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Massachusetts Health Reform Act: Striving for Universal Coverage and Controlled Costs

The Massachusetts Health Reform Act has captured the minds and attention of all residents of the United States. Its main goal is to achieve universal health insurance coverage and control costs and payments. The Massachusetts bill was enacted in 2006 by the initiative of Governor Mitt Romney, who contributed a lot to the implementation of health reform into life. New initiatives were considered by Congress and were supposed to provide regulation of health insurance in the public and private sectors and expansion of Medicaid and Commonwealth care. Massachusetts became the first American state to offer health insurance coverage to all its residents. The Massachusetts Health Reform is in progress now, and implementation faces many challenges. State officials and healthcare professionals continue to advance this reform in cooperation with the business community. The present Massachusetts governor Deval Patrick made a great contribution to the implementation of all initiatives into reality. At present, this health reform plan is developing, and observers are cautious about the outcome. Due to the Massachusetts health reform, many changes have been observed in the healthcare insurance system.

Health Care Access

Changes taking place in the American health care system today are evidently the main reason for the adoption of the Massachusetts Health Care Reform Act, which aims to improve the quality of health care in the state and keep costs under control by reforming the health care system and payment. Research reports that many patients are dissatisfied with the quality of their healthcare services, such as health plans. Doctors, on the other hand, are also worrying about the improvement of the services they are providing to patients.

Massachusetts chose to pass this legislation because of the lack of health insurance. The changes were needed in order to protect the Medicare program and make it more fiscally sound. Consumers have no guarantee that they will be able to receive quality care, regardless of what kind of that care it could be and where it is provided. The future improvement of health care services requires a number of proper strategies, which could provide serious changes in the health system and the development of the infrastructure. Research reports that the Massachusetts Health Care Reform Act became law on April 12, 2006. It was signed by the former Gov. Romney and continued to succeed by the present Gov. Patrick. Massachusetts authorities are relying on the federal government and its support.

Press reports that the act will allow consumers to receive more qualified health care assistance on a cost-effective basis, as well as give the opportunity to the health care industry to provide new effective innovations with the aim to deliver better health care services to the patients and control costs by reforming health system and payment. According to research, when the U.S. Supreme Court began to uphold the federal health reform, employers in Massachusetts had certain uncertainties about it. That is why the 2006 Massachusetts version was created. The employers are worrying about the millions of dollars that are at stake. They acknowledge that there is a need to set up two separate sets of regulations for state and federal reforms. The bill of 2006 made the Commonwealth of Massachusetts the first American state, can ensure access to health care for all its residents. High-quality care has become a reality.

How to Accomplish the Goals

The state regulators and authorities start to iron out the differences between the federal and state reforms. The research reports that in order to improve the Massachusetts healthcare system, the federal and state governments, healthcare providers, insurance companies, and stakeholders must work together. Thus, the act is supposed to accomplish all problems and complexities in order to achieve its goal and make the Massachusetts Health Reform Act perfect. Many observers consider that this act may help improve American healthcare insurance coverage, especially for poor and disabled people. In order to accomplish all tasks of the plan, a lot of details and possibilities of the state must be taken into consideration.

The legislation has to find out techniques and methods in order to realize this goal. First, healthcare organizations and groups of providers must work together in order to achieve healthcare improvement at lower prices. Second, the Commissioner of the Insurance Authority division is supposed to decide on the increase of health insurance, taking into consideration new criteria. Third, integrated care organizations must be created by 2015. Fourth, accuracy and transparency of costs, payments, quality measures and clinical outcomes have to be provided in order to improve healthcare services to the public. Fifth, the improvement of payment methods is needed. It is also worth mentioning the importance of communication between providers and patients. The legislation must support payment reforms and help them to move forward. New programs and initiatives are the main features that may lead to success. Thus, healthcare providers must work together with the state authorities to develop a strategy that will help make the transformation in the health insurance system and payment reforms.

