Dr. Alice Coombs: Mass. Health Law Put State On The Right Road

One of a series of analyses on the 10th anniversary of the 2006 Massachusetts health care overhaul. Dr. Alice Coombs was formerly the president of the Massachusetts Medical Society. She currently practices anesthesiology at South Shore Hospital. 

Before Massachusetts’ health care reform law went into effect, I distinctly remember a patient in the ICU who had difficulty breathing and had been dealing with hoarseness for more than a year. In a raspy voice, she told me she’d been working part-time, couldn’t afford medical care, and was waiting to see a doctor until after she turned 65 – when she’d be eligible for Medicare.

Because of this long wait her disease was much more advanced, involving intensive care as well as urgent surgery. My heart ached for what could have happened if only the patient had been able to see a doctor before her condition deteriorated. Instead, she came in with a more advanced stage of her illness and it changed her life trajectory.

With the Massachusetts health law, the key question was: Will patients be better off with universal health coverage? While my answer is unequivocally yes, I have concerns that still need to be addressed.

Early on one study found that African-Americans and Hispanics did not benefit from increased access in all regions of the state. When patients had to wait two to three weeks for an appointment, there was a correlation with increased emergency room visits. These patients were disproportionately vulnerable and minority patients. Other research found that many of those emergency room visits occurred between 9 a.m. and 5 p.m., a time when most clinics and physician offices are open. Nearly half of patients could have been treated in a non-emergency setting.

Today, despite improved access, racial disparities persist. One cannot deny the impact of poverty and social economic factors on health outcomes, however health care access is the absolute bottom line. If you can't access health care due to finances, then this becomes the rate limiting factor in quality. The patient described above is an example of the impact of costs on health care decisions and outcome.

Here in Massachusetts, the Medicaid acceptance rate is also a barrier for some patients. A person can live in an area with an adequate number of primary care physicians, but those physicians may not be accepting new patients, especially those on Mass Health/Medicaid. It’s like having a check that no one will cash and results in patients having to travel long distances for care.

Insurance plans with co-pays, coinsurance and high-deductibles can also impact access. Patients may postpone or skip care to save money.

We are seeing the unintended consequences of rising costs. Of course this was inevitable, costs were escalating prior to the passage of the state’s health care law. The Health Policy Commission was created to do address this problem and is exploring ways to reduce costs in a transparent way. But there are many areas of cost escalation that need to be addressed, including the price of drugs and medical equipment.

Despite our hurdles, and the work that still needs to be done, I am proud to stand with more than two-thirds of the physicians in the state in supporting the state’s health care law.

Health Law Turns 10: What Analysts Say: