Mass. Health Care Reform One-Year Later: Clear Successes and Challenges Emerge

Mass. Health Care Reform One-Year Later: Clear Successes and Challenges Emerge

Thursday, June 5, 2008


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CONFERENCE CALL: The New Voter Suppression and the Progressive Response

WHAT: Voting rights experts and legislators will discuss the history and tactics of voter suppression, rapidly expanding new techniques such as voter ID, and how progressives can respond.
WHEN: 1pm EST, Thursday, June 12
WHO: Jeanne Kohl-Welles, Washington State Senator
Kristen Amundson, Virginia State Delegate
Michael Slater, Deputy Director, Project Vote
Michele Lawrence Jawando, Policy and Litigation Counsel, People For the American Way
Christian Smith-Socaris, Election Reform Policy Specialist, Progressive States Network



Mass. Health Care Reform One-Year Later: Clear Successes and Challenges Emerge

One year after implementation, Massachusetts new health care law has dramatically reduced its rate of the uninsured by half, increasing coverage in both the public and private sectors for 355,000 previously uninsured residents, a new Urban Institute study published in Health Affairs shows.  The state has improved access to coverage but rising costs are a key challenge as the state moves forward.

Despite fears that state-funded programs would "crowd out" private coverage, employer-based coverage has actually increased 3%, compared to national trends showing a continued decline in employer-based coverage, as reported by the New York Times.  Between expanded private and public coverage, out-of-pocket expenses for all adults dropped, as did the number of adults who said they had difficulty paying medical bills, while more people received routine preventive care.

Before the law went into effect, roughly 600,000 residents lacked coverage.  Of those, 355,000 now have coverage, according to the Urban Institute study, reducing the uninsured rate to 7%. 62,000 residents were exempted from the controversial individual mandate contained in the law because they did not earn enough money and 97,000 residents decided to forgo their personal tax exemption, valued at $219, than pay for coverage.  This penalty will increase to $912 for individuals who remain uninsured throughout the year.

Key elements of the 2006 reform act included:

  • requiring all residents to have health care coverage
  • imposing a modest fee on employers that do not provide coverage
  • establishing several measures to help residents afford insurance.  
  • creating the Commonwealth Connector to negotiate and contract with private insurers to bring more affordable insurance options to market for individuals and small businesses.
  • combining small group and individual markets, resulting in a projected 15% decrease in individual premiums.
  • creating Commonwealth Care, a program offering subsidized coverage to adults ineligible for Medicaid with incomes up to 300% of poverty, and Commonwealth Choice, a similar program that offers non-subsidized health plans to individuals, documented immigrants, families and small businesses.  Both Commonwealth programs are administered by the Connector.

In a companion Health Affairs article, Health Care for All-Massachusetts reports on the key achievements made by the reform in addition to the increased access to health care - combining the individual and small group markets, establishing the Connector, etc. - and  maintains that containing public and private health care costs is the next major push for reform in the state.  

Overall, Massachusetts residents support the reform law, although only 44% of residents who did not previously have coverage support it -- reflecting dislike of the individual mandate aspect of the law and the associated tax penalties for lacking coverage.  Meanwhile, 71% of previously insured residents support the reforms.

Future challenges:  Despite the gains in coverage, the state faces clear challenges, including:

  • Rising costs - Insurers are raising premiums an average 8% to 12%, tax penalties for non-compliance will increase from $219 to a potential $912 for individuals, and the state share for subsidies is coming in $150 million more than earlier estimates.
  • Signs of a provider shortage - Despite more residents saying they are getting needed care, more said they had a hard time finding a doctor, particularly primary care doctors .
  • No change in emergency room visits - Anecdotal reports that some previously uninsured residents are still visiting ER rooms despite having primary care coverage, a habit state officials are looking to change.

The road ahead for Massachusetts will be far from easy.  Achieving affordability for all residents remains the chief goal as well as the chief challenge.  Getting there will depend on the state's ability to tackle the underlying growth of health care costs, which outstrip wages and the rate of inflation roughly three to one.  This year, lawmakers are advancing a package of reforms to contain costs and improve quality of care (SB 2660). Measures include a statewide electronic medical records system, enhanced transparency of health care costs, and several measures to reduce prescription drug costs, including a pharmaceutical company ban on gifts to doctors and a pharmacy academic detailing program.  

