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Massachusetts medical doctors show strong support for plan

88% of Massachusetts physicians believe Massachusetts reform improved, or did not affect, care or quality of care. 79% believe Massachusetts reform helped previously uninsured. 75% Believe Massachusetts reform should be continued. (slide #35 - 36th page)

Three Years Into Implementation, Docs Rate State's Health Care System Positively

Washington, D.C. -- A study published in today's New England Journal of Medicine finds that a large majority (70 percent) of practicing physicians in Massachusetts support health reform three years after its passage in 2006...

The poll found similar levels of support among primary care doctors and specialists. When asked about the law's future, 75 percent of physicians say they want to continue the policies - 46 percent with some changes and 29 percent as is... Only 13 percent of physicians in the state oppose the health reforms created through the legislation, and just 7 percent believe the policies should be repealed.

"There appears to be broad support among physicians in Massachusetts for the reforms that led to almost all state residents having health coverage," said Robert Blendon, Sc.D., one of the study's authors and professor of health policy and political analysis at HSPH. "The findings suggest that it is possible to provide near-universal coverage of the population and have a resulting system that most physicians believe improves care for the uninsured without undermining their ability to provide care to their patients." ...

"Massachusetts' recent experience in reforming health care provides invaluable insights for federal lawmakers," said Risa Lavizzo-Mourey, M.D., M.B.A. president and CEO of the Robert Wood Johnson Foundation. "Based on what we have seen in Massachusetts, doctors are supportive of the reforms and their patients appear to be better off. What's good for doctors and their patients is good for the health of our nation..."

"What is particularly impressive is that on almost every question in which physicians were asked about the impacts of the law on their own practice and patients, a majority reported that it is having either no impact or a positive one," said Gillian SteelFisher, Ph.D., M.Sc., co-author of the study and research scientist at HSPH.

Physicians rated the Massachusetts health care system much more positively than they did the national health care system, 63 percent to 33 percent. [63% rated Massachusetts system excellent or good, 33 percent rated current national system the same. Another 30% rated Massachusetts system fair and only 6% rated it poor.] Nearly four in five physicians (79 percent) believe that the law positively impacted those who were previously uninsured, though overall costs to the state continue to be a concern.

"Whether at the state or national level, health reform is about trade-offs, but the reaction among physicians in Massachusetts has been overwhelmingly positive," said Anya Rader Wallack, interim president of the Blue Cross Blue Shield of Massachusetts Foundation. "The state now has the lowest proportion of uninsured residents in the nation, and our physicians are looking forward to continuing and improving the health reform efforts already in place. That's a remarkable achievement."


Massachusetts citizens show strong support for plan

Two out of three adults support Massachusetts health reform... 69% of females and 68% of males support the law (fall 2009). In fall 2006, 69% of Massachusetts adults supported the law. (slides #32-33, pages 33-34)

BOSTON, MA - Two years after the implementation of a health care reform law aimed at providing health coverage for nearly all Massachusetts residents, public support for the law remains high. According to a new poll by the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation, over two-thirds (69%) of Massachusetts residents support the law... compared to 67% in 2007 and 61% in 2006.

Other signs of public support for the law include the following:

• 77% support providing subsidized coverage...

• 71% say the law has been successful at reducing the number of uninsured in Massachusetts...

In the two years since the law's passage, approximately 350,000 Massachusetts residents have gained health insurance coverage...

The law requires businesses that employ more than 10 people to provide health insurance for their employees or pay a fine of up to $295 per employee per year. The public is highly supportive of this provision with three out of four expressing support (75%).

A poll conducted this week by The Washington Post of 880 Massachusetts residents who said they voted in the special election found that 68 percent support the Massachusetts plan...

But support plummeted when voters were asked about health care proposals from Obama and Democrats in Congress.

The poll by Market Decisions, a research and consulting group, found that 84 percent of residents are satisfied with the Massachusetts plan, which requires most adults to have health insurance... The state health plan, launched under former Governor Mitt Romney, was given high marks for the range of services and the quality of care offered, according to the poll.


