Report from Massachusetts: employers largely support health care reform, and few signs of crowd-out appear

Based on a 2007 survey of 1,056 randomly selected Massachusetts firms, this paper presents findings about employers' attitudes about, knowledge of, and responses to recently enacted reform legislation. A majority of Massachusetts employers agree that all employers bear some responsibility for providing health benefits, firms not offering benefits should be required to pay a "fair share" contribution up to $295 annually per employee, and employers with ten or fewer employees should not be exempt from this requirement. Only 24 percent of employers with 3-50 workers are familiar with the Connector purchasing pool. About 3 percent of Massachusetts small employers intend to drop coverage, similar to national figures.     

How have employers responded to health reform in Massachusetts? Employees' views at the end of one year

In April 2006, Massachusetts enacted legislation that seeks to move the state to near-universal health insurance coverage, with key components of the reform effort targeting the role of employers. Based on surveys of working-age adults ages 18-64 in Massachusetts in 2006 and 2007, this paper examines employers' responses to health reform as reported by their employees. Results suggest that at roughly the end of the first year under health reform, employers in Massachusetts had made few changes in the insurance coverage they offered to their workers.     

Job-based health insurance in 2001: inflation hits double digits, managed care retreats

Drawing on the results of a national survey of 1,907 firms with three or more workers, this paper reports on several facets of job-based health insurance, including the cost to employers and workers; plan offerings and enrollments; patient cost sharing and benefits; eligibility, coverage, and take-up rates; and results from questions about employers' knowledge of market trends and health policy initiatives. Premiums increased 11 percent from spring 2000 to spring 2001, and the percentage of Americans in health maintenance organizations (HMOs) fell six percentage points to its lowest level since 1993, while preferred provider organization (PPO) enrollment rose to 48 percent. Despite premium increases, the percentage of firms offering coverage remained statistically unchanged, and a relatively strong labor market has continued to shield workers from the higher cost of coverage.     

Massachusetts health care reform: a look at the issues

Massachusetts recently enacted a major health reform that could move the state to close to universal health insurance coverage. We describe some of the politics behind the legislation and the law's key details. We discuss four major issues that the plan would face: (1) a definition of affordability-how much should be borne by individuals and how much by government; (2) issues the state will face in implementing the Insurance Connector; (3) whether employers will respond by dropping coverage; and (4) whether the financing would be adequate, both immediately and over time. Massachusetts will face challenges, but it offers a model that could be followed elsewhere.     

美国医疗保障制度改革的先行者——马萨诸塞州医改综述

马萨诸塞州2006年医改被视为2010年奥巴马美国医改的原型和模板,研究马州医改进展和效果,有助于推断美国医改可能取得的成绩及问题.2006年马州医改主要通过以下方式扩大医疗保险覆盖范围,提高医疗服务可及性.一是增加政府投入,扩大面向低收入人群的马州医疗援助计划覆盖范围,新建资助中低收入人群参保的公民健康保障计划,从而提高中低收入人群的参保能力;二是新建医疗保险交易局管理新建计划,干预私营医疗保险市场,新建致力于医疗保险标准化、面向高收入人群的公民健康选择计划;三是强制个人参保,要求雇主为雇员提供保险.综合现有文献,马州医改已取得许多成就,但也存在一定问题.一方面,无保障人群数量不断缩小,居民医疗服务可及性提高,可负担性也有所改进;另一方面,医疗支出快速上升影响了改革的可持续性,制度设计的一些缺陷影响了部分人群的医疗服务可及性,同时安全网计划资金的消减也可能影响医改效果.我国可借鉴马州经验建立商业健康保险管制机构,促进我国商业健康保险市场发展;同时需准备面对全民医保覆盖后的医疗费用快速增长问题,还需警惕全面覆盖后的“参保却不享有”问题.     

