COVERAGE: No "Crowd-Out" Seen in Massachusetts Study

Crowd-out—when public insurance programs displace private ones—has been a big concern in health reform. Anticipated crowd-out was one reason the Bush Administration opposed SCHIP expansion earlier this year, and critics of other health proposals (including Barack Obama's) fear that adding more public options would lead to a stampede away from private plans. A new study on the first year of health reform in Massachusetts, up on Health Affairs web site, suggests that's not the case.

We found no evidence of a drop in firms offering health insurance coverage. Overall, the share of workers in firms that offered coverage was constant over the period, at 90 percent. For workers in small firms (1-50 workers), where employers are less likely to offer coverage and where employers may be more likely to drop coverage under reform, we found no evidence that the share of workers in firms offering employer coverage dropped. In fact, the share of workers in small firms who were working for a firm that offered coverage actually increased slightly over the study period, from 72 percent in fall 2006 to 76 percent in fall 2007, although the difference is not statistically significant.

A Look At Massachusetts UPK

In 2006 Massachusetts began implementing a new Universal Pre-K Initiative that provides grants to existing early childhood providers--including school districts, Head Start programs, center-based childcare, and family child care homes--to improve the quality of pre-k education they provide to 3- and 4-year-olds. 131 providers received grants in fiscal year 2007, and the program added another 105 grantees in fiscal 2008. Selected providers were those that demonstrated capacity and committment to provide quality programs. A new report from Abt. Associates looks at how these recipients used grant funds and recommends next steps for the program.

COVERAGE: A Waiver of Relief for Massachussetts Health Program

Baseball playoffs haven't even started, but they're already celebrating in Boston. Yesterday, Massachusetts Governor Deval Patrick announced an agreement with CMS to provide a new three-year Medicaid waiver to support the state's health reform program.

The renewed waiver grants the state $21.2 billion in total spending authority ($10.6 billion in federal funding) over the next three years—an increase of $4.3 billion over the initial $16.9 billion 2006 waiver. Since Massachusetts passed its landmark legislation, 439,000 of the states estimated 650,000 uninsured have gained coverage—191,000 through private insurance, 176,000 through the state-subsidized Commonwealth Care and 72,000 through Medicaid. Massachusetts alone accounted for more than 28 percent of the 1.3-million decrease in uninsured seen in the latest census numbers.

Elementary Reading Proficiency Down in Massachusetts

Yesterday Massachusetts released results from the Spring 2008 administration of MCAS, the state's students assessment system that measures whether or not students are achieving proficiency on state standards. The big headline coming out of the report is that 1 in 5 high school sophomores failed to past the high-stakes 10th grade MCAS this year--a decline from past years--due in large part to the addition of a new science assesssment that students will have to pass in order to graduate. But some state officials are also concerned with a decline in reading proficiency rates among 3rd, 4th, and 5th graders on this year's MCAS.

COVERAGE: The Uninsured Census Numbers and Massachusetts...

We had just posted our blog item about the U.S. Census numbers and the worrisome erosion of private insurance and were ducking out for a nice health-minded salad and a bit of fresh air and sunshine, when one more thought occurred to us.... Some of the decrease in the number of uninsured is from Massachusetts. In fact, using very round numbers, more than a fourth of it is. (Massachusetts has insured 439,000 people - roughly 370,00 by the end of 2007, the time covered by the Census). So if we went from 47 million uninsured, to 45.7 million uninsured, a total decrease of 1.3 million, and 370,000 were from the Bay State... Maybe we can conclude that the state's health reform initiative, despite its cost challenges, is doing what it set out to do?

We then checked whether the Boston Globe's White Coat Notes blog had chimed in, and sure enough, it reported that Massachusetts now has the lowest percentage of residents without health insurance in the nation, according to the Census data.

Averaging data from 2006 and 2007, the study found that 7.9 percent of Bay Staters did not have health insurance. From 2004 through 2005, the rate was 10.3 percent.

IN THE STATES: Positive Lab Results from Massachusetts Reform

Here at the New Health Dialogue we like to highlight reform at the state level because they serve as "laboratories of democracy." One such laboratory, Massachusetts, is succeeding in its efforts to ensure access to affordable health insurance for all Massachusetts residents.

Most recently, Governor Patrick and the Health Care Finance and Policy Division of the state government put out a report on key indicators of health care in Massachusetts. And, almost all of the indicators point to good news.

IN THE STATES: No Panacea for Cost Containment? Let's Try a Plethora of Provisions!

Since the passage of Massachusetts’ landmark 2006 health care bill, it has been all eyes on Massachusetts. The results so far: more people have insurance, out-of-pocket spending has decreased, and the bill maintains impressive levels of public support. The biggest challenge has been the higher than expected costs.

Health costs in a state are influenced by federal spending and payment patterns and policies, not to mention the U.S. tax code. So how exactly should Massachusetts go about reining in health care costs so it can keep care affordable and keep everyone insured? Well, that’s a question being asked across the country and around the world. And while there are many promising ideas floating around, there is no consensus about which method is “the best." Ever the innovator, Massachusetts has a new idea: try a whole lot of them at once!

IN THE STATES: Massachusetts Tried Reform -- And Liked It

They tried it. And they liked it.

A new poll shows that more than two-thirds of Massachusetts residents approve of the state's health reform, which has halved the uninsurance rate, bringing it down from 13 percent in fall 2006 to 7 percent by fall 2007. The 69 percent approval rating is six points higher than the 61 percent positive rating that the plan had when it was enacted two years ago, according to the survey by the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts. Results appeared in the Boston Globe.

The approval was not without some caveats, but overall, when asked if it should be repealed, continued as is, or continued but with changes, 70 percent opted to continue, but with changes. The poll did not ask them to specify what changes they favored.

Survey author Robert Blendon, professor of health policy and political analysis at Harvard, told the Globe the findings show a sophisticated understanding of a complex law.

"They are basically saying it's better to have people covered, even though there are problems here," Blendon said. "People are aware there are costs to this thing, yet they still hang in because they think it's the right thing to do."

A New Massachusetts Tax Revolt?

A measure to abolish the state income tax in Massachusetts has qualified for the ballot. A previous effort, in 2002, received 45 percent of the vote. Massachusetts has a weak initiative system. A vote to abolish the income tax would merely refer the matter back to the legislature for action.

IN THE STATES: Massachusetts Reform Report Card

The results are in!

While there are still kinks to be worked out, the Massachusetts health care reform legislation seems to be achieving many of its goals, according to a study published this week in Health Affairs. The report focuses on a few key successes and a few remaining challenges facing the new program: