Today is the final day in the life of the Uncompensated Care Pool. Maybe it’s just me, but I’ve gotten no invitations to celebrations, funerals, parties or any other recognition of the sunset of a central facet of MA health care finance since its legislative creation in 1985 and its opening for business in 1986. Dense, complex, obscure, political – for better AND worse, it’s been the heart and soul of our health care safety net for 21 years.
The Pool (alternately called the Uncompensated Care Pool or the Free Care Pool) was set up during the “rate setting” era when Massachusetts regulated the growth of hospital inpatient revenues. The Pool was set up so hospitals caring for disproportionate numbers of uninsured (chiefly Boston City and Cambridge Hospitals) would not be financially disadvantaged for doing so.
Those present at the Pool’s birth (I was one) will recall it was intended as a temporary, short term fix to be replaced by a soon-to-be-enacted universal coverage system. The 1988 Universal Health Care Law (signed by then-Gov. Mike Dukakis) would have eliminated the Pool; but the law’s central mechanism – a “pay or play” employer mandate – was never implemented and repealed in 1996. Also repealed in 1991 was the rate setting system which spawned the Pool.
And yet the Pool survived, for two reasons. First, it made good policy sense to distribute the burden of paying for lower-income uninsured and underinsured. Second, hospitals found it in their self-interest to continue it. Another characteristic feature of the Pool’s life was constant infighting among hospitals over who gets how much from it.
Over the years, the Pool changed a lot and often. The biggest revisions occurred in 1988, 1991, 1997, 2002, and then, 2006 – Chapter 58 called for the demise of the existing Pool and its replacement (beginning tomorrow) by the “Health Safety Net Trust Fund.” (Click here for access to all recent UCPool reports from the Division of Health Care Finance and Policy which runs the Pool and its successor.)
Why a Pool/Fund at all given Chapter 58?
Because in spite of impressive coverage gains MA health reform is attaining and will continue to attain, at the end of the day, we will still have a lot of lower income uninsured and underinsured. A lot less, yes. A lot less expensive, yes. And still, a Pool-like mechanism is needed? Yes.
Imperfect, political, messy, maligned – for 21 years, the Pool has been the reality and symbol of a different value system in Massachusetts – less expansive than that of other civilized nation that covers everyone, and more robust and caring than can be found in just about any other US state. No cheers or tears today. Still, worth taking a moment to reflect on our abundant strengths and weaknesses, all amply on display in that damn Pool.
John McDonough
