Massachusetts and Universal Health Coverage

As the Presidential race begins to arc towards November, both contenders will undoubtedly battle over the problem of healthcare and health insurance reform: How do we cover the uninsured? How do we keep healthcare costs reasonable or make affordable health insurance coverage accessible?

I don't feel like McCain has many good answers to these questions, so the real question is going to be whether Obama actually has anything substantive to offer. Whether Obama can push the American healthcare system towards universal coverage waits to be seen however. The US has failed to implement universal coverage for more than 50 years, so it seems unlikely they will get the whole tamale in the next four years.

Whatever incremental reform plan Obama attempts to implement, much will rest on the success of Massachusetts's health care reform plan. In 2006, state officials in Massachusetts implemented a health reform plan aimed at getting the states 600,000 uninsured residents on some sort of health insurance. As of 2008, between 340,000 and 400,000 uninsured are now insured. However, observers believe the remaining 200,000 will be difficult to insure because they belong to the middle class, which means they make too much for poverty programs and not enough to afford private insurance at the present costs. Massachusetts has decided not to penalize these folks (this was a key argument Obama made when criticizing Clinton's plan in the primary), but it lacks a mechanism to help get them insurance.

At any rate, the Kaiser Family Foundation came out in May with an overview of the Massachusetts program. It found several successes and other issues, which you can read here. It also noted some challenges of implementation, including the following:

The costs of reform have been higher than expected.
Since more people enrolled than expected, "the Governor's budget request of $869 million for 2009 is about $400 million more than that for 2008, and it is believed that this funding level may still fall short." State officials are exploring new revenues and concepts of shared responsibility. They are also concerned that state's Medicaid 1115 waiver, which expires this year, might be renewed with different levels of federal funding that will affect how the state health insurance program allocates its funding.

As health care costs rise, keeping insurance affordable will be increasingly difficult.
State officials agreed to raise the rates they paid to managed care plans that participate in the program for doctor's visits and other services. This will mean they have to charge more to those on insurance. "Concerns have been raised," the Kaiser Family Foundation concludes, "that the increase in the affordability standards exceeds the rise in workers' earnings and does not recognize the challenges people face in affording health care coverage."

Future cost controls will impact Reform possibilities
The KFF notes that "continued success will depend on controlling health care cost growth and holding together the coalition of stakeholders that came together around the broad tenets of health reform. All eyes will remain on Massachusetts as it continues to carve a path toward comprehensive health care reform and as the nation debates national health care reform."

Source: By Roundtable rtbl.blogspot.com