“BOSTON, MA - Two years after the implementation of a health care reform law aimed at providing health coverage for nearly all Massachusetts residents, public support for the law remains high. According to a new poll by the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation, over two-thirds (69%) of Massachusetts residents support the law... compared to 67% in 2007 and 61% in 2006”
“Because of Governor Romney's leadership, the number of uninsured in Massachusetts has been slashed in half over the last year. His conservative, free-market reforms have brought down the cost of health insurance premiums and made healthcare more affordable for residents across the state. For the first time in the history of the Commonwealth of Massachusetts, hundreds of thousands of the low-income uninsured citizens have access to a choice of different private health insurance plans. And all of this was accomplished without any new taxes”
"It may be that this tale from Massachusetts reveals what kind of President Romney could be. ''He was incredibly impressive, with his intellect, his ability,'' says MIT economics professor Jonathan Gruber, a Democrat who advised Romney... ''If there is anything that qualifies him to be President of the United States, it is his leadership on this issue.''
"Comparatively speaking, the health-care situation in Massachusetts wasn't all that dire when Romney took office... But with a third of the state budget going toward health care, the sheer inefficiency of treating the sore throats of the uninsured in emergency rooms didn't sit well with the businessman in Romney...
"Meanwhile, religious groups and health-care advocates were pushing their solution: a liberal universal-health-care ballot initiative that would raise taxes. And the picture was about to get significantly worse: Health and Human Services (HHS) Secretary Tommy Thompson was threatening to take away $385 million a year in Medicaid money. The more the Governor thought about health care, the more intrigued he became by the idea of making it work better.
"That whiff of a challenge was reinforced by the stories Romney heard as he traveled the state. After talking to a jeweler in North Andover, a man about his age, Romney remembers thinking, ''Gosh, he's 55. He could have a heart attack. He could get cancer. He's got his own business, but he doesn't have health insurance? How can this be?''...
"When they considered the situation as if it were a business-school case study, some simple steps became clear...
"In November 2004, ... Romney was finally ready to go public with the beginnings of a plan. As it evolved, it became a proposal to achieve an end that liberals had long dreamed of, but through conservative means: creating more competition in the private-insurance marketplace and insisting that Massachusetts citizens take personal responsibility for their own coverage. ''From the minute you heard him articulate it, you knew this was a new concept in American health-care policy,'' says Robert Blendon, a Harvard University professor of health policy. ''It was a very different way of talking about coverage, and he was very articulate in framing it.''...
“... We've got over 20 states now that are trying to copy what he did, and that's a good sign that people think he's on the right track.”
"The bill that emerged from the legislature two weeks later was different in many respects from what Romney had initially proposed... There were far too many requirements placed on insurance companies for Romney's tastes, and he used his line-item veto on the bill's stipulation that employers who don't cover their workers pay $295 per employee each year into a fund to subsidize coverage. The lawmakers easily overrode it".
Dec 4, 2005: "Here is how it would work. Massachusetts now spends about $1 billion a year to provide emergency health care for at least 500,000 uninsured citizens. About 200,000 of those are young people, predominantly male, who are making enough money to buy health insurance but figure they don't need it. They would be required to buy a relatively inexpensive health insurance policy, with higher deductibles and co-pays--that's where the ''mandate'' comes in. Another 100,000 are extremely poor people who are eligible for Medicaid; a concerted effort would be made to bring them into the system.
"The remaining 200,000 are the people who have been most neglected by the system in the past: the working poor, people who have low-end service jobs or work part time for employers who don't offer health coverage. Romney's gamble is that Massachusetts can take the $1 billion it spends on the uninsured and use it to subsidize coverage for the working poor. . . ''Our plan would cost the poorest eligible families only about $2 per week in premiums,'' Romney said.
" ''The more you earn, the more you pay.'' Sounds simple enough. So why hasn't it been tried before? Because interest groups on the left and right hate the idea. Conservatives don't like the mandatory part: if a 28-year-old software designer doesn't want to buy health insurance, why should the government force him to do so? Simple answer: fairness. The rest of us pay for it now when he drives his motorcycle into a tree and runs up a huge medical bill... On the left... Some favor a government-funded system like those used in Canada and Europe. Others, realizing that socialized medicine just won't fly in the U.S., support an ''employer mandate'' similar to the program that Clinton proposed in 1993."
Those who want to create a consumer-based health system and deregulate health insurance should view Romney's plan as one of the most promising strategies out there. I know, because I've been part of the Heritage Foundation team advising the governor and his staff on the design, which builds on some of my work with officials in other states.
The overall design has two basic parts: reforming the state's insurance market structure and reforming its uncompensated-care payment system...
The Romney approach is ... a state health-insurance exchange ... exactly what stock exchanges do for the buying and selling of securities. Like a stock or commodity exchange, Romney's health-insurance exchange would be a clearinghouse but never a product regulator.
The exchange would be a single place where a small employer could send its workers to buy coverage, paid for with a defined contribution from the employer. For workers, it would be a "marketplace" in which to choose the plans that best suited them and which they could keep as they moved from job to job. Furthermore, the exchange is designed to ensure that premium payments by both employers and workers can be made on a pre-tax basis.
Such an exchange offers numerous advantages. For example, a two-earner couple could combine contributions from their respective employers to buy and keep the plan they want, instead of being forced to choose one employer's plan while forgoing the subsidy offered by the other employer. Similarly, a worker with two part-time jobs could combine pro-rated contributions from each employer to buy coverage, while the government would have a single place to send subsidies for those who need extra help.
In short, the exchange is designed to work around the limitations of current federal law to achieve, in a single state, the basic objectives of conservative health reform — consumer choice of plans, true coverage portability, and the functional equivalent of individual health-insurance tax credits to help pay for coverage...
Mitt explains healthcare plan in Massachusetts 0:53
Mitt explains healthcare plan for country 1:17
(Florida Debate Comments)
2007
Healthcare Views - Jan 2007 Funny but Factual
Edmund F. Haislmaier is a visiting research fellow in the Center for Health Policy Studies at The Heritage Foundation.
The Heritage Foundation is an influential conservative Think Tank in Washington, D.C. that was founded by Paul Weyrich, who also founded the Free Congress Foundation and co-founded the Moral Majority with Jerry Falwell. Paul Weyrich endorsed Mitt Romney in the 2008 Presidential Primary. Mr. Weyrich has since passed away. For a history of Weyrich's support click below:
Jim Talent, a Republican, who was a U.S. Senator from Missouri, stated:
Each candidate in the 2008 Presidential race will undoubtedly offer a health care plan... But only one candidate has actually done something, waded into the issue and emerged with a successful plan that does not resort to one-size-fits-all, government run "Hillary Care." That innovative candidate is former Governor Mitt Romney...
Massachusetts was afflicted with many of the same problems that plague the health care system across the country. There was no easy way to buy affordable insurance except through an employer. Without the employer option, it just was not feasible for many people to buy health insurance. As a result, they had to resort to emergency room care and the taxpayers ended up footing the bill. People choosing their health care provider could not get critical information about the cost or quality of care, and excessive state regulations reduced choices and drove up costs.
When Governor Romney decided to tackle the double-digit annual increases in health insurance costs, the average uninsured resident in Massachusetts had to pay $335 a month for private health insurance, which did not include coverage for prescription drugs and featured a $5,000 deductible. Moreover, the state was spending over $1.3 billion a year on "free care" for the uninsured.
Governor Romney actually got the Democrat-controlled legislature to enact a plan that addressed these problems. He took the time to understand what makes private health insurance markets work and transformed the market in his state from one that was government-controlled to one that allows competition to flourish.
Governor Romney's health care plan featured a number of reforms. First, his plan deregulated the overburdened Massachusetts insurance market to reduce the cost of private insurance, while giving consumers more choice from a broader range of plans. Second, the plan addressed the problems caused by the fact that many people could not get healthcare through their employers and could not afford it on the individual market. Third, he redirected the millions of dollars that were being spent on free emergency room care and used it instead to help those who truly were not able to afford private health insurance...
But Governor Romney's reforms did not stop at reducing the cost of insurance today. He also tackled a number of reforms that will help reduce the rise in health care costs over the long-term. His plan included medical transparency provisions that allow consumers to compare the quality of hospitals and providers, while tracking and recording the costs associated with the care they provide. The reforms also instituted measures to encourage the use of electronic health records, which will reduce medical errors and lower costs.
What's been the result of all these reforms? Although the reforms were signed into law just over a year ago, the changes are dramatic. The same uninsured individual whose choice was formerly limited to a policy with a $335 a month insurance premium with no drug benefits and a $5,000 deductible now can purchase quality private insurance, which includes coverage for prescription drugs, office and emergency room visits, and a $2,000 deductible, for $175 per month. Between July 1, 2006 and May 1, 2007, nearly 125,000 previously uninsured residents of Massachusetts got health insurance coverage...
All of Governor Romney's reforms are consistent with the goal of making private health insurance more available, flexible, and affordable. That is why many conservative organizations have hailed Governor Romney's health care reforms. The Heritage Foundation called it "one of the most promising strategies out there." Massachusetts Citizens For Limited Taxation said that Romney's plan was a responsible solution to America's health care challenges. And the Ethan Allen Institute praised Governor Romney's plan because of its focus on personal responsibility and choice.