Massachusetts' health care reform increased access to care for Hispanics, but disparities remain

Hispanics are more likely than any other racial or ethnic group in the United States to lack health insurance. This paper draws on quantitative and qualitative research to evaluate the extent to which health reforms in Massachusetts, a model for the Affordable Care Act of 2010, have reduced disparities in insurance coverage and access to health care. We found that rates of coverage and the likelihood of having a usual provider increased dramatically for Massachusetts Hispanics after the state's reforms, but disparities remained. The increase in insurance coverage among Hispanics was more than double that experienced by non-Hispanic whites. Even so, in 2009, 78.9 percent of Hispanics had coverage, versus 96 percent of non-Hispanic whites. Language and other cultural factors remained significant barriers: Only 66.6 percent of Hispanics with limited proficiency in English were insured. One-third of Spanish-speaking Hispanics still did not have a personal provider in 2009, and 26.8 percent reported not seeing a doctor because of cost, up from 18.9 percent in 2005. We suggest ways to reduce such disparities through national health care reform, including simplified enrollment and reenrollment processes and assistance in finding a provider and navigating an unfamiliar care system.     

Health Care Coverage and Costs in Small Business: An Exploratory Study

Health coverage and health care costs continue to frustrate employers, employees, and public policy makers. Controlling escalating health costs, improving coverage for the uninsured, and providing retiree health care are all important to the small employer. This study was undertaken to investigate the availability and extent of health care coverage and to assess the effects of health care costs on small firms. The results revealed that the percentage of small firms offering health benefits totaled 58 percent. The availability of group health insurance increases as firm size increases. Small employers cited insufficient profits, high insurance costs, and unavailable group coverage as the primary reasons for not offering health benefits. The results also indicated that the vast majority of small firms opposed a mandated employer-provided health coverage and suggested that small businesses should pool together to form groups to reduce the cost of health care coverage for small firms.     

The ABCs of HIPCs (health insurance purchasing cooperatives)

HIPCs, or health care purchasing cooperatives, are attracting widespread interest as a key element of the managed competition approach to health reform. HIPCs perform several useful roles for individuals and small employers unable to obtain health insurance coverage in the current system by spreading risk more evenly and purchasing coverage in a given region or market area. While HIPCs are generally associated with managed competition, they are also compatible with reform strategies that require employers to pay for coverage or those that provide incentives for expanded coverage.     

Health care coverage and costs in small business: an exploratory study

Health coverage and health care costs continue to frustrate employers, employees, and public policy makers. Controlling escalating health costs, improving coverage for the uninsured, and providing retiree health care are all important to the small employer. This study was undertaken to investigate the availability and extent of health care coverage and to assess the effects of health care costs on small firms. The results revealed that the percentage of small firms offering health benefits totaled 58 percent. The availability of group health insurance increases as firm size increases. Small employers cited insufficient profits, high insurance costs, and unavailable group coverage as the primary reasons for not offering health benefits. The results also indicated that the vast majority of small firms opposed a mandated employer-provided health coverage and suggested that small businesses should pool together to form groups to reduce the cost of health care coverage for small firms.     

Using Medicaid/SCHIP to insure working families: the Massachusetts experience

Massachusetts was the first State to implement a premium subsidy program for employer-sponsored health insurance, using both Medicaid and State Children's Health Insurance Program (SCHIP) funding. The Insurance Partnership (IP) provides subsidies directly to small employers, and the Premium Assistance Program provides subsidies to their low-income employees. Approximately 3,500 small firms currently participate, most of them offering health insurance coverage for the first time. Approximately 10,000 adults and children are covered through the program, the majority of whom had been uninsured prior to enrolling. Massachusetts' successful experience with premium subsidies offers important lessons for other States wishing to implement similar programs.     

Small businesses' changing views on health reform

Our national sample of 750 randomly chosen firms with fewer than 50 employees reveals surprising findings about the traditional views of small business on health care reform. A substantial segment of the small business community is sympathetic to health care reform, including such controversial measures as mandating that all employers contribute to the coverage of their workers, limits on health care spending, and altering the tax treatment of employer contributions for health insurance. Without premium savings, fewer than half of small businesses support the concept of health insurance purchasing cooperatives. With premium savings, a majority support it.     

Employers' benefits from workers' health insurance

Even though many employers believe that health insurance and health affect employees' productivity and firms' performance, health economists typically overlook and rarely measure firms' returns on health-related investments. Some research, however, suggests that firms may benefit economically by providing health insurance coverage for workers and their families. For example, health coverage may help employers recruit and retain high-quality workers. Health may contribute to productivity by reducing the costs of absenteeism and turnover and by increasing workers' productivity. This article reviews the evidence and proposes an agenda for future research. A better understanding of the benefits to employers of offering health coverage to workers may help clarify employers' behavior and help private employers and public officials make appropriate investments in health.     

