"Will Massachusetts Health Reform Survive Its Fiscal Storm?" by Elmer Freeman

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The report released this month, Health Insurance Coverage in Massachusetts: Estimates from the 2008 Massachusetts Health Insurance Survey, shows that more than 97% of Massachusetts residents have health insurance, marking yet another milestone for Massachusetts health reform. While we should be proud of what we have achieved, universal health insurance coverage is not the panacea for a health care system that provides such a poor return on investment…ranking lower in health status and life expectancy than nearly every developed country; has an infant mortality rate comparable to underdeveloped countries; and accepts persistent disparities and inequities in the health of its racial and ethnic minority populations. The current realities of uncontrollable health care costs and the state’s budget crisis, begs the question, will Massachusetts health reform survive its fiscal storm?

Adding to these realities are reports in the Boston Sunday Globe of significant increases in the number of unemployed Massachusetts residents applying to the state’s Medical Security Program. A remnant of universal coverage from the Dukakis era, the Medical Security Program, provides assistance to middle and low income residents who are collecting unemployment by paying up to 80% of their health insurance premium.

The unemployment rate has increased from 4.1 to 5.9% over the past eight months and over the past year the number of participants in the program is up 73%. While some companies offer COBRA, many find it too expensive to purchase and applications to the Medical Security Program have increased substantially. The total number of the unemployed and their dependents was 13,000 at the end of November as compared with 7,700 last year. The program is also faced with the challenge of having been tapped by the Governor for $35 million earlier this year to help finance health reform.

The challenges are many … the national economic crisis, increasing unemployment, demise of major corporations, and the squeeze on the middle class. Health reform, i.e. a major (transformative even)shift in the way the “business” of health care is conducted, should be, in fact, has to be at the forefront of the economic and public policy agendas for President Obama’s administration. As the Federal government readies an economic stimulus package for the states, Governor Patrick is seeking several hundred million of dollars through an enhanced Federal Medical Assistance Percentage (FMAP) as part of a package for Massachusetts. The question here is whether he will reinvest FMAP funds in restoring the 9C cuts to MassHealth, and other health programs or use it to address the myriad other fiscal challenges of the state.

Many make the simple argument that health money ought to go to support health needs and health reform and I agree. The calls for restoring the 9C cuts to MassHealth this fall; protecting Boston Medical Center and Cambridge Health Alliance, and increasing provider reimbursement rates with FMAP are understandable. The belief that pouring this money into the current system, for the same ole reasons will help sustain health reform is wrong. It’s pouring more money into a broken system.

Our investment should be done in a very deliberative and strategic way that supports the kind of “reform” we need in the system, such as: (1) increased support for and expansion of primary care; (2) support for the most vulnerable populations; (3) improved quality and increased accountability; and (4) elimination of health disparities and promotion of health equity. Universal coverage did not bring universal access as we experience a critical shortage of primary care physicians and providers as the door to the system and a medical home for the newly insured. The tight fiscal times have had its greatest impact on those most vulnerable in society, the poor, children, elderly, and infirmed and now challenge the health and well-being of the middle class as well. The Globe Spotlight Series on the power of Partners Healthcare makes the case for creating greater transparency and increased public accountability given the amount of public money and the public’s money that goes into financing our health care system. The great and growing diversity of the country makes the persistence of disparities in health and health care of racial and ethnic minorities unacceptable and warrants a more equitable system.

We must recognize and develop health policy within the broad framework of social policy and take into account the social, political and economic determinants of health and quality of life of individuals in their communities of residence. At the local, state and national level, education policy, employment policy, housing policy, transportation policy, tax policy, energy policy, legal policy, and all policy must be seen as health policy and weigh the implications and consequences of policy promulgation on the health of the population. Now is the time for strong visionary leadership for the implementation of real health reform in Massachusetts. We certainly have that in Secretary Bigby and we should support her in her efforts.

Elmer Freeman is Executive Director of the Center for Community Health Education Research and Service, Inc. and Co-Chair of the Disparities Action Network of Critical MASS and Health Care for All

This program aired on December 29, 2008. The audio for this program is not available.

Martha Bebinger Twitter Reporter
Martha Bebinger covers health care and other general assignments for WBUR.