Key Features of the Plan

The research reports that the Massachusetts state government act ensures universal coverage to all residents regardless of their income, residence of living, social status, and background. For example, interest in the Massachusetts health care reform captures a lot of state residents as well as other residents nationwide. Bigby reports that health reform in Massachusetts was initiated by Gov. Patrick, who announced the total insurance coverage for all state residents and control of rising costs and payments. The public interest in this act remains high because observers monitor its progress. They also maintain health insurance coverage for all residents and control payments and costs. It is remarkable that in 2006 then-Massachusetts governor Mitt Romney accomplished a plan that had no analogs in the history of any other state. Therefore, Massachusetts is the first state in the USA to cover all its citizens with health care insurance.

As far as its costs are concerned, this act cannot be a perfect model for the American nation. This reform has changed the method of payment and doctors` approach to patients. According to the legislation changes, all health care professionals have to provide health care services to all residents. The reform encourages healthcare providers to be flexible in using various methods of healthcare services. It is important to mobilize previous experience and provide new methods and techniques in order to maintain qualified services.

The Massachusetts Health Reform Act has certain key features that may be identified as follows: Medicaid, Commonwealth Care, Commonwealth Choice, the individual mandate, and the play-or-pay mandate. Medicaid rolls approximately 76,000 people, including long-term unemployed workers, children in families that earn up to 300% of the federal poverty level and disabled working adults. The research asserts that the new law does not bring benefits to all Massachusetts residents. The available information reports that those, who were previously uninsured and did not have Medicaid, are not satisfied with the new law. About 50% of the recipients consider that the law has hurt them, and only 22% directly say that the law is supporting them. Moreover, only 14% are sure that the costs have gone down, and about 50% are sure that the law has caused the cost to increase.

The cost of Medicaid is one of the biggest problems for Massachusetts. The number of unemployed residents has increased since the recession period, thus, rising the demand for this program. It is worth mentioning that qualifying for Medicaid is much easier than in other U.S. states, though it is putting huge pressure on Massachusetts financing. It is estimated that most of health care spending goes to Medicaid. Research asserts that it went up from 21% in 2000 to 37% in 2011. The available information asserts that Medicaid grew by $2 billion in 2011. Medicaid has been a problem for health insurance and the state budget for 25 years. Other state programs are supposed to be cut because of their relentless growth.

Research asserts that beneficiaries, who are enrolled in Medicaid, i.e., people with low income and those with disabilities, often complain that too often medical care they receive is fragmented and has very poor health outcomes. Therefore, a lot must be done in order to overcome these problems and improve Medicaid and the complex healthcare needs of the patients. The federal government spends a lot of money on Medicaid support for businesses and different companies. Due to this support, Massachusetts is able to provide health insurance coverage for all its citizens.

The Massachusetts Health Reform Act has created the Commonwealth Care program, which supports about 177,000 residents receiving health insurance programs. Through this program, people with incomes below 300% of FPL (Federal Poverty Level) are receiving health insurance. Commonwealth Care is one of the most recent programs that were provided as a key element of the Massachusetts Health Reform Act. Those who are not eligible for Medicaid are supposed to be covered by Commonwealth Care. This program provides health insurance mostly for those citizens, who have no health insurance at their workplaces, or for those, who do not work. It provides access to the residents of Massachusetts who make below 3005 of the FPL. The research asserts that Commonwealth Care requires a higher co-pay for individuals, who are insured by this plan. Thus, $5 is charged for a visit to a primary care provider and the same amount for a prescription. Every single person, therefore, would pay an extra $10,400 per year. This is a great amount of money for those residents who live just above the FPL.

Another key feature that provides access to health insurance due to the Massachusetts Health Reform Act is an individual mandate. It imposes fines on those who do not receive a waiver. A play-to-pay mandate is also one of the health insurance coverage programs. It ensures employers with more than 11 workers contribute a minimum of 33% of the cost of premiums and cover about 25% of their employees. Otherwise, they would have to pay a fine of $295 per worker. The research reports that 72% of Massachusetts employees are enrolled in health insurance. It is worth mentioning, therefore, that the national coverage is 59%. Research asserts that all available health insurance programs in Massachusetts are directed to cover employees spending on their health care. Unfortunately, the Massachusetts Health Reform Act has many challenges that are of the utmost attention to the government and the designers of this bill.