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State Pension Funds to be Invested in State Job Creation in Florida

Florida Governor Charlie Crist recently signed an economic stimulus plan for the state that redirects $1.95 billion of the state's pension fund into direct investments in Florida's economy. The amount is limited to 1.5 percent of the state's pension money, but even that limited percentage can add up to massive investments in jobs for the state's residents.

In creating the program, legislators and the Governor pointed to the success of similar programs in other states, particularly the California Public Employees' Retirement System (CalPERS), the nation's largest pension fund. A recent study found the California fund's in-state investments had fed an estimated $15.1 billion into in-state economic activity in 2006 and created 124,000 jobs, more jobs than the construction or motion picture industries.

One key goal in Florida is to capitalize on scientific breakthroughs at state universities through funding start ups that can commercialize the research and bring in matching private venture capital to further expand dollars invested in-state.

California is just one of a number of states that are collectively directing billions of dollars into targeted investments in local start ups and job creation.  Other examples include:

  • Washington State holds $1.4 billion in Washington-based investments, using the money to leverage additional capital from other sources to invest in the state.
  • New York's In-state Investment Program recently added new capital to its program, having invested $271.4 million in 107 New York state companies as of 2007, to a total of $836 million.
  • The New Jersey Division of Investment recently announced the New Jersey Directed Investment Fund, which will join pension fund investment with private-equity partners to support New Jersey-based firms and companies willing to expand state operations.

Florida is joining an increasing trend of states that are no longer willing to be at the mercy of global financial firms -- or pay out massive tax subsidies often with few returns -- but who are instead using their own pension fund capital to directly invest in the economic future of their states.

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Minnesota Governor Pawlenty Vetoes Bill to Help Stop Foreclosures

Giving into corporate efforts to protect banking interests, Minnesota Governor Tim Pawlenty vetoed SF 3396, which would have put a temporary hold on foreclosures while still requiring borrowers to make payments on their loans.  The bill would have required homeowners with a sub-prime or negative amortization loan to pay either 65 percent of the payment owed when the loan defaulted, or the minimum monthly payment when the mortgage was first created, whichever is less, for a one-year foreclosure deferment period.  The bill passed both chambers of the Minnesota Legislature with a wide margin, only to be vetoed (part of Pawlenty's record number of vetoes for a single session).  In the meantime, home foreclosures are projected to increase 39 percent this year in Minnesota, with one out of every 31 Minnesota households experiencing a foreclosure between 2005 and the end of this year.

We've highlighted the ways in which states have taken action to protect their citizens against the sub-prime crisis, including passing moratoriums.  The Brookings Institution recently released a new report listing 10 action steps that states can take to stem the sub-prime crisis.  Many of the steps focus on preventing foreclosures and vacant properties, re-emphasizing the importance of keeping people in their homes and allowing a fair restructuring of the mortgage.

Progress and Setbacks in the States: Earlier this year, Maryland passed a de facto moratorium of 45 days for foreclosures through HB 365. Last May, Massachusetts became the first state to pass a de-facto moratorium on foreclosures with a law requiring a 90-day notice of intent to foreclose that must be filed with the Division of Banks before a home can be foreclosed. 

Other states, however, have had more of an uphill battle trying to fight the foreclosure crisis in the face of financial interests' lobbying.  Connecticut SB 347 would have provided protections for newly unemployed homeowners facing foreclosure.  The bill passed both House and Senate committees but didn't pass either chamber.  Florida's effort to provide a Foreclosure Relief Act died in committee.  Indiana couldn't even pass a non-binding resolution urging Congress to impose a moratorium on foreclosures.

Other state bills are still moving forward: New York's AB 9695 has passed the Assembly and is now before the Senate and would provide a 1-year moratorium on foreclosures for sub-prime "fundamentally unaffordable" mortgages.  Michigan's SB 1305 is also active and would provide a two-year moratorium on mortgage foreclosures.  

But as Pawlenty's veto shows, too many politicians are beholden to financial interests at the expense of average homeowners.

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Paid Sick Days Approved by California Assembly

Last Thursday, the California Assembly approved a bill guaranteeing all workers in the state a minimum number of paid sick days each year, becoming the second legislative chamber in the country to do so following approval in the Connecticut Senate.  Washington, D.C. and San Francisco have enacted paid sick days reform into law locally. 

