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Massachusetts Leads the Way With Health Reform—Again!

Michael Bihari, MD

April 2011
Editorial

The state of Massachusetts is moving forward with a debate about ways to curb rising health care costs. Following the passage of health reform legislation in 2006, Massachusetts has the nation’s highest insured rate, more than 98%. With mandated health insurance and a state-subsidized plan for people who cannot afford all or part of their premiums, the Massachusetts legislation has served as the model for the federal Affordable Care Act.

Massachusetts has fewer primary care physicians than are needed, which created a serious problem as new people became insured. This situation has improved somewhat, but people living in more rural areas of the state still have long waiting periods for appointments.

With an aging population, increased demand due to mandated health coverage, and easy access to some of the most expensive specialty health care in the country, health care costs in Massachusetts continue to rise. One of the most popular health plans being offered in the state is a Blue Cross Blue Shield plan that limits an employee’s choice by charging hefty fees for receiving care from one of 15 higher-costs institutions.

The payment reform legislation introduced last month does not mandate the
creation of ACOs. However, the legislation encourages the formation and implementation of ACOs by shifting state employees, Medicaid recipients, and residents with state-subsidized health insurance into an ACO or other alternative payment system.

If passed, the state indicates that the infrastructure and payment strategy will be in place by 2014. The legislation also authorizes the state to seek antitrust waivers from the federal government, allowing ACO providers to more easily share risk and make referrals. 

The debate about the Affordable Care Act in Congress is likely to capture headlines. With all the bluster, it is unlikely ....


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