But much didn't change. Emergency rooms remain as crowded as ever; about a third of the non-elderly go at least once a year, and half their visits involve "non-emergency conditions." As for improvements in health, most probably lie in the future. "Many of the uninsured were young and healthy," writes Long. Their "expected gains in health status" would be mostly long-term. Finally -- and most important -- health costs continue to soar.
Aside from squeezing take-home pay (employers provide almost 70 percent of insurance), higher costs have automatically shifted government priorities toward health care and away from everything else -- schools, police, roads, prisons, lower taxes. In 1990, health spending represented about 16 percent of the state budget, says the Massachusetts Taxpayers Foundation. By 2000, health's share was 22 percent. In 2010, it's 35 percent. About 90 percent of the health spending is Medicaid.
State leaders have proved powerless to control these costs. Facing a tough reelection campaign, Gov. Deval Patrick effectively ordered his insurance commissioner to reject premium increases for small employers (50 workers or fewer) and individuals -- an unprecedented step. Commissioner Joseph Murphy then disallowed premium increases ranging from 7 percent to 34 percent. The insurers appealed; hearing examiners ruled Murphy's action illegal. Murphy has now settled with one insurer allowing premium increases, he says, of 7 to 11 percent. More settlements are expected.
Massachusetts Offers Preview of Obamacare - Newsweek
But we were promised by Obama, the dems and most of the media that once the bill was passed we would find out just how great it was. We were all just uneducated fools that were easily tricked by our republicans overlords. How could it be that this wonderful bill is not the panacea that we were promised?
The Massachusetts plan is working -- but the American health-care system is not
In recent weeks, critics of the Affordable Care Act have turned their attention to Massachusetts, where there's some evidence that the reforms signed into law by Mitt Romney in 2005 are struggling: Emergency room visits haven't dropped. Gov. Deval Patrick has been tussling with insurers over rates. There's anecdotal evidence of small employers dropping coverage (though recent studies show employer coverage expanding).
Before getting into isolated statistics and anecdata, let's do an overview: Between 2006 and the fall of 2009 (which is the most recent data [pdf] we have), insurance coverage among non-elderly adults jumped from 87.5 percent to 95.2 percent. Access to preventive care went from 70.9 percent to 77.7 percent. The gap in coverage between minority and non-minority residents disappeared. Out-of-pocket costs fell. These gains have persisted amid the recession, which is something of a surprise. State insurance plans tend to unravel during recessions.
Cost, however, is where things get complicated. In the non-group market -- which is where the reforms were concentrated -- premiums costs fell by 40 percent in Massachusetts even as they rose by 14 percent nationally, according to data from the insurance industry trade group AHIP. In the employer market, which did not see major reforms, costs have risen at about the national average: The increase in Massachusetts has been 21 percent, while the increase in the rest of the country has been 21 percent.
The plan's popularity also remains quite high: The Urban Institute study found approval at 67 percent in fall 2009.
Now, let's dig in a bit.
The Massachusetts reforms, unfortunately, were not designed to deal with cost. They weren't even designed to improve the delivery system. There was no excise tax, no independent commission to fast-track cost controls, no efforts to generate evidence for comparative effectiveness reviews or seed the system with medical records or spark a shift toward medical homes or accountable care organizations. "The initiative was to expand coverage and that still is going very well," says Sharon Long, who is studying the reforms for the Urban Institute. "They were very successful early on and they've managed to maintain that success despite the recession. The challenge is the cost issue, which they did not tackle in the initial reform."
Before the reforms, Massachusetts had the highest health-care costs in the nation. That's still true after the reforms. Massachusetts has an incredibly powerful hospital industry. Think of the legendary research hospitals in Boston -- Harvard and Tufts and Partners. Their reputation allows them to command huge premiums, and their centrality to the economy ensures them huge political power. Long mentions a survey that found one out of five households in Massachusetts gets some income from the health-care industry.
/End thread
Cost, however, is where things get complicated. In the non-group market -- which is where the reforms were concentrated -- premiums costs fell by 40 percent in Massachusetts even as they rose by 14 percent nationally,
State leaders have proved powerless to control these costs. Facing a tough reelection campaign, Gov. Deval Patrick effectively ordered his insurance commissioner to reject premium increases for small employers (50 workers or fewer) and individuals—an unprecedented step. Commissioner Joseph Murphy then disallowed premium increases ranging from 7 percent to 34 percent. The insurers appealed; hearing examiners ruled Murphy's action illegal. Murphy has now settled with one insurer allowing premium increases, he says, of 7 to 11 percent. More settlements are expected.
It also said right in my article that Massachusetts health care reform wasn't designed to cut costs down, so why are you trying to show that as a preview of Obama's national health care?
Did you know that Obama's plan punishes insurance companies that increase premiums?
Did you know that Obama's plan punishes insurance companies that increase premiums?
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