Ohio will likely be considering a similar reform on its ballot this fall and a new report by Policy Matters of Ohio highlights the stories and voices of workers for whom paid sick days are critically needed.  The report highlights the tragedy of a mother having to return to work the day after birth for fear of losing their job, a husband who can't go to the hospital when his wife was getting chemotherapy, or a restaurant worker having to come to work sick and thereby endangering others' health, along with positive stories of how paid sick days policies improve workplace experiences.  

Roughly half of all American workers don't have paid sick days policies at their workplace and even more can't use those days for care of family members, so enactment of California's and Ohio's paid sick plans would be a welcome precedent for the nation. Passing paid sick days legislation is a wildly popular issue, as a new Ohio poll shows--  by a margin of 71 to 24 percent, Ohioans polled favor the proposed paid sick days ballot measure there.

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Research Roundup

A new study by the Pew Charitable Trusts finds that while many children do improve their income relative to their parents, the degree of upward mobility is usually limited and blacks experience dramatically less upward economic mobility than whites.  The racial gap in economic mobility for the poorest families remains even when controlling for single- or two-parent families.

In The Challenges of Prisoner Reentry: Facts and Figures, the Urban Institute emphasizes the challenges faced by newly released prisoners, with less than a majority finding employment after release, lower wages for those who do find employment, little stability in housing, and high rates of rearrest.

Highlighting widespread disparities in health care by race and region, a new study, Disparities in Health and Health Care among Medicare Beneficiaries commissioned by the Robert Wood Johnson Foundation, finds that many patients fail to receive treatments of proven benefit.  One dramatic example highlighted is that the rate of leg amputation following diabetes and vascular diseases is four times greater in blacks than whites.

Addressing the roiling debate over use of ID cards, the Center for American Progress has released The ID Divide, a report that highlights both the misuse of ID laws to disenfranchise many low-income citizens and the social challenges, from opening a bank account to flying on an airplane, faced by anyone who lacks the documentation needed for a state ID.  The report urges that any identification law be designed to promote key principles of real security, inclusion and fairness for all.

Please email us leads on good research at


Mass. Health Care Reform One-Year Later: Clear Successes and Challenges Emerge

Kaiser Family Foundation - Summary of Press Coverage of Urban Institute Report
Urban Institute, Health AffairsOn the Road to Universal Coverage: Impacts of Reform in Massachusetts at One Year
Health Care for All-MA, Health AffairsMassachusetts Health Reform Implementation: Major Progress and Future Challenges

State Pension Funds to be Invested in State Job Creation in Florida

Progressive States Network - Economic Strategies for Nurturing Innovation and Job Growth
Progressive States Network - The New State Investment Model for Job Creation
CALPERS - CalPERS - An Economic Engine
National Association of Seed and Venture Funds
New York's In-state Investment Program
Washington State Investment Board Economically Targeted Investment Policy - 2007 Annual Report

Minnesota Governor Pawlenty Vetoes Bill to Help Stop Foreclosures

Progressive States Network - Dealing with the Foreclosure Crisis at the State Level
Brookings Institution - Tackling the Mortgage Crisis: 10 Action Steps for State Government
Center for Economic and Policy Research - The Subprime Borrower Protection Plan
MN: SF 3396
CT: SB 347
NY: AB 9695
MI: SB 1305
MD: HB 365
MA: Chapter 206

Paid Sick Days Approved by California Assembly

Progressive States Network - New Polling: Paid Sick Days and Family Leave Overwhelming Political Winners
CA AB2716
Policy Matters Ohio - Paid Sick Days: Voices from Ohio
Sick Days Ohio
National Partnership for Women & Families - States and Cities Taking on Paid Sick Days in 2008
National Partnership for Women & Families - Paid Sick Days Resources
ACORN - Paid Sick Days Campaign
CLASP - Paid Sick Days: A Legislator's Guide


The Stateside Dispatch is written and edited by:

Nathan Newman, Policy Director
J. Mijin Cha, Policy Specialist
Julie Schwartz, Policy Specialist
Christian Smith-Socaris, Policy Specialist
Adam Thompson, Policy Specialist
Austin Guest, Operations Manager
Marisol Thomer, Outreach Coordinator

Please shoot us an email at if you have feedback, tips, suggestions, criticisms, or nominations for any of our sidebar features.

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