In 2006, Massachusetts established a broader health care system to provide universal health insurance coverage to its residents while also cutting down costs. The Massachusetts health care reform features several crucial components that expanded coverage to more than 100,000 uninsured.  The reform requires all Massachusetts adults to enroll in a health insurance plan or risk penalty, while all employers must also provide health insurance to employees or pay a penalty. Low-income adults have the opportunity to join one of the state-run Commonwealth Care plans.

Massachusetts Must Control It's Health Insurance Costs

While Massachusetts has succeeded in expanding health insurance coverage, it has not succeeded in slashing costs. As of June 2010, Massachusetts has the lowest uninsured rate in the United States at 4.8 percent, having slashed the uninsured rate by 60 percent. Compare that to the United States as a whole, where 15.4% of citizens are not covered.  Massachusetts’ efforts in expanding covered should be classified as successful.

However, the successes of broader coverage cannot hide the plan’s inability to cut costs.  The wide coverage, coupled with state subsidies and reduced rivalry between health providers, has caused costs to rise. The Massachusetts Department of Insurance has denied insurers’ demands for rate hikes in an attempt to keep expenses low for consumers. Meanwhile, insurers argue that reducing rates without slashing health provider costs places undue stress on them. Premiums have increased substantially for individuals and families, while the use of the emergency room for non-emergencies did not markedly decrease, perhaps indicating a deeper issue: the primary care physician shortage.

The similarities between the Massachusetts plan and the 2010 US Affordable Care Act make Massachusetts’ successes and failures ever more glaring on the national stage. According to a report from Fortune Magazine, both the Massachusetts and Obama plans increase health care demands without addressing health care shortages.  Prices have gone through the roof, and according to Fortune, will not decrease until the government stops targeting insurers.  Insurance pools also grow more expensive as younger, healthier members drop out while sicker members stay in.  Subsidizing middle-income plans may also prove expensive, while additional state-mandated benefits have also strained the system.  According to Fortune, Massachusetts residents have begun to manipulate the system to optimize their health insurance benefits and subsidies.

If Massachusetts can successfully manage the costs associated with its health care reform, perhaps this will bode well for the Affordable Health Care Act.  Four years into the Massachusetts plan, costs have continued to skyrocket as more residents are covered. In the current economy, controlling costs is ever more crucial to the health care industry and to the country’s economy as a whole.  Solving the primary care and health provider shortage may prove a good step in shaving down costs.

In the end, it will be the costs, not universal coverage, that determine success for both the Massachusetts and federal reform programs. I hope that both reforms can find a way to cut costs beyond placing limits on insurers, perhaps by streamlining health care overall and improving the pool of preventative

Even as federal Medicaid funds through the stimulus package dwindle, experts and state officials are collaborating on ways to identify and enroll eligible children in CHIP and traditional Medicaid this year. They are also working on similar strategies to target the millions of adults who will become eligible for Medicaid in 2014. Kaiser Health Network recently interviewed three health policy analysts for their take on how states can bring the nearly 5 million eligible but unenrolled children into the Children’s Health Insurance Program. The experts from the National Academy for State Health Policy, the Center for Children and Families at Georgetown, the Kaiser Family Foundation, and the Center on Budget and Policy Priorities enumerated several strategies states could adopt.

First, simplify Medicaid enrollment by giving states the option to enroll children automatically based on their records with other government agencies like those that administer food stamps or subsidized school lunch programs. In early 2010, Louisiana identified nearly 10,000 children via its food stamp program who were eligible for CHIP or Medicaid by not enrolled. Express lane eligibility could be expanded by developing a joint Medicaid/CHIP online application which eliminates the now-mandatory in-person interview. This expedited process is currently allowed for enrolling children under a 2009 federal law and 18 states already use it as an option. Federal law could further be changed to allow express lane enrollment for adults, especially those who will become Medicaid eligible in 2014. Creating an express lane process which applies to all Medicaid eligible individuals would encourage enrollment by lowering the barriers to entry. Eligibility terms could also be increased from 6 months to 1 year, and the process for renewing Medicaid coverage could be streamlined.

New Strategies Employed to Enroll More Children & Adults in Medicaid

States might also consider eliminating the asset test applied when determining adults’ Medicaid eligibility. This test has already been dropped for parents enrolling their children in most states. One big barrier to enrolling more of the Medicaid eligible population is the social stigma associated with being on Medicaid. Unfortunately, this stigma places Medicaid enrollees in the same category as welfare recipients. Though both these programs provide necessary services to families in need, “welfare” has taken on a negative connotation in popular culture, one which Medicaid has also acquired. In order to encourage a culture of coverage, states could rename Medicaid to something more appealing and which sounds less like a welfare entitlement. My home state of Connecticut already made such a change, renaming CHIP the “Husky” Program after our NCAA Champion UConn basketball teams.

Finally, experts suggested paying incentives to nonprofit social service agencies who help enroll children in Medicaid and CHIP. Some states including Oregon, California, Louisiana, New Hampshire, Illinois, and Indiana have had success enrolling thousands of kids via these groups using paid incentives. Any or all of these strategies could prove useful to Medicaid program administrators in the years to come as the pool of eligible individuals is set to swell tremendously.

Senate and House bills were introduced yesterday that would ban insurance companies from keeping those with preexisting conditions from getting insurance. The bills will not allow insurance carriers to exclude patients based on preexisting conditions. It would also not allow disease-specific premiums or surcharges. The legislation is known as The Pre-existing Condition Patient Protection Act.

The bills are sponsored by Senator Jay Rockefeller of W. Virginia and Representative Joe Courtney of Connecticut. Congressional Democrats and President Barack Obama want to guarantee access to insurance for United States citizens including patients with preexisting conditions. Insurance companies exclude patients with chronic health conditions or other serious illness as well as even pregnancy in order to avoid paying for expensive medical care.

“This is a situation where the market is not going to solve the problem by itself,” Rockefeller said. “The insurance companies have always gotten away with what they can get away with.”

There are 25 million people who are underinsured and being denied health care by health insurance companies for having preexisting conditions. Over 133 million Americans have a bare minimum health plan along with a chronic condition.

The Pre-existing Condition Patient Protection Act can help insure those with preexisting conditions and chronic illnesses. This legislation is part of the plan to insure all Americans.

“Providing health care to more than ten million children through the Children’s Health Insurance Program will serve as a down payment on my commitment to ensure that every American has access to quality, affordable health care,” said President Barack Obama. He also stated that “As the worsening economy causes families to lose their jobs and health insurance, it is vital that we redouble our efforts to ensure that every child in America has access to affordable health care. That is why I am pleased that the Senate has joined the House in passing bipartisan legislation to provide health insurance to children whose families have been hurt most by this downturn.”

The Senate passing of legislation that will provide government-sponsored health care to approximately 4 million uninsured children is the start of Obama’s health care overhaul. The bill was approved yesterday 66 to 32 and will insure children in families that earn too much to qualify for Medicaid but not enough to afford private health insurance, increasing the amount of children who will be covered from 7 million to 4 million. The joint state-federal program will cost an additional $32.8 billion on top of the $25 billion over the next 4 ½ years. The expansion would be paid for by raising the cigarette tax from 39 cents a pack to $1.

“Low-income, uninsured kids all across America have been waiting for Congress to fulfill the promise of the Children’s Health Insurance Program for them,” said Senate Finance Committee Chairman Max Baucus. The House passed a nearly identical bill a few weeks ago with a vote of 289 to 139.

Similar legislation had been vetoed twice by former President George W. Bush. On the other hand, President Obama is eager to sign the legislation to begin the coverage that will hopefully lead to coverage for all Americans.

Along with the plans to build up clean-energy industries and boost security at U.S. ports, President Barack Obama is also promoting a plan to expand health insurance coverage in his stimulus package. His stimulus package is a part of the broader effort to pull the economy out of the recession it has been in the past year.

The report released on Saturday outlined the priorities for the two-year stimulus package which included health insurance coverage to the 8.5 million people who lost their jobs this past year. The $825 billion package of spending and tax cuts is a two-year plan that house Democrats have already begun working on.

Senate Version of Stimulus Package

The senate version of the stimulus package includes $149 billion in funds for health care. The package includes a provision that would extend Medicaid to families who have become ineligible because their incomes have increased at a cost of $1.3 billion over the next 10 years. The package also includes federal subsidies for 65% of the health insurance premiums under COBRA for 9months.

Another inclusion in the package is approximately $23 billion for health care information technology, whereas the House version is about $3 billion less at $20 billion.

House Version of Stimulus Package

The house version would allow states to expand their Medicaid programs to low-income, recently unemployed workers at a cost of approximately $9 billion through 2010. The house version of the package includes federal subsidies for 65% of the health insurance premiums under COBRA for one year. The house would also include in their version of the package, a provision that would allow recently unemployed workers ages 55 and older or those with at least 10 years of tenure at their jobs to continue to receive COBRA. They will receive COBRA until they find a job or reach 65 and are eligible for Medicare. The senate version does not include this provision.

“If we do not act boldly and swiftly, a bad situation could become dramatically worse,” Obama said on Saturday.