Massachusetts Health Initiatives: 30 Years of Change

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. In fact, "universal reforms" began in 1988, with a sweeping employer mandate law.  That law was postponed twice and then quietly repealed as part of the Massachusetts first-in-the-nation children's health law signed in 1996. One year later that state law became the template for the passage of the federal CHIP program.

As a result of national and in-state interest, 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 MASSACHUSETTS HEALTH REFORMS

  • 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.
  • 2016 Massachusetts Employer Survey. "Sixty-five percent of Massachusetts employers offered health insurance, which was higher than the national offer rate of 56%, and offer rates were lowest among firms with 3 to 9 employees at 48%." Released by CHIA, 3/30/2017.

     

     

    2017 Proposals to Cap State Medicaid Funding: Massachusetts Considerations.  -The Blue Cross Blue Shield of Massachusetts Foundation, is releasing a chart pack, Proposals to Cap State Medicaid Funding: Massachusetts Considerations. This chart pack, developed by Manatt Health, was commissioned by the Foundation for the Massachusetts Coalition for Coverage and Care. The coalition, co-chaired by the Foundation and Health Care For All, is a broad array of Massachusetts organizations. Download the chart pack (PDF)- 3/10/2017 *NEW*

    2016 Employer offer health insurance
  • Annual Report on the Performance of the Massachusetts Health Care System: 2015 - includes a calculation of the 0214 and 2013 Total Health Care Expenditures (THCE), a measure of total statewide health care spending in the Commonwealth.  It was $54 billion in 2014, or $8,010 per capita, representing a 4.8% increase from 2013. The report also includes information from public and private sources related to specific health care expenditures for Massachusetts residents, quality of care in the Commonwealth compared to national performance, enrollment and coverage trends, premiums and member cost-sharing, and payer use of funds. Spending for Medicaid (MassHealth) increased by $2.4 billion (+19%), while enrollment increased by 23%. Read full 2015 report at www.chiamass.gov/  Sept. 2015.
    > News Analysis: Health Care Spending In Massachusetts Rises Faster Than State’s Goal [Read the article] WBUR, Sept 4, 2015. http://khn.org/news/health-care-spending-in-massachusetts-rises-faster-than-states-goal/
  • Mass. State senators unwrap sweeping health care reform package- Oct 2017  *UPDATED*
    A wide-ranging proposal unveiled by Massachusetts Senate leaders Tuesday to revamp the state's health care system establishes the now-familiar goals of lowering costs and providing residents with access to first-rate care regardless of where they live and how much they earn. The more than 100-page bill was filed amid continued uncertainty in Washington over the future of federal health care policy, including the fate of billions of dollars in Medicaid reimbursements and subsidies for people who buy insurance through state exchanges such as the Massachusetts Health Connector. The legislation aims to squeeze out between $475 million and $525 million in overall health care savings by 2020. Read full article by AP, 10/17/2017

  • Reconciling the Massachusetts and Federal Individual Mandates for Health Insurance: A Comparison of Policy Options.  - Published November 5, 2012 by BCBSMA Foundation.  Full text: Reconciling the Massachusetts and Federal Individual Mandates for Health Insurance: A Comparison of Policy Options.  -pdf format of    2011 Health Care Cost Trends and Cost Drivers Report

  • The National Network of Public Health Institutes (NNPHI) and Health Resources in Action (HRiA) presented a case study, Universal Health Insurance Access Efforts in Massachusetts: Lessons Learned for Public Health Systems across the United States. The case study explores the health reform law in Massachusetts that transformed the state's health insurance landscape, expanded public programs, and impacted the public's health through a variety of other provisions. This research, published January 2014, has culminated in three reports and a Sept. 2014 Webinar:
    Universal Health Insurance Access Efforts in MA: A Case Study Lessons Learned for Public Health Systems across the U.S. 
    Universal Health Insurance Access Efforts in MA: A Literature Review
    Universal Health Insurance Access Efforts in MA: Comprehensive Report of Qualitative Findings 

