Washington Bureau
James Oliphant reporting from boston
Kim Geiger reporting from washington Three years ago, Massachusetts passed the most sweeping healthcare bill in the country, adopting a plan that closely resembles the proposals being considered by Congress--and a plan that now offers powerful "lessons learned" for the whole country. The Massachusetts system, like the proposals moving toward votes in the House and Senate, focused on three goals: making medical insurance almost universal, fostering competition through a regulated insurance exchange, and helping low-income workers pay for coverage. Today, the Bay State leads the nation with 96 percent of its residents covered by insurance, even more than some of the plans now before Congress. The employer-based insurance system remains intact despite fears that overhauling the old system might cause companies to pull back. And at least some Massachusetts residents who buy their own coverage are paying less. But there's another side to the Massachusetts story: Health insurance premiums for most residents are going up. Many middle-class people who had insurance before the overhaul see little change--except that they're spending more on healthcare. And costs, such as payments to doctors and hospitals, are still soaring. "What we did was health insurance reform, not healthcare reform," said Massachusetts Sen. James Eldridge, a former proponent who now regrets having voted for the bill. Take 62-year old Joan Young and her husband, who live in a suburb west of Boston. They pay more than $1,100 monthly for insurance, plus a $1,000 deductible each before coverage kicks in. Their insurer, Blue Cross/Blue Shield, like the others in the state, says it expects to raise the price of premiums by 10 percent next year. "It's not helping people like us," Young says. "They forget about the middle class." Now the legislature is going back and trying again, this time fashioning policies to govern insurers' profits and doctors' pay--entering a second phase of healthcare reform that many analysts think also lies ahead at the national level. A special state commission established to tackle the cost problem said the stakes are high. Continued cost growth, it said in a report this summer, "threatens the viability" of the healthcare initiative. Critics of the healthcare overhaul bill that passed the Senate Finance Committee this week say it, too, doesn't do enough on costs. Robert Laszewski, a healthcare policy analyst and former insurance company executive, calls the Finance bill "Massachusetts all over again." Ralph Neas, of the National Coalition on Health Care, says the cost provisions that do exist focus too much on public programs, especially Medicare, and not enough on reducing what doctors, insurers and hospitals charge customers who get their coverage from the private market. "The long-term cost control provisions are few, and they do not have adequate enforcement mechanisms," Neas said. But other experts say there's still time to address the cost issue more forcefully as the final Senate bill is hammered out by Democratic leaders later this month. "At the national level, there has not been an explicit decision to postpone cost containment," said Paul Ginsburg, who heads the nonpartisan Center for Studying Health Policy Change. "There's a lot of belief that we should deal with it now." On the plus side, the Massachusetts overhaul has made things better for the 430,000 residents who previously had no insurance. The state mandated coverage for almost everyone, as Congress is moving to do nationally level. And, as with the plans before Congress, it provided subsidies to help low-income individuals and families pay their premiums. "The subsidized plans--in terms of access for low income people--have been a godsend really," said Carol Pryor, policy director of The Access Project in Boston. Also, for some in the individual market who don't qualify for government assistance, the regulated exchange has produced policies with lower premiums-up to 20 percent lower, the state says. "If you are buying insurance on your own and you want the insurance, you're in a much better position," said Jon Kingsdale, executive director of the state's insurance exchange, the Commonwealth Connector. The price cuts have not been shared by all. Because consumers can still be rated by age, with insurers free to charge higher premiums to older consumers who may be more likely to incur substantial medical bills, a 55-year-old would pay almost as much as before. Moreover, while the subsidized plans cover only about three percent of the 5.4 million in the state who have health insurance, the subsidies are estimated to carry a price tag of $1.3 billion by 2011, double what it cost in 2007. At the same time, private premiums are skyrocketing. In 2008, yearly family premiums here averaged $13,788, the highest in the nation. They're projected to reach $26,730 by 2020. Experts say there is also no evidence that the law has done anything to slow the rate of medical bankruptcies. Then there is the problem of gaps in the relatively less expensive plans that many low-income residents are buying. These so-called "Bronze" plans offered on the exchange have high deductibles and make consumers responsible for a much larger share of any medical bills than the more expensive plans. Moira Rioux, 45, of Plymouth suffers from an immune deficiency requiring monthly treatments that cost $6,560 each. She's covered through her husband's employer-based insurance, but the policy only pays 40 percent of the cost of her treatments. Rioux now carries two policies-her family plan and a supplemental individual plan she bought through the government-regulated exchange. She's happy to have her second policy, which has helped some with the cost, but not enough, she said. "How am I going to manage these costs?" she asked. "It's nice that everybody in Massachusetts has care at this point, but there's still missing pieces to the puzzle." joliphantlatimes.com kim.geigerlatimes.com
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