The bipartisanship, innovation, conservative statesmanship and creativity he exhibited confirms my view that he is the kind of leader this nation needs.
Note: One inaccurate rumor about Romney's healthcare plan was that he decided to fund abortions with it. Information on his actions related to abortion, including the funding of abortion under this health care plan can be found here.
Massachusetts government power point showing other highlights:
• Reduces administrative burden for small business
• Makes it easier to find affordable policies
• Allows more people to buy insurance with pre-tax dollars, reducing price by 25% or more
• Allows part-time and seasonal employees to combine employer contributions in the Connector
• Individuals can keep policy, even if job changes
Market Reforms:
• Merger of the non-group and small group markets, reducing premiums for individuals by 25%.
New Products:
• Existing high-deductible plans can now be tied to Health Savings Accounts (many employees across the nation now benefit from this innovation going nationwide)
• Family plans to allow young adults to stay on the policy for two years past loss of dependency, or until 25, whichever occurs first
• Industry can develop special products for 19-26 year olds, offered through the Connector
• Medicaid providers received overdue rate increases over next three years
• total of $230M for hospitals across the state; $40.4M for physicians
The Employer Contribution before/after reform:
• Employers who PROVIDED coverage helped pay the cost of free care through an insurance surcharge.
• Employers who DID NOT provide coverage did’t pay this premium.
• Employers who don’t make a “fair and reasonable” contribution will be required to make a per-worker “fair share” contribution.
• Contribution represents the cost of free care used by the employees of non-contributing employers
• Contribution capped at $295 per full-time-equivalent employee, per year.
Arianna Huffington is the founder and editor-in-chief of the liberal magazine, The Huffington Post.
''Arianna Huffington, a CNN Pipeline analyst and Democratic activist, was impressed with Governor Romney's answer on health care. She thinks the Democrats may have reason to worry.
'' "This is his advantage, he can speak well on a strong Democratic issue like health care," Huffington said.
''Republican strategist Michael Murphy agreed: "It's like the Democrats running Colin Powell - a candidate who can take away the other party's strength."
''Romney, while Governor of Massachusetts, instituted one of the first statewide, comprehensive health care plans.''
“On April 12, 2006, Governor Romney signed into law landmark legislation ensuring that every resident of Massachusetts would have access to affordable, portable, quality private health insurance – without higher taxes, an employer mandate or a government takeover of health care.”
“On a Sunday morning in February 2006, Romney personally taped handwritten notes to the doors of senate president Robert Travaglini and house speaker Salvatore DiMasi, begging them not to let this opportunity die... The bill that emerged from the legislature two weeks later was different in many respects from what Romney had initially proposed... There were far too many requirements placed on insurance companies for Romney's tastes, and he used his line-item veto on the bill's stipulation that employers who don't cover their workers pay $295 per employee each year into a fund to subsidize coverage. The lawmakers easily overrode it”.
“The premiums are paid with an employee's pre-tax dollars — that saves money on withholding taxes for the employer and for the employee. If employers don't either pay at least one-third of the premiums, or get 25 percent of the employees to sign up, they'll have to pay a penalty (the state calls it a "fair share contribution") of $295 per employee per year.”
Note: The $295 fee for employers who don't pay 1/3 of employee insurance premiums or get 25% of employees to sign up is considered by some to be an incentive but not a mandate for employers to provide employee insurance, since they may choose to just pay the fee instead of ensure employees get covered by insurance. Even at that Romney vetoed that fee, which was overridden by the legislature.
By contrast, Obama's plan, which charges employers $2,000 per employee if employees are not covered (CNN.com), is considered by all a mandate that employers must provide insurance, since the charge is so high that an employer will not opt out.
This is one of just many differences between the two plans. Other big differences include that Obama's plan introduces new taxes while Romney's plan did not, and even bigger, was that Romney's plan was intended to address the specific situation and needs of one state, with the philosophy that states could each determine their own strategies and plans, and was so bi-partisan that the senate passed it unanimously and the house passed it with all but two votes in favor of it (NewsMax), while Obama's plan was a partisan plan forced on all states.
The biggest difference however, is in what Romney vs. Obama sought. Romney sought a free-market plan that didn't charge fees to individuals, even if they chose to not buy health insurance, but the legislature did not give individuals that option without a fee. Obama sought a government run healthcare system (referred to as socialized medicine), but the public prevented congress from giving him that option.
EMPLOYEE:
“Furthermore, to allow people to go without health insurance, and then when they do fall ill expect someone else to pay the tab for their treatment is a de facto mandate on providers and taxpayers. Romney proposes to take that option off the table, leaving only two choices: Either buy insurance or pay for your own care. Not an unreasonable position, and one that is clearly consistent with conservative values.
