In an Intensive Care Unit. (US Navy, Wikimedia Commons)
Figuring out the effects of having health insurance on people’s actual health must be a long-term game. Here in Massachusetts and elsewhere, greater access to insurance is expected to translate only gradually into better health outcomes.
But in an Obamacare season when everything that happens here holds the prospect of being multiplied by 50, here’s an interesting new data point: Initially, at least, the rise in insurance coverage in Massachusetts did not seem to translate into a rise in Intensive Care Unit use. But it also did not translate into a drop in ICU deaths. Why not? Shouldn’t better access to health care translate into fewer health crises and fewer ICU deaths? From a University of Pennsylvania press release:
While the study found no difference in mortality rates between ICU patients in Massachusetts and the four non-reform states, it determined that ICU-patient mortality rates remained the same in Massachusetts after health care reform was enacted — confounding expectations that earlier access to care might lower ICU death rates. Although previous studies demonstrated that lack of health insurance is associated with increased mortality in critical illness, it could be that lack of health insurance may coincide with other socioeconomic factors, such as unemployment or underemployment and poverty, and that acquiring health insurance does not counteract the negative impact of these factors.
Additionally, according to a recent study of Medicaid expansion, reductions in adjusted all-cause mortality were not apparent until five years after the policy change. Continue reading
The Beacon monument on Beacon Hill (Swampyank on Wikimedia Commons)
Yes, we in Massachusetts can sometimes sound a bit know-it-all-ish about health reform, what with our early experience with near-universal coverage and all. Before he signed the latest health reform bill into law on Monday, Gov. Deval Patrick began with a proud litany of the many ways that residents of Massachusetts are ahead on health care — there’s just no place else like it, he said.
We here at CommonHealth are guilty, too. Our “About This Site” section below even begins, “Massachusetts is the leading laboratory for health care reform in the nation.” But a new report just out from the Beacon Hill Institute at Suffolk University suggests that perhaps we should be a bit less provincially, pridefully myopic. (The institute is “grounded in the principles of limited government and fiscal responsibility,” and judging by recent headlines of its studies, it tends to be quite critical of the Massachusetts reform model.)
The report reviewed several health-reform policies in other states and concludes that there is much worth emulating, particularly when it comes to better serving consumers. From the press release:
BHI reviewed several consumer driven policies from others states. These include establishing Health Savings Accounts (Indiana and Georgia), eliminating the tax bias in favor of employer sponsored health plans (Missouri) and reforming guaranteed issue and community rating (Maine). The paper, entitled “Lessons for Massachusetts from State Health Care Reforms in Other States: What Chapter 58 Missed” also suggested that following Medicaid Reform in Florida and tort reform along the lines of Mississippi and Texas.
The study also examined Utah Exchange, that state’s private alternative to the Massachusetts Connector. The Utah Exchange offers high deductible plan choices which lowered overall premium costs rather than the more stringent ‘seal of approval’ plans vetted by the Connector.
The full study will be available on the Beacon Hill Institute’s Website. I just tried the link in the upper right of the homepage but it doesn’t seem to be live yet.
98% of Massachusetts residents have health insurance. That number, a result of the state’s 2006 health coverage law, has been more or less the same for the last two years. It is confirmed in the latest report from the Patrick administration.
Key Indicators: Quarterly Enrollment Update, June 2011 Edition, Released in February 2012 (Division of Health Care Finance and Policy, Commonwealth of Massachusetts)
What’s new is that the state now says 98% is as good as it gets. From the same report:
“Massachusetts may have reached maximum insurance levels based on existing demographics and health insurance characteristics.”
Let’s break that down. The Patrick administration says “existing demographics” refers to illegal immigrants who don’t qualify for health coverage. “Health insurance characteristics” refers to residents who receive a waiver because they can’t afford insurance and those who cycle in and out of coverage through their employer or a government insurance plan.
The administration points out that among the 98% covered, 99.8% of children in Massachusetts have insurance. The office of Health and Human Services spokeswoman Jennifer Kritz said:
“We serve as a national model for coverage expansions, because we’ve worked hard to make insurance more affordable and accessible. Massachusetts has attained the near-universal coverage envisioned in our 2006 law. We are hopeful that cost containment measures now being debated and the implementation of federal reform will make insurance affordable for even more Massachusetts residents.”
Some public health advocates urge the state not to give up at 98%. They say: Continue reading
From the Massachusetts Against the Mandate Webpage
By Martha Bebinger
If you chafe against the Massachusetts requirement that you have health insurance, sorry but you won’t have a chance to vote against it — not in the next election, anyway.
Backers of a ballot measure to repeal the state’s insurance mandate sent out an email last week saying they had failed to gather the needed signatures. (Points to policy-types-turned-crack-reporters Brian Rosman of Health Care for All and John McDonough of Harvard for reporting that development here and here.)
The ballot initiative’s organizers say their bid to derail the individual mandate failed because supporters were torn.
One group, those involved with Massachusetts Citizens for Life, worried about dividing their efforts between two ballot questions next year, one that would allow assisted suicide and one that would repeal the insurance mandate. In the end, fighting the assisted suicide question won.
In addition, conservative backers “were very concerned that this would make Mitt Romney look bad, and as they support him in the primaries they didn’t want to sign on to this, or donate to it or work for it” says Bridget Fay with Massachusetts Against the Individual Mandate. Continue reading
Thump thump thump. That’s the sound of the Boston Herald patting itself on the back on Thanksgiving, over this undeniably excellent news: Lauren and Nick Destito will not, in the end, have to pay a fine for having shoddy health insurance. Read the full Herald story here, including:
Weeks after the Herald chronicled the couple’s financial nightmare, there’s a very happy ending, thanks to her vigilant state representative, U.S. senator and the Herald, Destito said.
Herald columnist Margery Eagan reported on Oct. 18 that the Plainville couple, both 50, already bankrupt and behind on their mortgage, faced a $3,000 fine because their insurance didn’t meet the minimum standards established under Massachusetts health reform.
The case went immediately national, wielded by Newt Gingrich against Mitt Romney in a Republican presidential debate. It looked like it had the sympathy factor to become a widely cited example of how requiring virtually everyone to have health insurance could hurt people already knocked down by the recession.
This CommonHealth post added some context from the Connector, the agency that helps Massachusetts residents shop for and obtain health insurance — including the point that more than 60 percent of the residents who appeal their penalties, as the Destitos did, win their cases.
Connector spokesman Richard Powers in the Herald story: ““Health reform is about insuring people, not penalizing them.” From the Connector: Continue reading