Healthcare Reform in Massachusetts: A 6-Year Review

A robust healthcare reform initiative in the state of Massachusetts has significantly reduced the number of uninsured residents in the state and improved patient access to healthcare services, but there are still challenges that remain. These were some of the conclusions drawn in a new report from The Henry J. Kaiser Family Foundation that assesses the successes and challenges of the reform initiative 6 years after it went into effect. The report, titled Massachusetts Healthcare Reform: Six Years Later, also explores the insights garnered from this program, which could be beneficial for other states.

Massachusetts passed the healthcare reform initiative in 2006 in an effort to expand health insurance coverage for state residents. Under the reform, the state created the Commonwealth Health Insurance Connector, an insurance exchange that gives residents access to both subsidized and nonsubsidized private health insurance.

In addition, the state—which had already passed previous legislature outlining a guaranteed issue— created coverage and affordability standards, expanded Medicaid and the Children's Health Insurance Program to cover family incomes up to 300% of the federal poverty level, and adopted an individual mandate requiring all adults to purchase health insurance or be subject to a financial penalty. Employers were also required to offer cafeteria plans and contribute to their employees’ health insurance (if they had ≥11 employees) or pay a contribution of up to $295 annually per employee.

Since the reform initiative was passed in 2006, Massachusetts has seen a significant drop in the number of uninsured residents in the state. According to findings from the Current Population Survey, the percentage of uninsured residents in Massachusetts dropped from 10.9% in 2006 to 6.3% in 2010. These figures are in sharp contrast with the national averages, which were 17.1% in 2006 and 18.4% in 2010. Although the state has had gains in residents receiving coverage through the insurance connector, employer-sponsored coverage remains the largest source of health insurance coverage.

After implementation of healthcare reform, more adults acquired health insurance coverage. The state also found that more adults received preventative services, had a usual source of care, had fewer unnecessary emergency department visits, and had fewer inpatient hospital stays. However, the state has also seen a greater demand for healthcare, particularly in underserved communities. For example, according to the report, from 2009 to 2010, community health centers and safety net hospitals saw a 12% increase in their patient volume and some residents still reported difficulties finding a primary care physician who could see them in a timely manner.

To address this increasing demand, the state has adopted primary care physician recruitment programs, increased medical school enrollment for those students who are committed to becoming primary care physicians, and offered a loan repayment option for providers willing to work in underserved areas.

Massachusetts faces other challenges, such as cost containment. Based on data from the report, Massachusetts has per capita health spending 15% higher than the national average. In addition, the state has the highest individual market premiums in the nation. In 2008, Massachusetts passed additional legislation designed to begin cost containment efforts, and state officials still continue to explore new cost containment options.

The state will also face changes to healthcare when the federal reform goes into effect in 2014. Although federal reform was modeled in part on the Massachusetts reform, there are differences between the two and the state may need to shift existing programs, create new information technology systems, or adjust interagency coordination to meet the federal requirements.

Regardless of the challenges that remain for the state, the report concluded by saying that the early successes and challenges in Massachusetts may provide valuable insight for other states as the date for implementation of federal reform approaches.