“But beyond that, the Romney administration got downright Libertarian in figuring how to make it work. Under Romney's plan anyone opting to not buy insurance would be required to deposit $10,000 in an (interest-bearing) escrow account with the state. If they didn't pay their medical bills, the providers stuck with their bad debts could apply for that money. But what if they won't buy insurance and refuse to put $10,000 in escrow with the state? The answer is that they aren't allowed to claim the personal exemption tax-break on their state income tax, and any tax refunds due them are deposited into the escrow account until the $10,000 limit is reached.
“Having first proposed the creation of more and better health-insurance choices and more rational and efficient subsidies, Romney essentially says, "You will be free to choose, but your choices will have consequences."
“A conference committee of the Massachusetts legislature is now hammering out the details of the final legislation.”
Note: The Legislature did not accept Romney's proposal, but instead passed a bill that fined individuals who refused to get insurance an amount equal to half the cost of a policy, up to a maximum that equaled $76/month ($912/year) in 2008, but typically would have turned out to be $57.50/month, half of a $115/month policy. (see below)
“Beginning Jan. 1, 2008, individuals who fail to purchase health insurance will lose a portion of their state tax refund equal to 50 percent of an affordable health insurance premium. Penalties will be assessed for each month without creditable coverage.
“Of the state's approximately 500,000 uninsured, about 100,000 are eligible for Medicaid. Another 200,000, who are making less than 300 percent of the federal poverty level, but are not eligible for Medicaid, will receive premium assistance on an income-based sliding scale for policies with no deductibles. Another 200,000 individuals with incomes above 300 percent of the poverty level will be able to purchase reduced-cost policies in the private market. Premium assistance will be financed by directing a portion of the $1 billion currently being spent by state government on the uninsured.”
“Massachusetts now spends about $1 billion a year to provide emergency health care for at least 500,000 uninsured citizens. About 200,000 of those are young people, predominantly male, who are making enough money to buy health insurance but figure they don't need it. They would be required to buy a relatively inexpensive health insurance policy, with higher deductibles and co-pays--that's where the ''mandate'' comes in.”
“For 2008 and beyond, the penalty increased to 50 percent of the average cost of a health insurance plan in the geographic region in which the person lives, up to a maximum of $912. People can file for hardship exemptions from the mandate that are reviewed on an individual basis. In addition, roughly two percent of state residents are not subject to the mandate because it has been determined that insurance coverage will not be affordable for them.”
In 2007, a single person with no dependents making over 3 times the poverty level would be earning over $30,630/year, and if their employer did not provide health insurance coverage, they would pay approximately $115/month in pre-tax dollars for health insurance:
“The program provides subsidized health coverage for individuals with income below 300 percent of the federal poverty level ($30,630 for an individual).”
“Finally, residents of Massachusetts now have an avenue to purchase insurance with pre-tax dollars, leveling the playing field between the individual market and employer sponsored health plans, and bringing the monthly premium paid by the average uninsured resident in the state to as low as $115 a month.”
“The early signs of success are undeniable. First, over half of the uninsured in Massachusetts now have health insurance because of Governor Romney's reforms. This includes over 160,000 people who have purchased private health insurance in reformed markets that feature a variety of plans with cheaper premiums and more generous benefits.”
“The Massachusetts program has already managed to lower the rate of uninsured in the state to 3.3 percent compared to the national average of 16 percent. Since it began two years ago, 440,000 formerly uninsured residents out of a total population of about 6.4 million have gained health care coverage.”
“In November 2008, the Massachusetts Division of Health Care Finance and Policy estimated that 2.6% of Massachusetts residents remained uninsured as of June 30, 2008, the lowest rate in the country.”
Reports indicate Massachusetts healthcare costs were over $1.3 billion and going up by double digit percentages before the healthcare reform:
Aug 21, 2007: “When Governor Romney decided to tackle the double-digit annual increases in health insurance costs, the average uninsured resident in Massachusetts had to pay $335 a month for private health insurance, which did not include coverage for prescription drugs and featured a $5,000 deductible. Moreover, the state was spending over $1.3 billion a year on "free care" for the uninsured.”
In the two above articles, the information available or used was from two years earlier. For example, the uncompensated health care funds spent in 2005 was $1.38 billion, the amount spent in 2004 was $1.25 billion (Mass.gov), and the amount the year before (the year Governor Romney took office) was about a billion dollars as the previous article stated, or more precisely, approximately $1.1 billion as the next article indicates. The $1.1B to $1.25B to $1.38B increases amounted to a 13.6% increase followed by a 10.3% increase. The next year's expenditures were about a billion and a half, an increase which was less, but still fairly close to 10% (double digits).
