What Do Survey Results Tell Us About Health Care Reform?
A recent poll of Massachusetts residents found that 63% of respondents were in favor of the universal health care initiative started there 5 years ago. My son, Paul, cited these poll results in challenging my contention that the Massachusetts health care system is running into serious problems. The issue is important because the Massachusetts health care reform law was used as a model for the Affordable Care Act (ACA); and as a consequence, it may provide a preview of what’s ahead for the rest of us.
Like the ACA, the Massachusetts system
- – requires everyone to have insurance
- – provides for a highly regulated insurance exchange
- – subsidizes insurance costs to middle class workers making $64,000 per family of 4
- – increases the number of people receiving state-provided insurance (Medicaid)
- – dictates employers to provide health insurance or pay a penalty
- – demands that health insurers now accept patients regardless of their medical condition
Since the health care reform law was passed, less than 2% of Massachusetts residents lack health insurance, and 401,000 people have become newly insured, mostly through government programs or subsidies. These achievements, however, are being overshadowed by serious setbacks and escalating problems.
To begin with, under the law, health insurance premiums have risen dramatically. People who are not receiving subsidized medical insurance are paying 30% more than the U.S. average. Furthermore, the per capita rate at which their premiums is rising significantly faster than the U.S. rate. In addition, those people insured through their employers are being asked to contribute more as well.
Doctor access is another an issue. A 2011 Massachusetts Medical Society poll shows waiting periods for new patients to see a doctor have been steadily mounting since the new law went into effect. It now takes 48 days to see an internist and 36 days for a family doctor. In fact, Boston has the longest wait time to see a doctor in the nation
1 in 5 working-age adults say they have trouble even finding a doctor. One reason, according to a 2011 Massachusetts Medical Society study is that 53% of primary care doctors are not accepting new patients. In 2007 that percentage was 30. Another reason is that 62% of family primary care doctors and only 53% of internists will accept Mass Health (Medicaid). If the person is covered by government-subsidized insurance, they’ll find only 56% family doctors and 43% internists will accept them. It’s even worse for people employed by small businesses who purchase their health coverage through the Massachusetts insurance exchange. Only 44% family doctors and 35% internists will accept their insurance.
The State of Massachusetts, itself, faces far greater problems. Costs of the Massachusetts health care plan are rising faster than revenues. In addition, the federal stimulus money used to finance health care reform is running out. Other federal subsidies are soon to end as well. In short, the current cost outlay is unsustainable.
As a result, Governor Deval Patrick called for sweeping changes to the health care system, which he put before the Massachusetts legislature. In his proposal, fully 1/4 of Massachusetts residents would be switched into a new payment plan in which doctors and hospitals would be given a limited budget for each patient. This would apply to all state employees, Medicaid recipients and all others covered with state-subsidized health insurance. Altogether, 1.7 million residents would be affected. He also proposed increased co-payments and deductibles for people on the subsidized health plans. Other changes include price controls and restrictions on almost all health care providers. Legislative leaders said, in response, that it would take as much as 2 years to consider the plan because, in the words of one, “It would turn the health care system upside down.” The governor said, however, that what he proposed “was not an option” and absolutely necessary given the state’s financial situation.
Considering the wait times, growing doctor shortage, the highest health care costs in the country and headlines forecasting financial disaster for the state, why do polls show majorities supporting the Massachusetts health care reform? Let’s take a closer look at the poll’s results for some answers.
People making $30,000, qualifying them for state subsidized care, were most likely to say the new health care system helped them. And, since government subsidized insurance is provided to people making up to $64,000, it is no surprise that people making more than $75,000 were more likely to say the law is hurting their health care costs. Coincidentally, in 2010, the median income in Massachusetts was $64,057 meaning approximately half of the population in the state qualifies for government subsidies. With respect to the poll, it would be hard not to like something someone else is paying for.
In addition, regarding the state’s financial crisis, only 39% of the respondents recognized that the state cannot continue providing the benefits promised in the law. Despite the headlines, the majority weren’t aware that major changes to their health care system were necessary.
So, Paul, that’s why I contend that, despite the poll results, the Massachusetts health reform effort is running into trouble. And this should be a wake-up call for U.S. health care reform as well. Given the facts that the Affordable Care Act provides more liberal subsidies, creates and expands more agencies and adds more regulations, I’d say we’re headed for even bigger trouble.