“There was a study that just came out about 10 days ago, two weeks ago, that listed 15 ways in which Romneycare was the model for Obamacare.” -Rick Santorum; Presidential hopeful, GOP candidate, word mumbler.
In response, Mitt Romney reiterated his intent on repealing Federal Health Reform if he were to win the Presidential nomination. (If interested, you can see the transcript of the debate, here).
This begs the question: Has Massachusetts Health Reform been successful? According to a study published in Health Affairs last month, the answer appears to be yes. Of course, this all depends on how one defines success, but there are some impressive results for fairly standard metrics when evaluating whether or not a health policy is working well for the issues it intended to address.
The study used data from the Massachusetts Health Reform Survey, which targets adults ages 19-64. Health Affairs used data collected between 2006-2010, and compared health outcomes of post-health reform implementation (2007-2010) to outcomes of adults in 2006.
What the study found was insurance coverage in the state had reached 94.2%, (vs. 77.7% U.S. average), decrease in Emergency Department visits and Inpatient stays, and higher self-reported health status. In addition, the fear that public coverage would lead to the end of employer-sponsored insurance (e.g. “crowd out,”) didn’t happen – “Massachusetts’ high level of insurance coverage reflects high levels of employer-sponsored coverage in the state, which remained strong in 2010. More than two-thirds of nonelderly adults (68.0 percent) reported coverage through an employer. This is significantly higher than the level in 2006 (64.4 percent), before health reform.”
Increases in Primary Care utilization were also up 5.9 percentage points, an important shift for population health improvement.
Also, if you want a preview of what Health Reform’s Exchanges may look like, check out Massachusetts’ HealthConnector, the State’s website for those “shopping” for health insurance. I logged in the other day to test its ease of use (it’s easy!) and found that as an individual in her 20’s I could get a plan with a monthly premium of anywhere between $250 to $460, depending on the level of coverage I want.
You can check it out here; https://www.mahealthconnector.org/portal/site/connector/
Of course, similar to Federal Health Reform, MA Health Reform does little to address rising health care costs. “Massachusetts continues to struggle with escalating health care costs, reflecting the decision to defer addressing costs in the 2006 legislation so as not to hold up the expansion in coverage."
Generally speaking, I find these results promising and an important benchmark for what can happen as a result of Federal Health Reform. Some concluding thoughts:
1) Expanding health insurance coverage increased use of preventive care, decreased ED and IP visits, and led to better self-reported health outcomes. This seems like a no brainer to me – if given coverage, people will not wait until they are so sick that they have to go directly to the ED, and keeps them out of the hospital.
2) While MA health reform did not specifically address ways to reduce healthcare costs (e.g. a shift away from fee-for-service), it likely helped set in motion efforts by both payors and providers in the State to think of more efficient ways of delivering care (check out BCBS MA’s AQC initiative, as an example.)
3) What works in MA will work differently in other States. “Of course, the trajectory of policy and health reform will vary across the states, given the wide differences in their political, economic, and cultural environments and the wide range in the different states’ starting points.”
So, for the sake of healthcare, for the sake of the health of the American People, can we just call it "Rombama Care," (catchy, isn't it?) take health reform off the table in the Presidential debates, and all just get along? (and maybe focus on how the heck we can get things like bundled payments to work)?