“Comparatively speaking, the health-care situation in Massachusetts wasn't all that dire when Romney took office: the state's percentage of uninsured among its nonelderly (13.2%) was smaller than the national average (17.8%), and it had a better safety net, thanks to a $1.1 billion fund the commonwealth had established to reimburse hospitals and health centers that provided medically necessary care to people who couldn't pay for it.”
The state's healthcare reform budget was far less two years after healthcare reform than the healthcare budget was before (about $900 million in 2009 vs. over $1.48 billion in 2006).
Three years after the healthcare reform, the healthcare budget was still less than it was before the healthcare reform ($1.2 billion in 2010 vs. over $1.48 billion in 2006):
“For fiscal year 2010, a total of $1.2 billion has been allocated for health care reform”
“The Governor's budget request of $869 million for 2009 is about $400 million more than that for 2008, and it is believed that this funding level may still fall short.”
(After the new healthcare plan went into effect, costs transitioned from paying for uninsured to subsidizing poor with policies. The resulting costs of paying for the uninsured dropped drastically, while the costs of subsidizing poor with insurance policies quickly rose.)
“Taxpayer-funded "free care" is falling at double-digit rates, because the Romney reforms no longer allow people to let others pay for their health care if they can afford their own health insurance. Those who previously couldn't afford health insurance now have the help they need to get access to affordable, quality, portable private coverage. And, as he promised, Governor Romney did all this without raising taxes and without a government take-over of health care.”
(By 2008 the new healthcare plan costs were nearly half a billion dollars, or $469 million, while the uncompensated care costs paid through a fund with the healthcare reform that was called the Health Safety Net Trust Fund were only $354 million. By 2009, with over 97% of the people insured, the 2009 health reform budget represents nearly all the state's healthcare costs that originally went to pay for the uninsured.)
“As part of that [healthcare] reform, Section 30 of Chapter 58 required that, beginning on October 1, 2007, a new office would be responsible for the reimbursement of payments to Massachusetts hospitals that treat uninsured or underinsured patients. This new agency, the HSN [Health Safety Network], would operate differently from its predecessor...
“Funding for the Health Safety Net Trust Fund (“Trust”) will come from several sources...
“According to the Division, in 2008, the combined funding totaled $354 million, not including an additional $24 million from prior years’ residual balance.”
(The HSN fund went into effect in April 2008 as explained inside the previous link. Prior to that there was a transition period where the previous pay pool fund was being used, but its use was rapidly decreasing as previously noted.)
Result
The state's healthcare costs were less three years after the reform than they were before, and the costs before were going up by double digits indicating the costs after the reform are much less than they would have been without the reforms.
In addition the state would have paid hundreds of millions of dollars more for their healthcare costs without the reform, because they retained $385 million/year in federal funding by implementing the reform, which they were otherwise going to lose.
Even at that, the legislature overrode Romney's vetoes, adding $145 million a year and growing in extra costs as noted below. Costs are also higher during a recession when more people will obtain subsidized care, and the new governor and legislature have sought new coverage and regulation, costing the plan even more (although eventually having to cut back on on some of their excessive coverage):
“Romney had vetoed the dental benefit saying 60 percent of employers in Massachusetts don't offer the benefit to their workers. He also said the provision was unsustainable because it would cost $75 million a year...
“Rep. Mary Rogeness, R-Longmeadow, defended Romney's veto saying the cost could jeopardize the success of the new law.
“The House overturned four of the vetoes during the afternoon and then returned in the evening to override the remaining four, including a provision to give MassHealth coverage to so-called "special status aliens,'' legal immigrants who have come with the sponsorship of an individual who agreed to be financially responsible for them.
“Romney said the law should take into account the financial status of the sponsor. The House overrode the veto by a 137-19 vote.” (That provision also cost an additional $70 million a year - Boston Globe)
“Although the reforms were signed into law just over a year ago, the changes are dramatic. The same uninsured individual whose choice was formerly limited to a policy with a $335 a month insurance premium with no drug benefits and a $5,000 deductible now can purchase quality private insurance, which includes coverage for prescription drugs, office and emergency room visits, and a $2,000 deductible, for $175 per month. Between July 1, 2006 and May 1, 2007, nearly 125,000 previously uninsured residents of Massachusetts got health insurance coverage.”
“The early signs of success are undeniable. First, over half of the uninsured in Massachusetts now have health insurance because of Governor Romney's reforms. This includes over 160,000 people who have purchased private health insurance in reformed markets that feature a variety of plans with cheaper premiums and more generous benefits.
