In Mass., Administrative Burdens Weigh Heavily
Six years into Massachusetts’ ambitious effort to overhaul its health system, there are fewer uninsured residents, but costs continue to rise. Physicians say that cost containment will be a major challenge going forward – and likely will hit them hard.
Signed into law in 2006 by then-Gov. Mitt Romney, the health reform program, called “An Act Providing Access to Affordable, Quality, Accountable Health Care,” essentially requires all state residents to acquire health insurance. The state Medicaid program was expanded to cover those at higher income levels, and a health insurance exchange was created to offer private insurance to all others.
The state completely covers plans for residents with incomes below 150% of the federal poverty level and subsidizes others up to 300% of the poverty level.
Those who do not buy insurance are charged a penalty on their state tax return, based on income.
The success or failure of the plan is being closely watched, as it is widely considered the model for the federal Affordable Care Act.
Now, almost 98% of adults and close to 100% of children in Massachusetts have health insurance, Dr. JudyAnn Bigby, health and human services secretary for the commonwealth, said at a recent presentation in Washington. Reform has been mostly well received by both doctors and patients. A 2011 poll by the Harvard School of Public Health and the Boston Globe found that 63% of residents said they supported the law. A 2009 poll of physicians found similar views. Of 2,125 respondents, 70% said they thought reform had been a good thing. However, in spite of all the positives, 50% said that the medical practice environment had worsened since reform.
The biggest complaint: the law‘s administrative burden. Dr. Jonathan Kay, a Massachusetts rheumatologist, said in an interview that his state’s “health care reform plan, which was spearheaded by then-Gov. Mitt Romney, has had a positive effect in that it has provided individuals who previously were unable to obtain affordable coverage with the opportunity to have health insurance.
However, the resulting increased number of insured individuals has placed a burden on the already short supply of primary care physicians in Massachusetts. “For the past several years, it has be come even more difficult to find primary care physicians whose practices are open to new patients. This limited number of primary care physicians are now even busier, as an increased number of insured patients enter their practices.
The growing trend towards ‘concièrge medicine’ has further exacerbated this problem. “For rheumatologists, who already are in limited supply because of a reduced workforce relative to the number of pa tients needing our services, the greater number of insured pa tients in Massachusetts has increased the demand for rheumatologic care. The success of the Massachusetts health care reform program, by making health insurance coverage available to most residents of the Commonwealth, will have an effect on rheumatologists similar to that which it already has had on primary care providers: there soon will be too few to meet the need for rheumatologic subspecialty care in Massachusetts,” said Dr. Kay, who is the director of clinical research in the division of rheumatology at UMass Memorial Medical Center and a professor of medicine at the University of Massachusetts Medical School, both in Worcester.
Dr. Kay noted that although he works in an academic setting, he sees patients 24-27 hours a week. “During his administration, Gov. Romney signed into law the program that has served as the model for the national Affordable Care Act. In doing so, he demonstrated his socially progressive approach to health care reform. However, the Massachusetts health care reform program does not provide a mechanism by which to increase provider manpower to meet the greater demand for much needed services. Further work is required to come up with a mechanism by which primary care and the primarily cognitive medical specialty services are made more widely available, with man power appropriate to provide these essential services that provide the back bone of the reformed health care program in Massachusetts and the rest of United States,” according to Dr. Kay.
Physicians in the Harvard survey also expressed concerns about rising costs, and were split on the law’s impact on access to primary care: Roughly a quarter said the law was hurting access, where as the same number said it was helping. The concept behind the reform law “was brilliant,” because it increased insurance coverage and gave patients incentives to get preventive care, said Dr. Richard Dupee, governor of the Massachusetts chapter of the American College of Physicians. But at the same time, he said, the law “discincentivizes doctors from seeing patients because the reimbursement is so poor.”
