RSNA: Mass. healthcare reform may not work as national model

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While the 2006 healthcare reform law in Massachusetts, referred to as the Accountable Health Care Act, served as a model for national healthcare reform, a closer look at the state’s statistics showed it may not make an effective federal system, according to a presentation on Nov. 29 the 97th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA) held in Chicago.

Alexander M. Norbash, MD, of the Boston University School of Medicine, began by breaking down the two major components of the Massachusetts law, a coverage mandate and the creation of a public insurance broker to help residents find affordable plans.

The insurance mandates cover both employers and consumers, according to Norbash. Employers with more than 10 full-time employees must provide a “fair and reasonable contribution” to the health insurance premium of employees. This is defined as having 25 percent of full-time workers enrolled in a company health plan or subsidizing at least 33 percent of premium costs for individuals. Companies with more than 50 full-time employees must meet both requirements or have 75 percent enrolled in a company plan. Failure to meet these requirements results in a penalty of $295 per employee per year.

Residents also have a mandate to have insurance, with any person residing in-state for 63 days or more subject to the law, according to Norbash. Tax penalties for individuals without insurance are tied to income level, but can reach as high as $1,212 per year.

The Accountable Health Care Act also established the Commonwealth Health Insurance Connector to help residents purchase affordable insurance. Offering subsidized plans through the Commonwealth Care program, residents are eligible for programs subsidized based on income and tiered by premium, with the target minimum premium set at $250 per month.

These provisions are very similar to the Patient Protection and Affordable Care Act, which has been met with mixed reception from the public. The reasons there wasn’t more resistance to the Massachusetts law, according to Norbash, were sociopolitical.

Massachusetts is the seventh wealthiest state with stable population numbers. It also has a low number of undocumented immigrants, which can cause political tensions in other states.

“What we can put in place as a solution in Massachusetts may not be possible in Texas or in California for a variety of reasons,” said Norbash.

Positive effects of the law included a 98 percent insured rate among the state’s population with nearly 100 percent pediatric coverage. Physician satisfaction went up as well, from 34 percent to 41 percent, with radiologists being more satisfied than primary care physicians, according to surveys cited by Norbash. While immediate satisfaction rose slightly, physicians did report some skepticism about the future.

Although one goal of the law was to reduce the number of emergency department (ED) visits (due to uninsured residents waiting to use EDs rather than having access to a primary care physician before a condition worsens), ED visits actually rose 4 percent after implementation of the law. Norbash said this is due to a shortage of primary care physicians and increased wait times to see a physician.

Another issue that has arisen in the state is an explosion in profits for insurance companies, to the point that some companies are triggering investigations, according to Norbash.

Norbash concluded by saying that because of the unique setting, what works somewhat effectively in Massachusetts might not work in other states.

“This is an example of a universal healthcare solution that in a certain way worked in a single state at one point in time,” said Norbash. “It’s not clear how you can extrapolate from that and come up with a federal system that works.”