“Second, the conservative, market-oriented reforms that Governor Romney instituted have made health insurance more affordable. Before Governor Romney's reforms, the average uninsured resident was paying $335 a month to obtain an insurance policy with a $5,000 deductible. Now, that same individual only pays $184 a month for a policy with a $2,000 deductible. Finally, residents of Massachusetts now have an avenue to purchase insurance with pre-tax dollars...”
Over about a 3 month period, 35,000 more people signed up for health insurance policies, and crossing into a new fiscal year, they started costing $9 more, about a 5% premium increase. In addition to obtaining much better coverage for much less, those policies have gone up less than 10% in a year after the reform while healthcare costs were going up in double digits (over 10%) a year before the reform:
“When Governor Romney decided to tackle the double-digit annual increases in health insurance costs, the average uninsured resident in Massachusetts had to pay $335 a month for private health insurance, which did not include coverage for prescription drugs and featured a $5,000 deductible.”
Massachusetts healthcare costs after the reform were going up by less than 10% a year for those paying for their own insurance (Commonwealth Choice plans), but would increase by 10% for those who were being subsidized with insurance policies that had no deductible and started out costing as low as $2/week for a family (Commonwealth Care policies):
“As part of an agreement to raise rates paid to the managed care plans participating in the Commonwealth Care program, enrollees will face premium increases of 10 percent. They will also face higher cost sharing for doctor's visits and other services. Although the premiums for the Commonwealth Choice [unsubsidized] plans have not yet been released, the Connector Authority Board has indicated that the increases will be less than 10 percent.”
In Massachusetts premiums for people paying for their own insurance (Commonwealth Choice plans) have been going up by less than 10% annually. This is in comparison to national healthcare premium costs of people paying for their own insurance, which are still going up by double digit percentages, which in the first of 2010 was an annual reported increase of 20%:
“About 14 million people under age 65 have coverage through the non-group or individual market... policyholders report that their insurers most recently requested premium increases averaging 20 percent.”
Three Years Into Implementation, Docs Rate State's Health Care System Positively
Washington, D.C. -- A study published in today's New England Journal of Medicine finds that a large majority (70 percent) of practicing physicians in Massachusetts support health reform three years after its passage in 2006...
The poll found similar levels of support among primary care doctors and specialists. When asked about the law's future, 75 percent of physicians say they want to continue the policies - 46 percent with some changes and 29 percent as is... Only 13 percent of physicians in the state oppose the health reforms created through the legislation, and just 7 percent believe the policies should be repealed.
"There appears to be broad support among physicians in Massachusetts for the reforms that led to almost all state residents having health coverage," said Robert Blendon, Sc.D., one of the study's authors and professor of health policy and political analysis at HSPH. "The findings suggest that it is possible to provide near-universal coverage of the population and have a resulting system that most physicians believe improves care for the uninsured without undermining their ability to provide care to their patients." ...
"Massachusetts' recent experience in reforming health care provides invaluable insights for federal lawmakers," said Risa Lavizzo-Mourey, M.D., M.B.A. president and CEO of the Robert Wood Johnson Foundation. "Based on what we have seen in Massachusetts, doctors are supportive of the reforms and their patients appear to be better off. What's good for doctors and their patients is good for the health of our nation..."
"What is particularly impressive is that on almost every question in which physicians were asked about the impacts of the law on their own practice and patients, a majority reported that it is having either no impact or a positive one," said Gillian SteelFisher, Ph.D., M.Sc., co-author of the study and research scientist at HSPH.
Physicians rated the Massachusetts health care system much more positively than they did the national health care system, 63 percent to 33 percent. [63% rated Massachusetts system excellent or good, 33 percent rated current national system the same. Another 30% rated Massachusetts system fair and only 6% rated it poor.] Nearly four in five physicians (79 percent) believe that the law positively impacted those who were previously uninsured, though overall costs to the state continue to be a concern.
"Whether at the state or national level, health reform is about trade-offs, but the reaction among physicians in Massachusetts has been overwhelmingly positive," said Anya Rader Wallack, interim president of the Blue Cross Blue Shield of Massachusetts Foundation. "The state now has the lowest proportion of uninsured residents in the nation, and our physicians are looking forward to continuing and improving the health reform efforts already in place. That's a remarkable achievement."
BOSTON, MA - Two years after the implementation of a health care reform law aimed at providing health coverage for nearly all Massachusetts residents, public support for the law remains high. According to a new poll by the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation, over two-thirds (69%) of Massachusetts residents support the law... compared to 67% in 2007 and 61% in 2006.
Other signs of public support for the law include the following:
• 77% support providing subsidized coverage...
• 71% say the law has been successful at reducing the number of uninsured in Massachusetts...
In the two years since the law's passage, approximately 350,000 Massachusetts residents have gained health insurance coverage...
