Why is MA Changing Best Healthcare System in Country?

Thursday, May 08, 2014

Massachusetts tied for second in a recent national ranking for "best performing healthcare system" in the country -- but the future for healthcare coverage in the Commonwealth is facing major changes to the online insurance marketplace -- at a projected price tag of $121 million.

MA ranked number 2 behind Minnesota in the in the NY-based Commonwealth Fund for "health care access, quality, costs, and outcomes" over the 2007–2012 time period, prior to the technical issues that occurred with the rollout of the Affordable Care Act in 2013 that has sparked debate about the future direction of healthcare coverage in the state.

On Thursday, the Health Connector board approved a dual track approach to "stand up a functioning HIX by November 2014", from either using a new private contractor to design the site -- or else have MA join the federal healthcare exchange.

Most Recent Health Connector Proposal

"Since launching health care reform in 2006, Massachusetts has been a national leader in health care access and affordability. Our insured rate is 97 percent, tops in the country. The transition to the Affordable Care Act gives us the opportunity to expand coverage to more people, and offer more people the opportunity to get financial help for their premium costs," said Mass Dems Matt Fenlon.

Fenlon continued, "We just completed open enrollment that had some victories for Massachusetts. Through the very successful Medicaid expansion, more than 195,000 people were placed into MassHealth. At this point, more than 200,000 new people have applied for subsidized coverage through the Health Connector, and are currently receiving temporary coverage benefits."

As for the next steps, Fenlon said he was optimistic that the newest change would be successful. "In Massachusetts, we have the best health-care system in the world. We will have in place a system this fall that will make it easier for residents to access the benefits created by the Affordable Care Act."

Democratic gubernatorial candidate Joe Avellone was similarly hopeful -- but expressed concerns about costs moving forward.

"Massachusetts has some of the finest doctors and hospitals in the world, and our quality of care overall is very high. And we are the first state to have a system which insures everyone. We should be proud of that. The next challenge is to keep it affordable for everyone," said Democratic Gubernatorial candidate Joe Avellone.

Debate over Site

While MA Health Connect said the "dual track strategy reduces technology delivery risk and is the only responsible choice to achieve our top priority," interest groups -- as well as candidates, have voiced their opposition to such a move, specifically to the federally run website.

"Our preference would have been to delay the decision, and work with us to identify an approach to maintains a state exchange, to see if there were other simpler, less expensive options possible," said Eric Linzer with the MA Association of Health Plans.

Linzer continued, "I can't state strongly enough there is a complexity that comes with having to build two separate systems, especially the costs associated. The goal will be that the disruptions don't happen again. The federal exchange is not a good option, it doesn't reflect the uniqueness of the Massachusetts, and it doesn't have a working backend -- you can go in and shop, but that's about it."

Republican gubernatorial candidate Charlie Baker was vocal as well in his opposition to having Massachusetts potentially opt for the federal system -- and called for a preservation of the current platorm instead.

“Bipartisan cooperation made Massachusetts a national leader on health care reform, and our approach was working. The disruption, uncertainty, price increases, and loss of control and public accountability associated with the early rollout of the Affordable Care Act are hurting the people of our state,” said Baker.

“It is wrong to stand by and permit a successful state-based health care reform program to be derailed by a federal takeover. We should preserve what worked here in Massachusetts, and most important of all, to retain our ability to control the destiny of our health care system here in the Commonwealth."

MA Dems Split

Attorney General and gubernatorial candidate Martha Coakley said that while MA has been a top of the nation in terms of healthcare, it is necessary that changes are made in order to continue to be so - and should not include opting into the federal system.

“Massachusetts must continue to be a leader in providing access to quality health care for its citizens, and it is critical that we fix this problem," said Coakley. "There are three priorities now – getting an effective site up and running as quickly as possible, protecting consumers, and protecting taxpayers. This is the best of the remaining options to continue to maintain access to quality health care coverage for thousands of people."

Coakley continued, "I do not believe the solution is for Massachusetts to join the federal website. We have already made health reform work in Massachusetts, and we should have every opportunity to get our state site up and running effectively.”

On Thursday, democratic candidate Juliette Kayyem blasted Coakley for not being open to "Plan B."

"Once again, Martha Coakley is simply interested in scoring pointless political points, rather than in solutions," said Kayyem. "Her proposal makes little sense to anyone who has dealt with complex systems. Should we be upset by the failure of the health-connector website? Yes, we should be angry, especially those of us who believe in the government's capacity to make our communities a better place."

"But our approach to fixing the failure cannot be in closing off solutions. Having actually managed crises, I know that it is critical that multiple solutions are tested, especially when those systems have failed," continued Kayyem. "That is exactly what Governor Patrick is trying to do by launching two options to be considered to get the best solutions for our citizens."

Looking Ahead

In their report release, the Commonwealth Fund noted specifically the situation facing Massachusetts - and findings from the "Scorecard on State Health System Performance, 2014," signaingl both promise and caution for the future.

"Massachusetts’ experience with insurance coverage expansion suggests that cost-related barriers to care should ease for individuals and families who gain coverage under the Affordable Care Act. This increased access, in turn, should support broader improvements in quality of care and health status," said the Fund .

Democratic candidate Don Berwick gave his perspectives on the system's shortfalls -- and what he thinks can be done to fix it.

"I am deeply concerned by the Mass Health Connector's troubles. Too many people and families are faced with uncertainty, and it is a serious concern as we seek to maintain our commitment to health care as a human right in our Commonwealth. While I am confident that the problems will be fixed before this year's open enrollment, and I don't believe long-term delivery problems will result, we have many other urgent matters to address," said Berwick.

"Above all, our current multi-payer system adds complexity, bureaucracy, and cost. That's why I am the only candidate for Governor favoring a single payer system, similar to Medicare for all. There is tremendous opportunity for cost savings, simplification of care, and increased patient voice in single payer, and it's time to go there."