Massachusetts Health Care Reform : The Canary in the Coal Mine By Maggie Mahar

Advocates for health care reform have been keeping an eye on Massachusetts, hopeful that its new health reform law will serve as a pilot program for the nation.

I’m much less hopeful than I was two days ago.

Yesterday I attended the Massachusetts Medical Society’s Eighth Annual Leadership Forum where I was one of four speakers. This year, the Society (which owns The New England Journal of Medicine)  focused on the cost of health care –with a special emphasis on funding universal coverage in Massachusetts. The new was not good. While the citizens of   Massachusetts believe that everyone has a right to health care (when polled 92% say “yes”), no one wants to pay for universal coverage.   When asked “if the only way to make sure that everyone can get the health care services they need is to have a substantial increase in taxes [should we do it] 55% said “no.”

One speaker at the forum recalled a man who explained why taxpayers shouldn’t have to pick up the bill: “The government should pay for it.” (He didn’t disclose who he thinks “the government” is. )

Some citizens of the Commonwealth don’t even want to pay for their own health care insurance. Under the plan, everyone in Massachusetts is required to buy insurance (or pay a penalty), with the state providing a 100% subsidy for those who earn less than 150% of the poverty level. Those receiving the full subsidy are enthusiastic. The state had hoped to sign up 57,000 uninsured and they’ve over-shot their target: 76,200 of Massachusetts’ poorest citizens have enrolled.

At the other end of the spectrum, the program isn’t doing as well. Uninsured citizens earning more than 300% of the poverty level are expected to buy their own insurance. Here, the state hoped that 228,000 of its uninsured citizens would sign up. So far, just 15,000 have enrolled.  Apparently, they’ve done the math and decided that it would be cheaper to pay the penalty.  But their premiums are needed to keep the program going.  If more in this group don’t sign up, it is not at all clear how the state will be  able to continue subsidizing the poor.

Yesterday’s first speaker, Robert Blendon, a professor of Health Policy in Harvard’s Department of Health Policy and Management, talked about what Massachusetts experience might mean for the national health care debate: “Massachusetts is the canary in the coal mine,” Blendon declared bluntly. “If it’s not breathing in 2009, people won’t go in that mine.”

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