Lessons from Massachusetts Health Reform Focus of INQUIRY'S 2012-13 Winter Issue

ROCHESTER, NY (02/15/2013)(readMedia)-- As states prepare to implement provisions of the Affordable Care Act (ACA), they may look to Massachusetts, which enacted its own health reform in 2006, for signs of what to expect. Featured in the Winter 2012/2013 issue of Inquiry, "Findings from Massachusetts Health Reform: Lessons for Other States," examines health insurance exchanges and health care coverage, access, affordability and utilization under the Massachusetts reform:

"Health Reform: Learning from Massachusetts," by Helen Levy – This introductory paper summarizes the similarities and differences of the ACA and the Massachusetts reform and explains why the experience of Massachusetts, though not a "typical" state with its relatively well-off, well-educated population and a fairly low uninsurance rate (10.7 percent) prior to reform, still provides useful lessons for other states.

"Coverage, Access, and Affordability under Health Reform: Learning from the Massachusetts Model," by Sharon K. Long, Karen Stockley, and Kate Willrich Nordahl – Under reform, health insurance coverage in Massachusetts expanded significantly, from 86.5 percent of nonelderly adults in 2006 to 94.2 percent in 2010. The gains reflect growth in both employer-sponsored insurance and public or other coverage. Improvements in health care access and affordability were widespread, and included a 28 percent reduction in unmet need for physician care and a 38 percent decline in high out-of-pocket costs. While the gains have been significant, the authors say achieving them has been challenging: health care costs continue to rise and concerns exist about provider capacity and "churning" or changing coverage.

"The Effect of the Massachusetts Reform on Health Care Utilization," by Sarah Miller -- While expanding insurance coverage to the uninsured lowered their out-of-pocket costs and encouraged them to use more medical services, evidence from Massachusetts indicates they used services more effectively. Results of this study show that the Massachusetts reform increased residents' use of primary and preventive care, reduced their reliance on the hospital emergency room as a usual source of care, and improved self-assessments of physical and mental health. All are signs of a "meaningful improvement in the way patients interact with the health care system," Miller notes.

"Designing and Regulating Health Insurance Exchanges: Lessons from Massachusetts," by Keith M. Marzilli Ericson and Amanda Starc -- Using the Massachusetts exchange experience, this paper describes the types of insurance products that consumers select and the dynamics behind consumer choice. Because consumers have difficulty trading off attributes of complex insurance products, they tend to rely on heuristics, or rules of thumb. Choice architecture affects the market and exchange designers can improve consumer satisfaction by providing a platform that simplifies and clarifies trade-offs. Consumers tend to choose less generous plans in the exchange than in traditional employer-sponsored insurance, but there is considerable diversity in demand and some evidence of adverse selection. Because of the imperfect competition that exists in insurance markets, it is important to consider the impact of pricing and product regulation on the level and distribution of premiums.

Two research papers also are featured in INQUIRY's winter issue:

"Is Policy Well-Targeted to Remedy Financial Strain among Caregivers of Severely Injured U.S. Service Members?" by Courtney Harold Van Houtven, Greta Friedemann-Sànchez, Barbara Clothier, Deborah Levison, Brent C. Taylor, Agnes C. Jensen, Sean M. Phelan, and Joan M. Griffin – Looking at the financial strain experienced by caregivers of U.S. service members seriously injured since the wars in Iraq and Afghanistan, this national study found that 62 percent of caregivers depleted assets and/or accumulated debt, and 41 percent of workers left the labor force. Primary caregivers of veterans needing intensive assistance were at much higher risk of leaving the work force, and accrued $27,500 more in depleted assets or accumulated debt than the caregivers of veterans needing little help. While it appears that benefits under the Caregivers and Veterans Omnibus Health Services Act are reaching those caregivers with the greatest financial need, the authors say further research is necessary to fully understand how the policy affects households, incentives to work, the quality of informal care and the recovery of injured veterans.

"The Out-of-Network Benefit: Problems and Policy Solutions," by Kelly A. Kyanko and Susan H. Busch -- Health insurance plans that include coverage for out-of-network providers potentially can reduce health care costs and improve quality. However, they also can expose consumers to unexpected and unreasonable out-of-pocket costs due to: lack of accurate information on network participation, nontransparent out-of-pocket costs, inadequate provider networks, involuntary use of out-of-network emergency care, and use of out-of-network providers at in-network hospitals. While the ACA and states provide some consumer protections, the authors say these may not be enough; there is consensus that greater transparency is needed, particularly regarding network participation and cost.

Also featured in INQUIRY's winter issue:

"Reflections: Yesterday, Today and Tomorrow," by David H. Klein -- In this column, Klein, who recently retired as CEO of The Lifetime Healthcare Companies and Excellus BlueCross BlueShield, reflects on his four decades in the health care industry, highlighting changes and making some predictions for the future.

"The View from Here: Let's Take the 'Pols' Out of Policy-Related Research," by Alan C. Monheit -- In this column, INQUIRY's editor criticizes efforts, particularly aggressive in the recent presidential campaign, to politicize objective research and put ideology above all else. At a time when the country is faced with critical issues such as health reform and climate change, Monheit says it is more important than ever that factual and objective research be disseminated to the public.

INQUIRY, the journal of health care organization, provision, and financing, is in its 49th year. The nonprofit Excellus Health Plan, Inc., publishes INQUIRY; the journal maintains a freelance editorial staff and is run as an independent, peer-reviewed, quarterly academic journal. Press releases and article abstracts are available on the INQUIRY website at www.inquiryjournal.org under "Current Issue Table of Contents."