Massachusetts businesses show support for plan

77% of Massachusetts employers believe all employers bear some responsibility for providing health benefits to their workers and 52% believe health care reform has been good for Massachusetts. (October 28, 2008 Survey - Slide #34 - 35th page)

“Employer offer rates have grown from 70 percent to 76 percent since implementation of reform.” (Slide #3 - page 4) (At the same time, the Massachusetts employer contribution toward individual coverage have decreased from 77% to 72% while employee participation in employer offered health insurance has increased to 80%. - slides #18-19, pages 19-20)

Most Massachusetts businesses believe that they have a responsibility to help provide health benefits to their workers, support "play-or-pay" provisions of the state's landmark 2006 health care reform legislation, and even believe that the play-or-pay requirements should apply to firms with ten or fewer workers, which they currently do not...

The RWJF/NORC (Robert Wood Johnson Foundation/National Opinion Research Center) survey found broad support among Massachusetts businesses both for the concept of employer responsibility for health benefits and for the specific provisions of the Massachusetts reforms. Seventy-seven percent of employers in the state either "strongly" (34 percent) or "somewhat" (43 percent) agreed with the statement that "all employers bear some responsibility for providing health benefits to their workers." The statement garnered majority support among firms of all sizes and even among firms not offering health benefits, although those nonofferers were significantly less likely than firms offering benefits were to strongly agree.

These sentiments translated into similarly widespread support for the "play-or-pay" aspects of the Massachusetts reform legislation: Sixty-nine percent of employers either "strongly" (35 percent) or "somewhat" (34 percent) agreed with the requirement that firms with eleven or more workers either offer health benefits or pay the "fair share" contribution of $295 per worker. Even among nonoffering firms, half either "strongly" or "somewhat" supported this provision.

In fact, Massachusetts businesses were prepared to go farther than the state's recent legislation...

"This striking support among even the smallest businesses for universal employer responsibility speaks to how all sectors have taken on the shared goal of access to health care for all residents of the Commonwealth," noted Jarrett Barrios, president of the Blue Cross Blue Shield of Massachusetts Foundation.



TIME — Mitt Romney's Defining Moment

"It may be that this tale from Massachusetts reveals what kind of President Romney could be. ''He was incredibly impressive, with his intellect, his ability,'' says MIT economics professor Jonathan Gruber, a Democrat who advised Romney... ''If there is anything that qualifies him to be President of the United States, it is his leadership on this issue.''

"Comparatively speaking, the health-care situation in Massachusetts wasn't all that dire when Romney took office... But with a third of the state budget going toward health care, the sheer inefficiency of treating the sore throats of the uninsured in emergency rooms didn't sit well with the businessman in Romney...

"Meanwhile, religious groups and health-care advocates were pushing their solution: a liberal universal-health-care ballot initiative that would raise taxes. And the picture was about to get significantly worse: Health and Human Services (HHS) Secretary Tommy Thompson was threatening to take away $385 million a year in Medicaid money. The more the Governor thought about health care, the more intrigued he became by the idea of making it work better.

click to Play

Sen. Jim Demint discusses Mass. Healthcare System

“... We've got over 20 states now that are trying to copy what he did, and that's a good sign that people think he's on the right track.”

"That whiff of a challenge was reinforced by the stories Romney heard as he traveled the state. After talking to a jeweler in North Andover, a man about his age, Romney remembers thinking, ''Gosh, he's 55. He could have a heart attack. He could get cancer. He's got his own business, but he doesn't have health insurance? How can this be?''...

"When they considered the situation as if it were a business-school case study, some simple steps became clear...

"In November 2004, ... Romney was finally ready to go public with the beginnings of a plan. As it evolved, it became a proposal to achieve an end that liberals had long dreamed of, but through conservative means: creating more competition in the private-insurance marketplace and insisting that Massachusetts citizens take personal responsibility for their own coverage. ''From the minute you heard him articulate it, you knew this was a new concept in American health-care policy,'' says Robert Blendon, a Harvard University professor of health policy. ''It was a very different way of talking about coverage, and he was very articulate in framing it.''...

"The bill that emerged from the legislature two weeks later was different in many respects from what Romney had initially proposed... There were far too many requirements placed on insurance companies for Romney's tastes, and he used his line-item veto on the bill's stipulation that employers who don't cover their workers pay $295 per employee each year into a fund to subsidize coverage. The lawmakers easily overrode it".



TIME — The Republican Who Thinks Big on Health Care

Dec 4, 2005: "Here is how it would work. Massachusetts now spends about $1 billion a year to provide emergency health care for at least 500,000 uninsured citizens. About 200,000 of those are young people, predominantly male, who are making enough money to buy health insurance but figure they don't need it. They would be required to buy a relatively inexpensive health insurance policy, with higher deductibles and co-pays--that's where the ''mandate'' comes in. Another 100,000 are extremely poor people who are eligible for Medicaid; a concerted effort would be made to bring them into the system.

"The remaining 200,000 are the people who have been most neglected by the system in the past: the working poor, people who have low-end service jobs or work part time for employers who don't offer health coverage. Romney's gamble is that Massachusetts can take the $1 billion it spends on the uninsured and use it to subsidize coverage for the working poor. . . ''Our plan would cost the poorest eligible families only about $2 per week in premiums,'' Romney said.

" ''The more you earn, the more you pay.'' Sounds simple enough. So why hasn't it been tried before? Because interest groups on the left and right hate the idea. Conservatives don't like the mandatory part: if a 28-year-old software designer doesn't want to buy health insurance, why should the government force him to do so? Simple answer: fairness. The rest of us pay for it now when he drives his motorcycle into a tree and runs up a huge medical bill... On the left... Some favor a government-funded system like those used in Canada and Europe. Others, realizing that socialized medicine just won't fly in the U.S., support an ''employer mandate'' similar to the program that Clinton proposed in 1993."


NYTimes.com NY Times — Massachusetts Sets Health Plan for Nearly All

Massachusetts is poised to become the first state to provide nearly universal health care coverage ...

The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance. It accomplishes that in a way that experts say combines methods and proposals from across the political spectrum, apportioning the cost among businesses, individuals and the government.

"This is probably about as close as you can get to universal," said Paul B. Ginsburg, president of the nonpartisan Center for Studying Health System Change in Washington. "It's definitely going to be inspiring to other states about how there was this compromise. They found a way to get to a major expansion of coverage that people could agree on. For a conservative Republican, this is individual responsibility. For a Democrat, this is government helping those that need help." ...

"It is not a typical Massachusetts-Taxachusetts, oh-just-crazy-liberal plan," said Stuart H. Altman, a professor of health policy at Brandeis University. "It isn't that at all. It is a pretty moderate approach, and that's what's impressive about it. It tried to borrow and blend a lot of different pieces." ...

The Massachusetts bill creates a sliding scale of affordability ranging from people who can afford insurance outright to those who cannot afford it at all. About 215,000 people will be covered by allowing individuals and businesses with 50 or fewer employees to buy insurance with pretax dollars, and by giving insurance companies incentives to offer stripped-down plans at lower cost. Lower-cost basic plans will be available to people ages 19 to 26.

Subsidies for other private plans will be available for people with incomes at or below 300 percent of the poverty level. Children in those families will be eligible for free coverage through Medicaid, an expansion of the current system...

"Whenever you can have the medical community, the business community and the advocates all applauding our efforts, I think that's indicative of a successful exercise," said State Senator Robert E. Travaglini, the majority leader.

Mr. Romney, who is considering running for president in 2008, said in an interview Tuesday that the bill, passed by a legislature that is 85 percent Democratic, was "95 percent of what I proposed."

He said, "This is really a landmark for our state because this proves at this stage that we can get health insurance for all our citizens without raising taxes and without a government takeover. The old single-payer canard is gone."

Mr. Romney pushed the idea of the "individual mandate," requiring people who can afford insurance to buy it. The bill makes it possible for employers to enable many of those people to use pretax dollars, saving them 25 percent or more...

Mr. Romney said that with more people insured, everyone would "get better health care" and that premiums for people who already had insurance might drop because "providers won't be pushing the cost of the uninsured onto the people who have insurance."

James Roosevelt Jr., president and chief executive of Tufts Health Plan, agreed.

"I think that will help both improve the quality of health care and lower the cost," Mr. Roosevelt said...

Advocates for the uninsured held a victory rally at the Statehouse.

"We're thrilled that this truly represents a commitment to the poor and the working poor," said Rabbi Jonah Pesner, a leader of the Greater Boston Interfaith Organization.



washingtonpost.com Washington Post — Mass_ Bill Requires Health Coverage

Tuesday's votes approving the bill -- 154 to 2 in the House and 37 to 0 in the Senate -- were the culmination of two years of politicking and several months of backroom negotiations, as rival health-care plans from Romney and the two Democrat-led chambers were hammered into one.

