Monday Morning Health Reform Reading

Three health reform items released last Friday for your Monday morning reading list:

1. The Division of Health Care Finance and Policy released the latest edition of their quarterly report The report paints an overview of the Massachusetts health care landscape through data on health insurance coverage, the Health Safety Net, health insurance premiums, health plan financial performance, acute hospital and community health center financial performance and access to care. The latest report found that:

• Over 428,000 people have gained insurance coverage since health reform implementation began and Dec. 31, 2008.
• Growth in enrollment decreased slightly between June 30, 2008 and December 31, 2008, due to a decline in MassHealth and Commonwealth Care enrollment. (this decline has subsequently been erased, as CommCare has experienced substantial new enrollment this year).
• About half (49%) of residents enrolled in private group insurance are in self-insured plans.
  While financial performance for acute hospitals improved from FY03 to FY07, margins declined significantly from FY07 to FY08. In FY08, 23 hospitals (35%) experienced overall losses.
• Between 2007 and 2008, health plan profit margins declined for 7 health plans, and improved for 4 plans.

2. The Commonwealth Fund, a national foundation that promotes health care access and quality, released an issue brief last week that describes the structure and function of the Connector Authority, providing an introduction to health care reform for policymakers at both the state and national level. The study, by Amy M. Lischko, Sara S. Bachman, and Alyssa Vangeli, (all long-time friends of HCFA) can be viewed The authors describe how the Connector effectively streamlines administration, offers portability of coverage, and provides some standardization and choice of plans, and offer it as a model for future reform around the country.

These descriptive articles will pay an important role in introducing Massachusetts health reform to national audiences.

3. Jon Kingsdale, the executive director of the Connector, in Health Affairs on lessons learned from implementing health reform in Massachusetts. His key point defends the wisdom of Massachusetts health reform expanding coverage before tackling cost control:

At the strategic level, there is political advantage in conceptualizing comprehensive health reform as a continuous campaign. This is not the incrementalism of little steps: after all, most states have shied away from the individual mandate as too controversial, and California’s brave effort to build on the Massachusetts model stalled in the state Senate. Rather, this is recognition that the implementation of major reform takes years and will create unforeseen challenges, so a truly comprehensive approach must be sequenced. …

Massachusetts took the ethical high ground and chose to begin with near-universal coverage. To the standard arguments that we must reduce waste in order to control government spending and remain internationally competitive, we have added this imperative: only by controlling costs can Massachusetts sustain near-universal coverage.

Kingsdale warns that as Congress takes on national health care reform, coverage expansion and cost reduction will be difficult to attain simultaneously. If national universal health care is to become a reality, Congress must learn from both Massachusetts’s successes and sequence the steps needed to make health care both widely available and affordable.

Posted in healths nad youga