Massachusetts, Model for Universal Health Care, Sees Ups and Downs in Policy

By KEVIN SACK

 The New York Times

May 28, 2009

Despite a weakening economy, Massachusetts continued to measure gains in the share of residents who reported having a steady source of health care in 2008, its second year of near-universal coverage, a new study has found.

But the annual survey, taken each fall since 2006, also raised red flags regarding the ability of residents to actually use that care, with growing numbers saying they could not afford needed treatments and many reporting shortages of primary care physicians.

The studys authors wrote that there were lessons for Washington, where Congressional committees are incorporating much of the Massachusetts model into federal health care legislation.

Although major expansions in coverage can be achieved without addressing health care costs, cost pressures have the potential to undermine the gains, wrote the researchers, Sharon K. Long and Paul B. Masi of the Urban Institute.

The difficulties in receiving care were severest among low-income residents, who have gained the most from expanded access under the states law, passed in 2006. It requires most residents to have health insurance and provides state-subsidized plans for the poor. Massachusetts now has the countrys lowest percentage of the uninsured 2.6 percent, compared with a national average of 15 percent.

But the study, which was scheduled for publication Thursday in the journal Health Affairs, found that increased demand for care from the newly insured was confronting an insufficient supply of willing physicians. One in five adults said they had been told in the last 12 months that a doctor or clinic was not accepting new patients or would not see patients with their type of insurance. The rejection rates for low-income adults and those with public insurance were double the rates for higher-income residents and those with private coverage.

The authors concluded that the high rejection rates helped explain another important finding: that there has been little change in the use of emergency rooms for non-emergency treatment. Among low-income residents defined as those with incomes of less than three times the federal poverty level, or $66,150 for a family of four 23 percent said their last trip to an emergency room had been for a non-emergency, the same as in 2006.

The report sets the stage for legislative recommendations expected next month from a state commission that hopes to slow the growth in health spending. The commission has already drafted principles calling for a system of global payments to networks of doctors, hospitals and other providers. The networks would be paid for an individuals ongoing care, rather than for each procedure or office visit, providing an incentive to keep patients healthy rather than merely treating their ailments.

The researchers found consistent yearly increases in the percentage of residents who said they had a usual source of care and who had seen a doctor or dentist in the past year. But they concluded that initial gains in procuring needed care had begun to erode by the fall of 2008.

For instance, the share of people from low-income families who did not get needed care in the previous year because of cost dropped to 17 percent in fall 2007 from 27 percent in fall 2006. But it then jumped to 18 percent last year.