  • Health Insurance Coverage and Health Care Access and Affordability in Massachusetts: Holding Steady in 2013  
    The Massachusetts Health Reform Survey (MHRS), funded by the Robert Wood Johnson Foundation and the Blue Cross Blue Shield of Massachusetts Foundation, provides an important new baseline against which to compare the results of the implementation of the Affordable Care Act (ACA), whose major provisions began in 2014. Findings highlight the state's ongoing success at maintaining near universal health insurance coverage and high levels of health care use, as well as the continued need to address the burden of health care costs.
    Five-page summary report | Full narrative report | Chart pack. Published bythe Urban Institute, 11/25/2014   

  • Massachusetts Health Reforms: Uninsurance Remains Low, Self-Reported Health Status Improves As State Prepares To Tackle Costs. Massachusetts is in its sixth year of a reform initiative that provided the template for the federal Affordable Care Act of 2010. This Health Affairs article reports on the status of health reform in Massachusetts as of 2010, providing an early indication of potential gains and challenges under national reform.  Published in Health Affairs: by Sharon Long, Karen Stockley, Heather Dahlen.  January 2012.
  • 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 (pdf format of    2011 Health Care Cost Trends and Cost Drivers Report  45 pages; 1.3MB) |  Presentation on Mass. Health Reform  |  Presentation on Health Reform and Health Inequities pdf format of    2011 Health Care Cost Trends and Cost Drivers Report

  • 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 coverage rose, even as coverage declined nationally.  The Massachusetts experience illustrates why employers contemplating benefits changes 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. (pdf format of    2011 Health Care Cost Trends and Cost Drivers Report  6 pages;)

  • 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.  Commonwealth 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

2016: Health Care Hospital and Facilities Pricing bill signed into Law

 

Health care pricing panel starts work with split views. The first meeting of a special commission assembled to study price variation showed that reaching consensus won’t be easy. Article by Boston Globe, 9/14/2016


HEALTH COST CONTAINMENT AND SPENDING TRENDS

§ 228(a): Prior to an admission, procedure or service and upon request by a patient or prospective patient, a health care provider shall, within 2 working days, disclose the allowed amount or charge of the admission, procedure or service, including the amount for any facility fees required; provided, however, that if a health care provider is unable to quote a specific amount in advance due to the health care provider’s inability to predict the specific treatment or diagnostic code, the health care provider shall disclose the estimated maximum allowed amount or charge for a proposed admission, procedure or service, including the amount for any facility fees required.
     (b) If a patient or prospective patient is covered by a health plan, a health care provider who participates as a network provider shall, upon request of a patient or prospective patient, provide, based on the information available to the provider at the time of the request, sufficient information regarding the proposed admission, procedure or service for the patient or prospective patient to use the applicable toll-free telephone number and website of the health plan established to disclose out-of-pocket costs, under section 23 of chapter 176O. A health care provider may assist a patient or prospective patient in using the health plan’s toll-free number and website.

  • 2018: How States Can Control Health Care Costs
    State policymakers want to know how to control health care costs. To find out more about how Massachusetts did it, we asked David Seltz, executive director of Massachusetts’s Health Policy Commission, six questions about how the state addressed health care costs and, in particular, established a state health care cost growth target in statute.  A dialogue from the Milbank Fund, 4/30/2018 *NEW*
  • 2017 Update: Signalling A Firmer Line, Mass. Sets 3.1 Percent Limit On Health Cost Increases. "A panel of state appointed experts charged with curtailing rising fees voted (3/29/2017)  to allow no more than a 3.1 percent increase, setting the stage for the state to become more active in forcing the medical market to keep costs down. Last year's benchmark was 3.6 percent. (News from WGBH, 3/30/2017)

  • 2014 Report: The Center for Health Information and Analysis (CHIA) is the state entity that monitors a wide variety of health system indicators in Massachusetts.  CHIA's most recent analysis – The 2014 Annual Report on the Performance of the Massachusetts Health Care System – includes a first-ever calculation of the Commonwealth’s Total Health Care Expenditures (THCE). THCE is a measure of total statewide spending for health care in Mass. The report includes specific health care expenditures for Massachusetts residents from public and private sources. 

