The Massachusetts Plan: One blueprint for health care reform
In 2006, 10 percent of Massachusetts' citizens were uninsured, 71 percent of employers offered insurance, and universal access to care and coverage was a shared value. With the highest health care costs in the nation, the goal was to drive down the cost of health care and improve quality.
Since passage of the Massachusetts Plan, 400,000 people have obtained insurance coverage, half of them covered through their employer, and 2 percent of the state's citizens are uninsured. Ninety-three percent of employers offer coverage. Premium rate increases have stabilized at less than 5 percent year over year.
Health reform's net cost to the state is approximately 1 percent of the total annual budget. The state is beginning to address cost and payment reform efforts are just beginning: Blue Cross Blue Shield of Massachusetts has instituted a payment model that rewards improved quality outcomes.
The Commonwealth Health Insurance Connector Authority is an insurance marketplace and a policy-making body that assists in implementation of the health reform law. The Connector (the exchange) covers 215,000 people, 82 percent of whom receive subsidies. Five health plans participate, and 40 percent of participants are in narrow provider networks. Operating costs are funded from a portion of premiums. The cost to taxpayers has been marginal, adding an additional $400 million from 2006-08 to a state budget of $200 billion to $300 billion
Colorado has some of the lowest health-care costs in the nation, 55 percent of employers offer insurance, and 17 percent of Coloradoans are uninsured. Modern reform efforts began with Gov. Bill Owen's creation of the Blue Ribbon Commission on Health Care Reform. Gov. Bill Ritter continued the journey with his Building Blocks on Health Care Reform.
The passage of the Affordable Care Act has accelerated the pace of change, and the establishment of the Health Insurance Exchange Governing Board under Gov. John Hickenlooper's leadership is the next chapter. Colorado has chosen a less regulatory approach to exchange creation, viewing the exchange as a marketplace for the purchase of affordable insurance for individuals and small businesses.
Based on Massachusetts' experience, what can Colorado learn?
• Many changes put in place in advance of 2006 enabled Massachusetts' results and the same is true in Colorado.
• Massachusetts' results have taken more than five years; we can accelerate that timeline, but we are not likely to see dramatic changes within the first year;
• The small business community in Massachusetts has been less involved in reform efforts. Colorado must include the consumers and business in the creation of the exchange, especially small business;
• Colorado is ahead of many other states in its exchange implementation, and there is opportunity to be innovative in its creation;
• Striking the proper balance between free market principles and regulation will take patience and intentionality;
• Successful reform will result in both direct and indirect job creation.
• Massachusetts is just beginning to address health costs. Colorado's work to improve quality and decrease costs can complement our exchange creation. Examples include CIVHC, the provider fee bill, and the Regional Care Collaborative Organization.
Jandel Allen-Davis is vice president, government and external relations, Kaiser Permanente Colorado