"Applying the Massachusetts Model" by Karen Davis

Editorial note: This week we will hear from national health policy experts who are tracking the Massachusetts health coverage law.

As the country prepares for a new administration that will have a unique opportunity to improve access to health care for all Americans, it's important for the nation to look closely at the effects of the historic Massachusetts health reform law. It's clear that the law has already had a major impact, halving the uninsured rate among working-age adults in the state in its first year. A Commonwealth Fund-supported evaluation published in Health Affairs also found that low-income adults reported better access to care, such as more preventive care visits, and lower out-of-pocket spending on health care. Additionally, the new public coverage did not lead to "crowd out," where employers drop coverage or employees opt for public coverage over employer coverage.

A national approach to universal coverage should incorporate the core elements of the Massachusetts plan. Like the Massachusetts law, the Building Blocks framework my Fund colleagues and I described in another recent Health Affairs article calls for expanding public coverage while maintaining the current role of employer-sponsored insurance. It also includes a new national insurance connector—similar to the subsidized Commonwealth Care and unsubsidized Commonwealth Choice —that would provide a selection of insurance plans for the uninsured, small businesses and the self-employed. We also recommend implementing an insurance mandate, as Massachusetts has done.

As highlighted in a recent issue of the Commonwealth Fund newsletter States in Action, moving forward, Massachusetts will need to consider how to best to enforce its mandate and ensure coverage is affordable. To that end, it will be critical to ensure the plan has sustainable financing.

Karen Davis, President, The Commonwealth Fund