Mass Health Access, Cost Term Paper

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[. . .] 2011). Hispanics as a group are still more likely to be uninsured than their non-Hispanic white counterparts in the state, yet the percentage Hispanics that acquired insurance after the legislation was passed was more than twice that of non-Hispanic whites (Maxwell et al. 2011). The Hispanic population is also a fairly reliable predictor of certain economic demographics, and the increased access seen here directly correlates to increased access for those between the income levels necessary to receive Medicare benefits and those that made purchasing private insurance truly affordable.

The affordability of insurance and of care has been a major cause of the improved access experienced under the Massachusetts healthcare reforms, but maintaining adequate levels of medical professionals has also been a key part of the legislation's success. The incremental building on the private insurance system that already existed in the state and the lack of any radical change in the payment systems or compensation levels of physicians and other medical professionals and institutions is in large part responsible for the lack of disruption in levels of medical service. Though predictions of long waits for doctors abounded in the run-up to the actual implementation of this legislation, this has not been evidenced at all in the actual provision of service in Massachusetts (Wilson 2008; Steinbrook 2008; Chen et al. 2011). Overall, access to care has not been dramatically improved by the legislation, but there have been incremental improvements and no significant movements in the other direction.

Costs

A key element of measuring the effectiveness of the new healthcare program in Massachusetts is examining the costs of providing healthcare both before and after the reform s went into effect. Estimating these costs is also, of course, one of the more controversial and disputed elements of this and any other healthcare legislation, and numbers are not at all agreed upon by different measurements and analysts. Even within the first year, it became clear that certain cost estimates were too low, however, and they have unquestionably ballooned since then (Wilson 2008). Cost remains Massachusetts biggest healthcare hurdle.

In provisions similar to what were ultimately included in the federal healthcare reform legislation, Massachusetts set requirements for insurance providers that mandated coverage for individuals with pre-existing conditions at comparable premium rates to individuals without such conditions, without setting any overall premium caps. This led to rapid increases in premium rates for insurance carriers throughout the state, though most premiums are still considered affordable at rates between approximately seven and ten percent of household income, on average (Steinbrook 2008). The affordability achieved despite the increase in premium rates is a function both of the marketplace established by the legislation, which provides easily comparable plans offered by competing insurers, and of the level of government spending that has been appropriated to pay for care or subsidize insurance premiums, which enhances capitation payments overall, providing more cost-effective care and payment plans for physicians and consumers (Steinbrook 2008; Gabel et al. 2008).

Employer contributions to the healthcare system are a major source of revenue for the government-run healthcare options and subsidies, and yet these, too, are considered highly affordable by the employers that pay them (Gabel et al. 2008; Wilson 2008). Current costs for employers that do not offer insurance to their employees are approximately $300 annually per employee at the high end, and most business groups have advocated even higher contributions (Gabel et al. 2008). These funds are used to offer low-cost insurance options to those that cannot afford to purchase private insurance but do not qualify for Medicare.

Quality Assurance

Again, the changes that were wrought via the Massachusetts healthcare reform legislation were primarily in the mandates for insurance possession and the setting up of both a regulated insurance marketplace and a low-cost public insurance option similar in some ways to Medicare (as well as an expansion of Medicare coverage itself). The provision of care itself was not greatly affected, and even the direct compensation methods for physicians and medical institutions was not greatly changed, and thus Quality Assurance was not a major focus or concern of the legislation (Shi & Singh 2011). This is not to suggest that the quality of care provided has not been considered worthy of study, of course, and there have been numerous attempts to ascertain a change in care quality following the implementation of the healthcare reforms, but the results have been generally inconclusive (Chen et al. 2011; Wilson 2008; Steinbrook 2008). As with access to care, there does not seem to have been any significant change in the quality of care prompted by the legislation.

Quality assurance in the insurance industry has been more directly and purposely impacted by this legislation. The creation of the public marketplace for insurance has not impacted the creation of all insurance plans in the state, but the plans offered through the marketplace must all be guaranteed to all applicants and must meet specific guidelines that make them easy to compare (OECD 2008). All insurance plans in the state are also required to provide certain levels of coverage, meaning that the quality of these plans is more assured than in a less regulated system.

Summary and Conclusion

The Massachusetts healthcare reform legislation passed in 2006 and went into almost immediate effect, and in the five years since its inception has had a mixed set of results on healthcare provisions and costs in the state. Health insurance premiums for almost everyone in the state have increased, yet they remain at low enough proportions of average income to be considered affordable; subsidized insurance a public insurance option, and Medicare expansion combined with mandates for insurance coverage have decreased the numbers of uninsured citizens in the state, yet these numbers still remain close to five percent; access to care has improved, but not as much as might have been hoped…the list of less-than-stellar-yet=promising results goes on. Clearly, Massachusetts did not stumble upon a radical cure for the ills of the healthcare system in the United States, nor was the state aiming for such a radical change -- the very essence of the state's healthcare reform package was incremental change and a building up of the market system, not replacing it.

What worked in Massachusetts -- or what appears to be working so far -- might not work for the United States. The insurance mandate and the public marketplace both seem to have created greater affordability of and access to care, however, and as these are both elements of the United States healthcare reform legislation they provide means of predicting what might be expected as results of these reforms. Individual premiums might increase, but overall care becomes more affordable, on the whole.

References

Chen, C., Scheffler, G. & Chandra, A. (2011). Massachusetts' Health Care Reform and Emergency Department Utilization. New England Journal of Medicine 365: e25.

Gabel, J., Whitmore, H. & Pickreign, J. (2008). Report From Massachusetts: Employers Largely Support Health Care Reform, And Few Signs Of Crowd-Out Appear. Health Affairs 27(1): 13-23.

Heslop. K. (2010). How does U.S. healthcare compare to the rest of the world? Guardian. Accessed 15 October 2011. http://www.guardian.co.uk/news/datablog/2010/mar/22/us-healthcare-bill-rest-of-world-obama

Maxwell, J., Cortes, D., Schneider, K., Graves, A. & Rosman, B. (2011). Massachusetts' Health Care Reform Increased Access To Care For Hispanics, But Disparities Remain. Health Affairs 30(8): 1451-60.

OECD. (2008). OECD Economic Surveys: United States 2008. Washington, DC: OECD.

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