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Massachusetts Health Initiatives: 25 Years of Change
In This Resource Report
Related Resources
The Bay State has tried health reforms for a wide variety of goals. Several have attracted nationwide attention.
Published/Updated April 2013
Ever since the Massachusetts legislature enacted the nation's most far-reaching, comprehensive health reform law in April of 2006, there has been a great deal of interest and attention to how and why, and what are the actual results including coverage, costs and cost savings.
As a result, there are a number of recent and detailed studies, surveys and reports that illuminate these goals laws and results. The items listed below are among the more informative to state-based policymakers. NCSL also can provide contacts for in-state information if needed.
OVERVIEW OF HEALTH REFORM
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Massachusetts Law: St. 2006, chapter 58. An Act Providing Access to Affordable, Quality, Accountable Health Care. The Massachusetts Mandated Health Insurance Law. Added MGL c.111M and amended many other sections. Key provisions of the law include subsidized health insurance for residents earning less than 300% of the Federal Poverty Level, and low-cost insurance for all other residents who are not eligible for insurance through their employers, using the HealthConnector as a statewide marketplace for obtaining affordable insurance.
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Massachusetts Health Reform in Practice - Mass-Care, the single-payer advocacy organization, has published a comprehensive analysis of the 2006 Massachusetts health reform law, including its successes and its shortcomings. Full text: Report: Mass Health Reform in Practice ( 45 pages; 1.3MB) | Presentation on Mass. Health Reform | Presentation on Health Reform and Health Inequities
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A closer look: The Massachusetts Experience: Employer-sponsored health insurance post reform. More than seven years after Massachusetts enacted its health reform law, data from the state reveal that employer health coveragerose, even as coverage declined nationally. The Massachusetts experience illustrates why employers contemplating benefitschanges ought to consider a range of factors including recruitment and retention, absenteeism, tax implications along with the influence of an individual mandate. Report by PriceWaterhouse, May 2013. ( 6 pages;)
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Mass. health insurance exchange enrollment hits record high - In March 2013, 201,178 state residents were enrolled in Commonwealth Care, the program created by Massachusetts’ pioneering 2006 health care reform law to provide subsidized coverage to the lower-income uninsured. The March Commonwealth Care enrollment was 2,900 higher than February and nearly 28,000 higher compared with March 2012. The enrollment figures were reported April 11, 2013 by the Massachusetts Health Connector, which administers Commonwealth Care and a second exchange, Commonwealth Choice, which offers unsubsidized coverage to individuals and employers with up to 50 employees.
Enrollment surged since last May, when state officials amended eligibility requirements to comply with an earlier Massachusetts Supreme Judicial Court ruling that struck down a 2009 law that had barred certain legal immigrants from the program. Under the measure passed during the Great Recession to save the state money, legal immigrants who had lived in the United States for less than five years no longer were allowed to enroll in the state’s Commonwealth Care program. Instead and as a result of the court ruling, about 25,000 legal immigrants were allowed to enroll in a new state program, Commonwealth Care Bridge, that offered less generous coverage and required higher premiums than the regular Commonwealth Care program. Commwealth Care is available to uninsured state residents with incomes that are less than 300% of the federal poverty level. The Commonwealth Care program has helped Massachusetts achieve the lowest uninsured rate — 3.4% in 2011 — of any U.S. state, according to the U.S. Census Bureau. [4/11/2013 - Massachusetts Connector Board] [Reported in Crain's Business Journal]
Reports in Detail
HEALTH COST CONTAINMENT AND SPENDING TRENDS
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Premiums and Expenditures (in Massachusetts.) Multiple studies have shown that health insurance premium costs in Massachusetts and the Northeast region are among the highest in the nation, placing a substantial burden on consumers and employers seeking good value for their spending on medical services. In 2010, Massachusetts had among the highest premium level (9th highest in this report) for family coverage among all 50 states and the District of Columbia. In 2011, the Northeast region had the highest premiums of any region across all plan types. Understanding the factors that influence premiums in Massachusetts and how those premiums are changing over time will help policymakers address rising costs with effective solutions. Published May, 2012 by the Mass. Center for Health Information and Analysis, Mass. Dept. of Health & Human Services. Full text:
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Efficiency of Emergency Department Utilization in Massachusetts. As health care costs continue to rise in Massachusetts and across the United States, policymakers are interested in finding ways to make health care system more efficient. As a major component of the health care delivery system, emergency departments (ED) are intended to provide critical services to patients in need of immediate medical attention and sometimes life-threatening conditions. Health care resources are utilized inefficiently and inappropriately when patients seek care at the ED for conditions that are non-emergent, treatable in primary care settings, or avoidable. The objectives of this report are to describe the trends of ED visits and costs in Massachusetts, examine the magnitude of inefficient ED utilization, and investigate various factors behind the ED trends, including the leading clinical conditions and characteristics of ED users. The total volume of outpatient ED visits reached 2.4 million in Massachusetts in FY 2010, which was almost three times more than the total number of inpatient discharges. The preventable/avoidable ED visits accounted for 49 percent of the total ED volume, where non-emergent visits accounted for 23 percent, emergency but primary care treatable visits accounted for 21 percent, and emergency but preventable visits accounted for 6 percent.
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Preventable Hospitalizations (in Massachusetts). Identifying and quantifying inefficiencies in the health care system can assist policymakers in developing interventions that increase value by lowering costs and improving quality. Hospital costs account for the largest proportion of overall health care expenditures, both nationally and in Massachusetts. Measures of potentially preventable hospitalizations estimate the prevalence of an expensive yet poor outcome that may have been avoided if patients had better access to primary and preventive care, chronic disease management services, or an integrated health system that treats patients in the most efficient care setting. Preventable Hospitalizations. file size 1MB
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Health Care Costs and Spending in Massachusetts: A Review of the Evidence This comprehensive chart pack pulls together many of the major findings and analyses from recent state and national research efforts including reports by the Massachusetts Division of Health Care Finance and Policy, the Massachusetts Attorney General’s Office, as well as analyses by the Centers for Medicare and Medicaid Services and the Dartmouth Atlas of Health Care. The chart pack features data and complete references on topics such as Massachusetts health care spending trends, cost drivers, variations in pricing as well as key differences between Massachusetts and the U.S .- March 2012.
> Health Care Costs and Spending in Massachusetts: A Review of the Evidence as a PDF file
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2011 Report on Health Care Cost Trends and Cost Drivers (Massachusetts). Released August 3, 2011 by the Mass. Center for Health Information and Analysis, Mass. Dept. of Health & Human Services. Full text: 2011 Examination of Health Care Cost Trends and Cost Drivers Pursuant to G.L.c 118G, § 6 1/2(b) (Full with Appendix - PDF) file size 1MB
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Premium Levels and Trends in Private Health Plans: 2007-2009. - The report discusses enrollee demographics in the Massachusetts commercial markets, trends in premiums paid by employers and consumers for health insurance, the medical expenses and retention charges included in those premiums, and the impact of premium trends on the health insurance purchasing decisions of employers and individuals. Published 2011 by Mass. Dept. of Health & Human Services. Full text: Premium Levels and Trends in Private Health Plans: 2007-2009
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Price Variation in Massachusetts Health Care Services. - The report examines the prices paid by private health plans for commercially insured members in three service categories: inpatient hospital care, outpatient hospital care, and physician and other professional services. In each category, a sample of high-volume health care services was selected to maximize comparability across providers. Published 2011 by Mass. Dept. of Health & Human Services. Full text: Price Variation in Massachusetts Health Care Services
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