The law requires businesses that employ more than 10 people to provide health insurance for their employees or pay a fine of up to $295 per employee per year. The public is highly supportive of this provision with three out of four expressing support (75%).
A poll conducted this week by The Washington Post of 880 Massachusetts residents who said they voted in the special election found that 68 percent support the Massachusetts plan...
But support plummeted when voters were asked about health care proposals from Obama and Democrats in Congress.
Most Massachusetts businesses believe that they have a responsibility to help provide health benefits to their workers, support "play-or-pay" provisions of the state's landmark 2006 health care reform legislation, and even believe that the play-or-pay requirements should apply to firms with ten or fewer workers, which they currently do not...
The RWJF/NORC (Robert Wood Johnson Foundation/National Opinion Research Center) survey found broad support among Massachusetts businesses both for the concept of employer responsibility for health benefits and for the specific provisions of the Massachusetts reforms. Seventy-seven percent of employers in the state either "strongly" (34 percent) or "somewhat" (43 percent) agreed with the statement that "all employers bear some responsibility for providing health benefits to their workers." The statement garnered majority support among firms of all sizes and even among firms not offering health benefits, although those nonofferers were significantly less likely than firms offering benefits were to strongly agree.
These sentiments translated into similarly widespread support for the "play-or-pay" aspects of the Massachusetts reform legislation: Sixty-nine percent of employers either "strongly" (35 percent) or "somewhat" (34 percent) agreed with the requirement that firms with eleven or more workers either offer health benefits or pay the "fair share" contribution of $295 per worker. Even among nonoffering firms, half either "strongly" or "somewhat" supported this provision.
In fact, Massachusetts businesses were prepared to go farther than the state's recent legislation...
"This striking support among even the smallest businesses for universal employer responsibility speaks to how all sectors have taken on the shared goal of access to health care for all residents of the Commonwealth," noted Jarrett Barrios, president of the Blue Cross Blue Shield of Massachusetts Foundation.
Massachusetts is poised to become the first state to provide nearly universal health care coverage ...
The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance. It accomplishes that in a way that experts say combines methods and proposals from across the political spectrum, apportioning the cost among businesses, individuals and the government.
"This is probably about as close as you can get to universal," said Paul B. Ginsburg, president of the nonpartisan Center for Studying Health System Change in Washington. "It's definitely going to be inspiring to other states about how there was this compromise. They found a way to get to a major expansion of coverage that people could agree on. For a conservative Republican, this is individual responsibility. For a Democrat, this is government helping those that need help." ...
"It is not a typical Massachusetts-Taxachusetts, oh-just-crazy-liberal plan," said Stuart H. Altman, a professor of health policy at Brandeis University. "It isn't that at all. It is a pretty moderate approach, and that's what's impressive about it. It tried to borrow and blend a lot of different pieces." ...
The Massachusetts bill creates a sliding scale of affordability ranging from people who can afford insurance outright to those who cannot afford it at all. About 215,000 people will be covered by allowing individuals and businesses with 50 or fewer employees to buy insurance with pretax dollars, and by giving insurance companies incentives to offer stripped-down plans at lower cost. Lower-cost basic plans will be available to people ages 19 to 26.
Subsidies for other private plans will be available for people with incomes at or below 300 percent of the poverty level. Children in those families will be eligible for free coverage through Medicaid, an expansion of the current system...
"Whenever you can have the medical community, the business community and the advocates all applauding our efforts, I think that's indicative of a successful exercise," said State Senator Robert E. Travaglini, the majority leader.
Mr. Romney, who is considering running for president in 2008, said in an interview Tuesday that the bill, passed by a legislature that is 85 percent Democratic, was "95 percent of what I proposed."
He said, "This is really a landmark for our state because this proves at this stage that we can get health insurance for all our citizens without raising taxes and without a government takeover. The old single-payer canard is gone."
Mr. Romney pushed the idea of the "individual mandate," requiring people who can afford insurance to buy it. The bill makes it possible for employers to enable many of those people to use pretax dollars, saving them 25 percent or more...
Mr. Romney said that with more people insured, everyone would "get better health care" and that premiums for people who already had insurance might drop because "providers won't be pushing the cost of the uninsured onto the people who have insurance."
James Roosevelt Jr., president and chief executive of Tufts Health Plan, agreed.
"I think that will help both improve the quality of health care and lower the cost," Mr. Roosevelt said...
Advocates for the uninsured held a victory rally at the Statehouse.
"We're thrilled that this truly represents a commitment to the poor and the working poor," said Rabbi Jonah Pesner, a leader of the Greater Boston Interfaith Organization.
