I read a great blog posted at Commonhealth (run by WBUR, Massachusetts) that asks an obvious question that I’ve rarely seen discussed: Is Massachusetts’ mandatory health insurance law real health "reform" or merely an expansion of health coverage? As Michael Chiaro of Community Partners sees it:
According to Merriam-Webster Online:
Reform: to put or change into an improved form or condition; to amend or improve by change of form or removal of faults or abuses.
Expand: to open up; to increase the extent, number, volume, or scope of.
My area of expertise is eligibility and enrollment. From this
perspective, I would suggest that what we have created is primarily a
beneficial expansion of health coverage options, an “opening up” as
opposed to an “improved or changed form.”
According to the Connector’s April 29 handouts, 230,000 of the 340,000
newly insured through Chapter 58 owe their coverage to expanded
eligibility: 55,000 people have been added to MassHealth and 175,000
people are now covered by the Commonwealth Care program. Commonwealth
Care is essentially a beneficial addition to the menu of subsidized
coverage options that offers expanded eligibility but a fundamentally
Getting more people enrolled in subsidized health insurance is a great thing. But does that mean the system has really changed?
Fundamentally, it seems that the ways people get or don’t get insurance
have not been reformed. If people can afford coverage, they get it; if
they cannot, they don’t. This is best illustrated by the “people in the
middle” – people who are not poor enough to get subsidized coverage but
are not earning enough to pay for private insurance. They are at the
heart of the health care challenge in Massachusetts, and in America.
These moderate-income people may be exempt from the individual mandate
penalty, but they still have no affordable health coverage. Chapter 58
has significantly reduced their numbers, but those remaining uninsured
face the same challenges they did before.
The Massachusetts law at its core left the current system intact. Insurance companies decide what insurance covers and what it costs. In fact, the few real reforms that proponents of mandates in other states (including California) have proposed were already in place in Massachusetts, including community rating and guaranteed issue. Nevertheless, a health insurance mandate can only work around the edges (and continue expanding government assistance) without first addressing the fundamental issue of affordability. That means taking on the mighty health insurance industry.