LESSONS FOR THE NATION by Celia Wcislo

Last week, the Patrick administration and the Connector Board shared the news that 300,000 residents now have health insurance, and these numbers are still climbing week by week.

And as we conclude the first full year of our efforts to provide health insurance coverage to nearly all Massachusetts residents, this administration, members of the business community, healthcare advocates, and providers remain committed to our approach of shared responsibility.

As a longtime healthcare advocate, I remain firmly committed to the true spirit of the law, which is ensuring that individuals are only asked to purchase insurance if it is affordable. The law recognizes that at rates of 10-12% medical inflation each year, individuals are uninsured in Massachusetts simply because they can't afford it.

Massachusetts has made incredible progress by providing affordable, comprehensive coverage this first year, and we have some very valuable lessons to share with our fellow states on the verge of healthcare reform and the nation:

Lesson #1: Most states don't know how many residents are uninsured. Massachusetts is no different.

The former administration estimated roughly 380,000 uninsured, and it's clear from enrollment rates that there are many more uninsured - possibly as high as 500,000-600,000. Now we are getting a better idea of the problem we have to solve, and we are well on the way to solving it.

Lesson #2: All states will struggle to control medical costs. Even if there's an identified source of revenue for reform, we all need a way to address the escalating cost of insurance and prescription drugs. Massachusetts insurers estimate an increase of 10-12% next year, estimates which are spurring on the Connector's work to comprehensively address the issue of cost inflation. We've seen the forecasts, but we are not backing away from our commitment to insure everyone.

Lesson #3: From a public health perspective, the individual mandate is succeeding. It helps ensure that all Medicaid and SCHIP eligible patients are participating in these federal programs, and it makes preventative and more cost effective treatment of serious chronic diseases possible.

Lesson #4: Healthcare reform doesn't happen in one year. The Commonwealth is phasing in coverage, and is focused on getting the uninsured into the right plan. We are learning (and growing) day by day.

Lesson #5: We have already overcome many obstacles, and additional success will undoubtedly mean additional hurdles for us. Can we save money through limited networks? Will minimum creditable coverage really protect people and provide quality care, or have we set deductibles too high for those with limited finances? Whatever our future holds in Massachusetts, our challenges will be those of success, not failure.

Lesson #6: The stories of individuals who now have health insurance warm the soul of every caregiver and healthcare advocate I know. Instead of waiting for hours in an E.R. with a problem, there are now far more individuals who can now see their doctor first to head off that problem.

Lesson # 7: Massachusetts is just the starting point to real health insurance reform. With almost 47 million uninsured nationally and a system that is spinning out of control in terms of cost, we need a national solution to our national crisis.

As California and Colorado, Minnesota and Pennsylvania, New York and Washington state roll out their own efforts to expand health coverage, we have a lot more to share and to learn from one another. I'm confident that Massachusetts' lessons of success and challenges will be invaluable to these states, and ultimately shape and inform our first national healthcare reform plan.Celia Wcislo
Assistant Division Director
1199SEIU United Healthcare Workers East