Massachusetts Health Care Reform

In Massachusetts and across the country, the Commonwealth’s health care reform has taken on an exaggerated “persona”; for some, it embodies all that is evil about government intrusion into health care markets; for others, it exhibits all the virtues of government action.

The simple fact is that the reform is an experiment. It is likely to succeed on some fronts and fail on others. State-level experimentation is needed to test and ultimately to drive the national debate on health care reform. As occurred with welfare reform in the eighties and nineties, robust experimentation allowed federal officials to draw important lessons from the successes and failures of a number of states as they sought a thoughtful national welfare reform bill.

In a field as complicated as health care, where government involvement is already considerable and where states have historically played a defining role, we need a sensible debate based on facts. Pioneer has not yet taken a position on the reform act. We seek first to understand and measure its performance empirically. This was the impetus behind our four-part Interim Report Card series, summarized below. Our Report Card series is the first attempt to provide a comprehensive assessment of the Massachusetts Health Care Reform Act.

In March 2011, Pioneer released Fixing the Massachusetts Health Exchange, an assessment of the Connector and recommendations for reform. Click the video below to watch an interview of the author, Dr. Amy Lischko. She is a Pioneer Senior Fellow and Associate Professor at Tufts University School of Medicine.

2010 interim report cards on massachusetts health care reform

Access

The first installment in Pioneer’s Report Card series focuses on “Increasing Access.” The four metrics utilized were given the following grades:

Metric 1: Number of Uninsured Over Time and Rate of Change---A

Metric 2: Size and Growth of Commonwealth Care Program and
Measure of Crowd-Out---B

Metric 3: Employer Offer and Employee Take-Up Rates for Health
Insurance Coverage---B

Metric 4: Utilization Rates of Preventive Care Services---I

Financing

The second installment in Pioneer’s Report Card series focuses on “Equitable and Sustainable Financing.” The six metrics utilized were given the following grades:

Metric 1: Gross Contributions to Health Care Funding and Funding by Revenue Source---B

Metric 2: Changes in Per Capita Health Care Spending For the Newly Insured
vs. Health Safety Net Trust Fund Expenditures---C

Metric 3: Changes in Overall Health Care Spending in Terms of Other Economic Indicators---I

Metric 4: Changes in Average Premiums---C

Metric 5: Exemptions to the Individual Mandate Due to the Affordability Standard---B

Metric 6: Changes in the Rates of Medical Bankruptcy, Compared to Other States---C

Administrative Efficiency

The third installment in Pioneer’s Report Card series focuses on “Administrative Efficiency.” The three metrics utilized were given the following grades:

Scorecard Metric 1: Premiums and Medical Loss Ratios in Small and Non-Group Market
Compared to Large Group Market---B

Scorecard Metric 2: Competition and Adverse Selection---B

Scorecard Metric 3: Insurance Distribution Costs---C

Quality

The fourth installment in Pioneer’s Report Card series focuses on “Cost Effective Quality.” The four metrics utilized were given the following grades:

Metric 1: Availability of Health Care Quality and Cost Data and Rate of Use---D

Metric 2: Changes in Accepted Quality Metrics Compared to Control States---I

Metric 3: Cost-effectiveness of Quality Gains, as Measured by the
Changes in Overall Costs and Quality from the Reforms---Removed

Metric 4: Changes in Health Disparities---B