"National Health Reform: Where Adages Apply" by Bruce Bullen

In the coming months, the Obama Administration and the new Congress are expected to give serious consideration to reforming the nation’s health care system and expanding coverage. Senator Kennedy is expected to play a key role in this effort, giving us a unique opportunity to apply what we have learned from the Massachusetts health reform experience to the national debate. A bit of time worn advice for federal policymakers:

Don’t reinvent the wheel. States have considerable experience providing coverage to low-income populations through their Medicaid and SCHIP programs. These programs can be scaled to grow quickly. Massachusetts has been able to successfully reduce the number of uninsured by expanding its Medicaid and SCHIP programs in both the mid-1990’s and in the most recent health reform initiative. Sensible expansion of these programs should be a key building block for federal reform.

One size does not fit all. Uninsured individuals have coverage needs that differ based on age, income, and health status. The Massachusetts Connector model recognizes this: Commonwealth Care enrollees have very little point-of-service cost sharing and pay little or no premium; Commonwealth Choice enrollees can choose among three levels of coverage. Limiting coverage options, say, to the Federal Employees Health Benefit Plan could either depress enrollment or greatly increase subsidy costs.

Health care is local.

Just as uninsured individuals are not the same, neither are the states. Massachusetts has succeeded, in part, because control has been local, allowing us to integrate reforms into existing state programs and market offerings. Local stakeholders come together and build consensus. It would make sense for Congress to set a broad framework and allow states to implement in a way that meets each state’s unique needs.

If the nation builds successfully upon work that has begun in Massachusetts, universal coverage may turn out to be more than a dream.

Bruce Bullen
Chief Operating Officer
Harvard Pilgrim Health Care