This month, we celebrate the sixth anniversary of Massachusetts’ health care reform. Our reforms are an expression of values, a codifying of our belief that health is a public good and that everyone deserves access to affordable, high-quality care.
Like President Barack Obama’s Affordable Care Act, we took a hybrid approach, relying mainly on private insurance provided through the workplace, and added varying degrees of public subsidy depending on a person’s ability to afford private insurance.
It’s working. Today, more than 98 percent of Massachusetts’ residents have health care coverage, including 99.8 percent of children. No other state in America can touch that. More companies offer their employees insurance today than before the bill was passed.
In addition, more than 90 percent of our residents have a primary care physician, and four out of five respondents to a recent survey have seen their primary care doctor in the last year. Emergency room visits for primary care are down, and spending on the uninsured and underinsured has dropped by nearly half.
We’re healthier, too. For example, because of access to screenings, we’ve seen a 36 percent decrease in cervical cancer in women.
All this while adding about 1 percent to state spending on health care.
Those are the numbers, but policy matters most where it touches people. I remember meeting a young woman named Jaclyn Michalos, a cancer survivor who got the care she needed through the Commonwealth Connector, our version of the federal health law’s insurance exchange. She had no way to afford treatment before Massachusetts’ health care reform. The state’s reforms saved her life. Another profound change brought about by the state’s reforms — people no longer have to fear that their insurance would be cancelled when they get very sick and need it most, or that a serious illness would leave them bankrupt.
Our next challenge is slowing the growth in health care premiums. This is a national problem, one neither caused by our reform nor unique to Massachusetts. Spending on health care makes up 18 percent of all spending in the United States, and it is projected to reach 34 percent by 2040. As health spending continues to grow at this historic rate, it weakens our ability to compete and slows job growth.
But just as we in Massachusetts have provided the national model for universal access, I believe we are on track to crack the code on cost control.
We have already seen significant progress. Two years ago, I directed the state’s insurance commissioner to disapprove excessive premium hikes. While an admittedly blunt tactic, and not in and of itself a long-term solution, it was a necessary step to galvanize the market to act.
Since then, hospitals and insurance carriers have reopened their contracts and cut rate increases, in some cases by more than half. We’ve created limited network health plans to give consumers opportunities to get great care in neighborhood settings at lower cost. Certain plans tailored for small businesses promise to be as much as 20 percent cheaper than current rates. We are also ending administrative duplication by requiring common codes and forms from insurers and providers. And, with the help of the Affordable Care Act, more providers are piloting medical home or accountable care models that manage wellness for the whole person, and promise to deliver better and more cost-effective care.
These tactics are making a difference. In the last two years, average premium increases for small businesses and individuals have dropped from more than 16 percent to less than 2 percent today.
Our focus now is on making these gains last.
There are a number of strategies we are pursuing, including putting an end to the “fee-for-service” model wherever practicable — to stop paying for the amount of care and start paying instead for the quality of care. We are working with our health care community to accelerate this transition to innovative, sustainable models in which incentives are realigned to reward integrated care that emphasizes wellness and lowers costs for everyone. Our goal is for integrated, cost-efficient caregiving to predominate throughout Massachusetts by 2015.
This is a complex challenge, but we are making great progress in Massachusetts and will be successful in the end.
For us, and for this country, solving the health care challenge has everything to do with fulfilling our generational responsibility — that old-fashioned idea that each of us in our time must do all we can to leave things better for those who come behind us. This challenge belongs to all of us, from whatever party or no party. We owe it to our future to get this right.
Deval Patrick began his second term as governor of Massachusetts in 2010.