The Massachusetts Model for Health Care - Editorial - NYTimes.com

June 16, 2008

WHY CAN'T OUR UPA AND THEIR SOCIALISTIC AND RED ALLIES DO SOMETHING SMILAR FOR INDIA. THEY ARE HAPPY IN PREVENTING REFORMS AS LONG THEY AND THEIR KITH AND KIN GET 5 STAR TREATMENT IN INDIA AND ABROAD AT STATE EXPENSE. ALL OF THEM GET TREATED AT PRIVATE HOSPITALS IN INDIA AS WELL ABROAD EXCEPT THOSE LIKE YECHURRY WHO ARE TREATED FOR CORYZA (COUGH AND COLD) IN THE ICCU OF AIIMS MEANT FOR CRITICAL HEART PATIENTS.

RAJINDER SANDHIR

June 16, 2008

Editorial

The Massachusetts Model

Massachusetts’s pioneering plan to provide universal health coverage is off to a good start and is heartening evidence that national health care reform may be possible if sufficient skill and determination are applied to forge a political consensus.

The state requires that all residents take out health insurance or suffer tax penalties if they don’t. It also requires employers to offer coverage to their workers or make alternative payments if they don’t. As it enters what could be a critical year in determining its viability, the plan can claim some substantial successes.

It has already covered some 350,000 of the uninsured — more than half of the roughly 650,000 residents who were estimated to be uninsured when the plan began in 2006. Two-thirds of the new enrollees signed up for subsidized coverage available to low-income people. The rest signed up for private commercial insurance, either through their employers, or on their own, or through a new “connector” organization that funnels people to unsubsidized private plans.

Critics — opponents of new entitlement programs are watching closely — are accurate when they say that coverage is hardly universal if 300,000 people still don’t have insurance. But the plan is in its early days. Enrollment has grown faster than expected, especially for a complex, newly established program.

The real test will come this year, when higher penalties for those who fail to get coverage will kick in and we will see whether coverage can really be made mandatory without sparking political resistance. So far, polls show increasing public support.

Massachusetts has also held premium increases in the unsubsidized component of the program to 5 percent, far less than the previous double-digit increases. It has reformed the costly individual insurance market so that everyone can now get insurance at low group rates — an opportunity unavailable elsewhere.

Two of the original concerns — that people might drop private insurance to gain subsidized coverage or that businesses might dump employees on the state program — have not materialized. On the downside, many of the newly insured reported difficulty finding a primary care physician, and the share of low-income residents using emergency rooms for nonemergency care rose slightly, the opposite of what was supposed to happen.

The chief criticism, however, is that costs have risen faster than the original projections, forcing the state to raise its spending estimates for the current fiscal year from $472 million to $625 million and from $725 million to $869 million for next year. The shortfall occurred mostly because the state underestimated the number of uninsured residents and how fast low-income people would sign up for subsidized coverage. It is a warning to other states to keep projections realistic.

The key challenge will be to keep costs under control and find new sources of revenue while maintaining widespread support for the program. How well Massachusetts handles that challenge will determine whether its pioneering health plan falls into a financial pit or points the way toward universal coverage.

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