What resulted is a proposal that health-care experts say is unlike any other in the country. What to do about the 45 million Americans without health insurance has flummoxed both the Bush administration, whose proposal for "health savings accounts" fizzled, and that of Bill Clinton, whose broad plan for health-care changes fell flat...

The idea was applauded by Uwe E. Reinhardt, a professor of economics and public affairs at Princeton University, who said that he has long believed that the American system of allowing uninsured patients to receive care at the government's expense was nothing more than "freedom to mooch."

"Massachusetts is the first state in America to reach full adulthood," said Reinhardt, noting that the new measure is a move toward personal responsibility. "The rest of America is still in adolescence." ...

The bill's passage was celebrated as a victory in the state legislature, with House Speaker Salvatore F. DiMasi (D) telling colleagues that they had succeeded where other states had failed.

"We did something to solve the problem," he said.

The same message might provide a political boost to Romney, who is considering a presidential run in 2008. By proving he can work with Democrats, and find a health-care solution that relies on the private sector, Romney can portray himself as an executive who can work across the aisle in harshly partisan times.

"It might help him to say, 'Look, I have a solution for health insurance,' " said Julian E. Zelizer, a professor of history at Boston University.


ABC and CBS Networks

ABC's World News Tonight: "Good evening. We begin with a bold experiment in health insurance that could change the way you pay your medical bills. After terrorism and the war in Iraq, health care is the major concern for Americans. Most people think medical costs are too high and would like a universal insurance system to cover everyone. Forty-five million people in the U.S. have no insurance [number on screen], and repeated attempts by the federal government to come up with a solution have all failed. Which is why the state of Massachusetts is getting so much attention tonight. ABC's Nancy Weiner reports from Boston."

Weiner: "With the new system, residents who make less than $9,500 a year will get free health insurance -- no premiums, no deductibles. Families with low incomes but above the poverty line will pay premiums on a sliding scale. But still, no deductibles. And for the vast majority of residents who do have health insurance, lawmakers predict cutting the roles of the uninsured will bring down premiums for everyone. Forty-year-old Faith Burdell, who is legally blind and can't work, says health costs currently eat up most of the little money she has."

Faith Burdell, Massachusetts resident: "I think I'd be able to afford a gallon of milk, whereas before I wasn't able to always get a gallon of milk at the store."

CBS Evening News: "Good evening. I'm Russ Mitchell. Imagine this: Virtually everyone guaranteed health insurance coverage. It's happening in one state, and it could be a model for the rest. So we'll begin there tonight."

"Health care costs are rising by the day, and more than 45 million people in this country have no insurance to cover it. Now, one state is doing what no other state or the federal government has been able to do: Provide near-universal health coverage. The Massachusetts legislature approved it with overwhelming bipartisan support. And it could become a model for the rest of the country. Here's Trish Regan."

Trish Regan: "President Clinton promised it but did not deliver, states have wrestled with it unsuccessfully for decades, and now Massachusetts has apparently done it. It's about to become the first in the nation to provide nearly universal health coverage. Under a bill approved by the legislature, the state will require every citizen to be insured. Governor Mitt Romney pushed for the program."

Governor Mitt Romney (R-MA): "I thought it would be impossible."

Regan: "He considers health coverage essential, like car insurance."

Romney: "Well, when people drive a car, we insist that they have automobile insurance because we don't want to have a huge accident occur and have the other driver, or other taxpayers have to pick up the bill. Well, individuals also have a responsibility."

Regan: "Currently, Massachusetts spends an estimated $1 billion a year covering its half million uninsured residents."

Romney: "We concluded that, in fact, if we took the money we're spending giving people free care who don't have insurance and instead use that money to help them buy insurance, we can keep from shifting the cost of the uninsured onto people who are already covered."

Regan: "Here's how the plan is expected to work: All residents will be required to either buy insurance through an employer or through the government. Those who can't afford a plan will be subsidized. They can buy insurance through the state for as little as $2.30 a month. If someone chooses not to buy a plan, there will be tax penalties, up to $1,200 a year."

Stuart Altman, Institute for Health Policy: "It would be a mistake to think of this as some crazy liberal pinko kind of Massachusetts, 'Taxachusetts,' the important thing is this is a moderate proposal."

Regan: "Stuart Altman has worked on health care policy for nearly every President since Nixon."

Altman: "I think every state should take a look at it, and I think many states will look at it very positively, and I would suspect that, I would hope that also the federal government would take a look at it."