    Key Findings: In 2013, the Massachusetts health care system performed favorably on a number of indicators. Notably, the overall per capita growth in Total Health Care Expenditures (THCE) was below the Commonwealth's 2013 health care cost growth benchmark. Furthermore, commercial premium levels and member out-of-pocket cost-sharing did not increase from 2012, while benefit levels remained steady.

    2014 Annual Report on the Performance of the Massachusetts Health Care System (PDF) pdf format of chia-annual-report-2014.pdf
 - published September 2014

  • Mass. Releases First Report on the Massachusetts Health Care Market.  2013 Annual Report on the Massachusetts Health Care Market. The report, mandated by the Commonwealth’s 2012 health care cost-containment law, examines trends in the commercial health care market between 2009 and 2011, including changes in premiums and benefit levels, spending and retention, and market concentration.  Published by the state's Center for Health Information and Analysis (CHIA), August 14, 2013.
  • 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:  Premiums and Expenditures (PDF) pdf format of    premiums-and-expenditures.pdf  file size 1MB | Premiums and Expenditures Appendix A (PDF) pdf format of    premiums-and-expenditures-appendix-a.pdf  | Excel  | Premiums and Expenditures Appendix B. Data and Methodology (PDF) pdf format of    premiums-and-expenditures-appendix-b.pdf  | Word
  • In Pictures: 15 Facts Pres. Obama Needs To Know About Mass.'s Healthcare Reform - Pioneer Institute,10/29/2013

  • ACA Comes to Massachusetts: Post #1: 40% Premium Increase and Higher Co-pays On the Connector - Pioneer Institute, 10/28/2013

  • Efficiency of Emergency Department Utilization in MassachusettsAs 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.  
    Efficiency of Emergency Department Utilization in Massachusetts (PDF) file size 1 MB | Word  |  Published August 2012 by the Mass. Center for Health Information and Analysis

  • 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. pdf format of    2011 Health Care Cost Trends and Cost Drivers Report  file size 1MB

  • 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 pdf format of    2011 Health Care Cost Trends and Cost Drivers Report

  • 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 Servicespdf format of    2011 Health Care Cost Trends and Cost Drivers Report


AFFORDABLE CARE ACT (ACA) IMPLEMENTATION IN MASS.

Mass. firms mull cuts in health benefits; Fear rising costs under new US law  - Link to Sept. 02, 2013 Article (c) Boston Globe
    Among the primary concerns for companies with fewer than 50 employees is that the federal law requires Massachusetts to dismantle its own insurance rating system that allowed insurers to consider about 10 factors in setting the rates for small businesses.  The federal law mandates that insurers use only four rating factors — age, number of family members, geographic area, and tobacco use — and does not take into account the size of the company, a change that small businesses fear will drive costs up by more than 50 percent.  The federal government has agreed to allow Massachusetts to phase in the change over three years, but the Bay State business community, as well as the Legislature, will continue seeking a federal waiver.  (c) Globe  Read full article (may require password or subscription)
 
MARIJUANA LEGALIZATION IN MASSACHUSETTS
A marijuana contingency plan for the Legislature - [read full article, Boston Globe 4/2/2015
Senate President Stanley Rosenberg asked Sen. Jason Lewis to take on a months-long study of marijuana policies in reaction to a bill and a widely expected 2016 ballot measure seeking to legalize its recreational use. The committee will not address whether Massachusetts should legalize recreational use of marijuana. Instead, Lewis has been charged with examining the hundreds of judgments and decisions lawmakers may need to make if full legalization of marijuana is approved. 
 
Exchanges: Quote of the Season

"It's criminal, frankly, that [investment in exchange platforms and their maintenance and upgrades] is where [exchanges] are spending so much of their budget, when the crying need is to go out and do the marketing and find people who need the coverage. According to the Urban Institute, there are 7 million subsidy-eligible uninsured still out there. The exchanges have reached only about 60% of subsidy-eligible uninsured."

Jon Kingsdale, Ph.D., the founding executive director of Massachusetts' Commonwealth Health Insurance Connector Authority in 2006 and now a director at Wakely Consulting Group's Boston office, told AIS's Inside Health Insurance Exchanges. April 2016