of Overdose Reversal Drug Spikes

Evzio’s “Trainer.” (Jesse Costa/WBUR)

Evzio’s “Trainer.” (Jesse Costa/WBUR)

In the midst of the opioid epidemic, there’s a spike in the price of injectable naloxone, the drug used to reverse an overdose.

Evzio, made by Richmond-based Kaleo, is a user-friendly, pocket-sized device. The wholesale price for a kit was $690 when it hit the market in July 2014. In November 2015, the wholesale price rose to $900. At the beginning of February, it increased 400 percent to $4,500.

Health plans in Massachusetts cover Evzio. It’s “a very important component of dealing with the heroin and opioid epidemic,” said Massachusetts Association of Health Plans CEO Lora Pellegrini. “So it’s really shocking to see these price increases and I’m not sure that they’re justified.”

Kaleo CEO Spencer Williamson says the price hike is justified by the behavior of insurance companies. He has a story that explains what he means.

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U.S. Health Care Is Less Private, More ‘Socialist’ Than You Might Think

The extent of the government's role in health care has become a key issue in the Democratic presidential primary. Here, candidates Hillary Clinton and Bernie Sanders are seen in a debate on Jan. 17 in Charleston, S.C. (Mic Smith/AP)

The extent of the government’s role in health care has become a key issue in the Democratic presidential primary. Here, candidates Hillary Clinton and Bernie Sanders are seen in a debate on Jan. 17. (Mic Smith/AP)

By Richard Knox

Readers, a pop quiz:

The proportion of U.S. health care paid by tax funds is (a) less than 30 percent, (b) about half or (c) more than 60 percent.

If you picked “more than 60 percent,” you’re right — but you’re also pretty unusual.

“Many perceive that the U.S. health care financing system is predominantly private, in contrast to the universal tax-funded health care systems in nations such as Canada, France or the United Kingdom,” David Himmelstein and Steffie Woolhandler write in a new analysis of U.S. health spending in the American Journal of Public Health.

They find that 64.3 percent of U.S. health expenditures are government-financed. And they project the tax-supported proportion will rise to 67.1 percent over the coming decade as the baby boom generation ages and retires — nearly as high as Canada’s 70 percent.

“We are actually paying for a national health program, we’re just not getting it,” Woolhandler says.

tax dollars for U.S. health spending

Now, Himmelstein and Woolhandler have an agenda. For decades, they’ve been perhaps the leading researchers promoting the kind of single-payer health system that Socialist and Democratic presidential candidate Bernie Sanders has put on the debate agenda. One recent poll suggests more than half of Americans (and 30 percent of Republicans) support the idea.

But even if you disagree with the Himmelstein-Woolhandler ideology, their research is generally regarded as sound, and their method is straightforward.

They added up what federal and state governments spend on health through Medicare, Medicaid, the Veterans Health Administration, government employees’ health care premiums, tax subsidies and other programs. They argue that accounting by government agencies (the Center for Medicare and Medicaid) undercounts the real tax burden because it leaves out major pieces of the pie — such as government employees’ care ($156 billion a year) and tax subsidies for private, employer-sponsored coverage (nearly $300 billion).

And whatever you think about Medicare-for-all, it’s a good idea to see the present U.S. health care system for what it is — an increasingly government-funded financing scheme. Continue reading

Options Weighed To Address State’s Health Care Price Variations

Updated 6:50 p.m.

BOSTON — Variations in prices for the same service at different hospitals in Massachusetts do not reflect different qualities of care and have not evened out over time, according to a Health Policy Commission report released Wednesday.

The report found that higher prices “are not generally associated” with better care, and that prices vary across the different types of hospitals — academic medical centers, teaching hospitals, community hospitals — as well as within each individual group.

To highlight the difference in costs just at community hospitals during a Wednesday meeting, Health Policy Commission executive director David Seltz pointed to levels of spending on maternity care. Spending for a low-risk pregnancy ranged from $16,000 at North Shore Medical Center to $9,000 at Heywood Hospital.

“While some variation in prices is warranted to support activities, unwarranted variation in prices — combined with a large share of volume at those higher-priced institutions — leads to higher spending overall and inequities in our distribution of resources,” Seltz said.

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