Is Massachusetts the Way to Go?

Les Masterson, for HCPro, Inc., February 27, 2008

Massachusetts sparked the American Revolution, founded the first public schools, and led the movement to abolish slavery. Since those heady early years, Massachusetts has been known not as a leader, but for corrupt politicians, bloated public projects, and the Red Sox.

It's been a long time since Massachusetts took the lead, but The Bay State has grabbed the reins on the top domestic issue--healthcare.

The Massachusetts health insurance experiment, which is called Commonwealth Connector, is closing in on the two-year mark since the Health Care Reform became law on April 12, 2006. There have been some successes as hundreds of thousands of previously uninsured residents now have health insurance, but the initiative has also needed to maneuver around some Boston potholes. The latest dispatch from the epicenter of healthcare reform is that the subsidized state program is struggling with costs and bursting enrollment. While officials predicted a 5 percent premium increase for the nonsubsidized (and less popular) Commonwealth Choice plan, the subsidized Commonwealth Care could see as much as a 14 percent premium increase and doubling of copayments.

The subsidized plan, which insures Massachusetts residents below 300 percent of the poverty level, has been inundated with a larger than expected elderly population. With four months left in fiscal year 2008, Commonwealth Care already has 33,000 more enrollees than predicted by the end of the fiscal year.

Supporters and foes should not reach conclusions about the program's success or failure just yet. Keep in mind that Commonwealth Connector is still in its infancy and with any new venture there will be speed bumps.

Over the next few years, there will be a number of questions that need answering in the Massachusetts experiment and in healthcare reform in general:

  • Experts are already pointing to primary care physician shortages, and having more insured Americans with access to primary care physicians will surely exacerbate that problem. Things are already tough for doctors in Massachusetts. What impact will more insured residents have on the already burdened healthcare system?

  • Will state leaders--faced with spiraling costs--take a bite out of health insurers and/or cut physician payments rather than raise premiums? And if this happens, will managed care walk away from the initiative? Will doctors stop accepting Commonwealth Connector patients?

  • Gov. Deval Patrick, a Democrat who took over January 2007, rode his way into the corner office campaigning as an outsider who wanted to shake up the State House. He has experienced a bumpy ride during his year in office--even though the legislature is largely Democratic. Patrick is a proponent of Commonwealth Connector and recently proposed an increase in Commonwealth Care spending from $471 million in fiscal 2008 to $869 million in fiscal 2009. With costs and enrollment on the rise, will that kind of support remain? Is there the political will to suffer through the peaks and valleys of this unique program?

  • Several governors have presented their own healthcare plans in order to control costs and offer insurance to the estimated 47 million uninsured Americans. States have presented health reform legislation that is different than Massachusetts' individual insurance requirement. Instead, they have implemented cost controls, taxed businesses that don't provide health coverage, required employers to allow parents to have their children (in some cases as old as 30) on their health coverage, and forced insurers to give coverage to those who switch from group plans to individual plans.

    Massachusetts' requirement caused enrollment in the Commonwealth Connector programs to go from a mere trickle to a flood once the penalty deadline grew near. Five years from now, how will Massachusetts' requirement compare with other state initiatives? Can leaders find a way to create healthcare coverage to the uninsured without it crippling state budgets, managed care, and the healthcare system?

  • The Bay State's insurance plan faces some major hurdles, and Massachusetts finds itself as a national leader. For those who live in the commonwealth and observe its leadership, that realization is frightening.

    Here's hoping today's Massachusetts leaders can take some inspiration from the commonwealth's forefathers and create a healthcare system that doesn't sink into a morass of mandates, regulations, political infighting, and costs. The last thing we need is for the Commonwealth Connector to become the healthcare version of The Big Dig--an endless money pit that is an embarrassment, potentially unsafe, and destroyed by incompetence and greed.

    Les Masterson is senior editor of managed care with HCPro, Inc. He may be reached at
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