Challenges and Future Trends

Like any other program, the Massachusetts Health Reform Act has many challenges that are supposed to be overcome in the future. The biggest problem is that Massachusetts has a high cost of health care services and insurance. Professionals argue that insurance coverage of all residents has led to the problems of those who were not insured and paid the health care bills. Today, health insurance in Massachusetts costs 30% higher than in other American states. Thus, compulsory health insurance costs approximately $16 897 for a family of four persons in Massachusetts, while in other states, it costs around $ 12,700. State and health care officials are worrying about this fact and trying to implement the appropriate measures to improve this situation. The three main insurance plans mentioned above regulate the health insurance process in the state. Thus, there is no competition and very little consumer choice. Government regulations control most businesses and their health insurance plans.

According to this reform, regular citizens and private companies have lost the opportunity to be engaged as partners while creating health insurance plans. This research asserts that the Massachusetts health care system cannot be a model for other U.S. states, which have different health insurance coverage for their residents. The study informs that instead of lowering costs, health reform has become more expensive as it was expected. According to the reform, for example, all prescribed drugs must be covered by the insurance plan. This increases costs for insurance, which is usually challenging for small companies. Initially, managed healthcare was a great idea, but most insurance companies do not manage proper insurance for the patients. Many experts consider that most insurance companies just manage money in most cases. Thousands of patients avoid visiting hospitals. Instead of this, they prefer less expensive medical offices in their residential areas.

The information mentioned above proves that despite the Massachusetts Health Reform Act has provided a new approach to the health insurance system, it has many gaps that should be identified and fixed in the future. Some experts argue that the Massachusetts plan is an example of federalism, and it is necessary to create a competitive marketplace for alternative health insurance systems that may provide uninsured residents to use hospital emergency rooms at taxpayer expense. The state authorities are working to develop the strategy in order to make the helpful transformation in order to support and improve this plan. It is important to understand that more hospitals and doctors are supposed to be involved in the global payment system in order to give access to treatment for poor residents. In order to achieve universal coverage for all residents, the authorities have to overcome all problems and complexities in order to achieve their goal and make the Massachusetts Health Reform Act perfect.

Conclusion

The Massachusetts health care Reform Act has become an important issue of today’s discussion among government authorities, healthcare providers and consumers. In order to achieve universal health care insurance coverage and control of costs and payments. Today the bill is facing many challenges and problems that enable the legislation to implement the appropriate measures for its improvement. Congress is supposed to support new initiatives and provide regulation of health insurance in the public and private sector, expansion of Medicaid and Commonwealth care. The Massachusetts health reform is still in progress now. State officials and healthcare professionals continue to advance this reform in cooperation with the business community. The present Massachusetts governor Deval Patrick made a great contribution to the implementation of all initiatives into reality. At present, this health reform plan is being developed, and observers are cautious about the outcome. The residents hope for better results in the nearest future.

📎 References

1. Bigby, JA. (February 18, 2011). A Massachusetts milestone: health care payment reform legislation.
2. Blum J. (November 10, 2011). Improving Quality, Lowering Costs: The Role of Health Care Delivery System.
3. Cohn, M. (November 15, 2011). Advocacy group offers plan for affordable health care.
4. Levenson, M. (January 3, 2011). “Medicaid cost crisis looms for Bay State: Budget is pushed to brink as more enroll in program”. Boston Globe Staff.
5. Long, S.K. (October, 2008). “Who Gained the Most Under Health Reform in Massachusetts?” Massachusetts Health Reform Survey, Urban Institute.
6. Patrick, DL. (March 28, 2011). “An Act Improving the Quality of Health Care and Controlling Costs by Reforming Health Systems and Payments,” Massachusetts Medical Society.
7. Turner, GM. (January 9, 2009). “The Value of Innovation in Health Care”. Galen Institute.