Tuesday's votes approving the bill -- 154 to 2 in the House and 37 to 0 in the Senate -- were the culmination of two years of politicking and several months of backroom negotiations, as rival health-care plans from Romney and the two Democrat-led chambers were hammered into one.
What resulted is a proposal that health-care experts say is unlike any other in the country. What to do about the 45 million Americans without health insurance has flummoxed both the Bush administration, whose proposal for "health savings accounts" fizzled, and that of Bill Clinton, whose broad plan for health-care changes fell flat...
The idea was applauded by Uwe E. Reinhardt, a professor of economics and public affairs at Princeton University, who said that he has long believed that the American system of allowing uninsured patients to receive care at the government's expense was nothing more than "freedom to mooch."
"Massachusetts is the first state in America to reach full adulthood," said Reinhardt, noting that the new measure is a move toward personal responsibility. "The rest of America is still in adolescence." ...
The bill's passage was celebrated as a victory in the state legislature, with House Speaker Salvatore F. DiMasi (D) telling colleagues that they had succeeded where other states had failed.
"We did something to solve the problem," he said.
The same message might provide a political boost to Romney, who is considering a presidential run in 2008. By proving he can work with Democrats, and find a health-care solution that relies on the private sector, Romney can portray himself as an executive who can work across the aisle in harshly partisan times.
"It might help him to say, 'Look, I have a solution for health insurance,' " said Julian E. Zelizer, a professor of history at Boston University.
ABC's World News Tonight: "Good evening. We begin with a bold experiment in health insurance that could change the way you pay your medical bills. After terrorism and the war in Iraq, health care is the major concern for Americans. Most people think medical costs are too high and would like a universal insurance system to cover everyone. Forty-five million people in the U.S. have no insurance [number on screen], and repeated attempts by the federal government to come up with a solution have all failed. Which is why the state of Massachusetts is getting so much attention tonight. ABC's Nancy Weiner reports from Boston."
Weiner: "With the new system, residents who make less than $9,500 a year will get free health insurance -- no premiums, no deductibles. Families with low incomes but above the poverty line will pay premiums on a sliding scale. But still, no deductibles. And for the vast majority of residents who do have health insurance, lawmakers predict cutting the roles of the uninsured will bring down premiums for everyone. Forty-year-old Faith Burdell, who is legally blind and can't work, says health costs currently eat up most of the little money she has."
Faith Burdell, Massachusetts resident: "I think I'd be able to afford a gallon of milk, whereas before I wasn't able to always get a gallon of milk at the store."
CBS Evening News: "Good evening. I'm Russ Mitchell. Imagine this: Virtually everyone guaranteed health insurance coverage. It's happening in one state, and it could be a model for the rest. So we'll begin there tonight."
"Health care costs are rising by the day, and more than 45 million people in this country have no insurance to cover it. Now, one state is doing what no other state or the federal government has been able to do: Provide near-universal health coverage. The Massachusetts legislature approved it with overwhelming bipartisan support. And it could become a model for the rest of the country. Here's Trish Regan."
Trish Regan: "President Clinton promised it but did not deliver, states have wrestled with it unsuccessfully for decades, and now Massachusetts has apparently done it. It's about to become the first in the nation to provide nearly universal health coverage. Under a bill approved by the legislature, the state will require every citizen to be insured. Governor Mitt Romney pushed for the program."
Governor Mitt Romney (R-MA): "I thought it would be impossible."
Regan: "He considers health coverage essential, like car insurance."
Romney: "Well, when people drive a car, we insist that they have automobile insurance because we don't want to have a huge accident occur and have the other driver, or other taxpayers have to pick up the bill. Well, individuals also have a responsibility."
Regan: "Currently, Massachusetts spends an estimated $1 billion a year covering its half million uninsured residents."
Romney: "We concluded that, in fact, if we took the money we're spending giving people free care who don't have insurance and instead use that money to help them buy insurance, we can keep from shifting the cost of the uninsured onto people who are already covered."
Regan: "Here's how the plan is expected to work: All residents will be required to either buy insurance through an employer or through the government. Those who can't afford a plan will be subsidized. They can buy insurance through the state for as little as $2.30 a month. If someone chooses not to buy a plan, there will be tax penalties, up to $1,200 a year."
Stuart Altman, Institute for Health Policy: "It would be a mistake to think of this as some crazy liberal pinko kind of Massachusetts, 'Taxachusetts,' the important thing is this is a moderate proposal."
Regan: "Stuart Altman has worked on health care policy for nearly every President since Nixon."
Altman: "I think every state should take a look at it, and I think many states will look at it very positively, and I would suspect that, I would hope that also the federal government would take a look at it."
NY Times — Massachusetts Sets Health Plan for Nearly All
Washington Post — Mass_ Bill Requires Health Coverage