On the road to universal coverage: impacts of reform in massachusetts at one year

In April 2006, Massachusetts passed legislation intended to move the state to near-universal coverage within three years and, in conjunction with that expansion, to improve access to affordable, high-quality health care. In roughly the first year under reform, uninsurance among working-age adults was reduced by almost half among those surveyed, dropping from 13 percent in fall 2006 to 7 percent in fall 2007. At the same time, access to care improved, and the share of adults with high out-of-pocket costs and problems paying medical bills dropped. Despite higher-than-anticipated costs, most residents of the state continued to support reform.     

The Massachusetts model: an artful balance

The Massachusetts health reform law has attracted national attention for its bold vision and its unique combination of tested and innovative policy approaches. Despite the law's promise, implementation challenges lie ahead, including building and sustaining public and legislative support for the law; ensuring care for those who are left out; and containing health care costs. The provisions that are most certain of success should provide coverage to 70 percent of the state's 530,000 uninsured residents. The state's ultimate success in reaching its goal of near-universal coverage will depend on how well the state can respond and adjust as implementation proceeds.     

Massachusetts reform plus President Bush's tax credits: a national model?

The Massachusetts health reform offers an important opportunity for a new federal-state strategy to cover the uninsured. President George Bush's proposed health insurance tax credits could be added to the Massachusetts health reform. The combined plan would include Medicaid expansions; offer workers affordable coverage through competitive insurance markets; and provide federal, state, employer, and individual financing. Many other states might be interested in similar federal-state partnerships for the forty-five million uninsured Americans. Ending the national impasse on coverage needs this kind of bold initiative.     

Employers' views on incremental measures to expand health coverage

This paper examines employers' views on the importance of health benefits and their perspective on policies aimed at expanding health coverage, reducing administrative expenses, and improving the quality of care. Employers of all sizes hold a positive view of the value of health benefits in attracting and retaining workers and in improving workers' health and productivity. Small employers support strategies that would make coverage more affordable; large employers support policies that reduce administrative costs and improve quality. Both support policies that would require additional administrative action as opposed to greater financial commitment on the part of firms in expanding coverage.     

Rekindling reform--how goes business?

Employers were a major cause of the failure of President Clinton's Health Security bill. This did not have to be so. The substantive and political factors that caused employers to turn against the Clinton Plan could prove instructive in the next reform effort. The unwillingness of employers who do provide benefits to engage seriously in the struggle over health care reform contributes to maintaining the status quo that penalizes them while rewarding employers who fail to provide coverage. The lessons that can be learned from the Clinton Plan debate, if heeded by both employers and health reform advocates, raise hope that key elements of the business community can play a positive role in the next comprehensive health reform effort.     

Women and Health Reform: How National Health Care Can Enhance Coverage,Affordability, and Access for Women (Examples From Massachusetts)

BackgroundMassachusetts women have the highest rates of health insurance coverage in the nation and women's access to care has improved across all demographic groups. However, important challenges persist. As national health reform implementation moves forward under the Affordable Care Act (ACA), states will likely encounter many of the same women's health challenges experienced in Massachusetts over the past 7 years.MethodsA review of the literature and data analyses comparing health care services access, utilization, and cost, and health outcomes from Massachusetts pre- and post-2006 health care reform identified two key challenges in women's continuity of coverage and affordability.ConclusionThese areas are crucial for state and national policymakers to consider in improving women's health as they work to implement health care reform at the state and federal levels.     

The Massachusetts approach: a new way to restructure state health insurance markets and public programs

In April 2006, Massachusetts enacted legislation to reorganize both its health insurance markets and a large portion of its health care subsidy system. In this paper we consider how the Massachusetts approach differs from most previous state health reform efforts, while also noting its antecedents. We examine the policy implications of the legislation's key elements and discuss how other states might consider altering the scope and specifics of those components. We conclude that both parts of the Massachusetts reform strategy merit consideration by other states and together hold promise for expanding coverage, particularly by addressing the problem of coverage discontinuity.