What it looks like on the other side

As California moves toward health care reform …oh — in the next 3 weeks — we had a visitor from a state that is in the middle of implementing it’s health care reform from last year.

Jon Kingsdale, executive director of the Commonwealth Connector, which is the board in Massachusetts that is charged with implementing its health reform, gave us a glimpse of what life would be like once legislation was passed. They’re in the first of a three-year process to implement the new law.
Kingsdale was in the Capitol today courtesy of the California HealthCare Foundation.

While the most highly publicized part of the Massachusetts reform legislation was the fact that it would require every citizen to purchase health insurance, the pieces of the plan that are furthest along — at this point — are the expansions in public programs. More than 70 percent of those that qualify for Medicaid are now enrolled; 75 percent of those qualified for subsidized health coverage have purchased coverage.

That means nearly 3/4 of Massachusetts residents who earn less than $41,000 (a couple) are in some kind of publicly funded program. If we transplant that rate of enrollment success to California, we’d be covering 2.7 million people!

Of course, we can’t really compare Massachusetts to California — on MANY levels.

Population- and coverage-wise:

  • First, the entire state has 6.2 million people. That’s FEWER people than California has in uninsured.
  • Secondly, only 6 percent of its population was uninsured prior to reform, compared with California’s 20 percent.

My colleague Beth has a great one-page fact sheet on how much more robust coverage in Massachusetts was before they began their reform, which includes the fact that more employers were providing coverage before reform (69.4 percent in MA compared with 57.7 percent in CA), and Medicaid spending was higher there ($5,400 per enrollee in MA versus $2,250 in CA)

Market-wise, we’re in completely different places, as my colleague Anthony has written about before, MA providing more consumer protections than in CA.

But, in spite of the differences in regulation, population, politics, and coverage, one thing Kingsdale said resonated:

“Nowhere in the country does the non-group market work.”

Translated: the market where poeple must go out and search for coverage on their own without an employer or public group is a wreck, which says to me that any attempts to rely on the individual market to diminish the number of uninsured, or shrink group markets by thrusting people into the individual market is a bad idea.

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