A Voice Is Heard From The Right

The libertarian Cato Institute never liked chapter 58 from the beginning, so of course they think it’s a “model for failure.” Writing on WBUR’s Commonhealth blog, Cato Senior Fellow Michael Tanner throws all of his arguments at health reform.

Here’s his points and our responses:

Michael,

While your interest in such an important issue as health reform is admirable, your hyperbolic critique of the Massachusetts law is not.

Let me address your concerns (in bold) in order:

The law has failed to cover every Massachusetts resident, therefore the law is a failure. When Chapter 58 was signed, Massachusetts policymakers and advocates knew the law would not cover every uninsured individual. We blogged frequently (example) on why no one should call the law “universal.” In a press release from the day the legislature passed the bill, former HCFA Executive Director John McDonough commented that the bill is “an important, meaningful step forward on the road to affordable, quality health insurance coverage for every resident of Massachusetts.” And that’s exactly what has happened. As you yourself acknowledge, the state’s rate of uninsurance among working age adults has been cut nearly in half from 13 percent to seven percent. And that’s just in the first year. More progress is happening.

Most of those signing up for coverage are “low income individuals” therefore the only reason the law is succeeding is because of the “expensive and generous Massachusetts subsidies.” Many of those who lacked health insurance prior to the passage of the health reform law were without insurance because they were low income and could not afford it. That’s why the law calls for subsidies to help low income residents afford access to care. Bay State residents agree that this is a wise use of public funds. A public opinion poll taken in June found that 77 percent of those polled backed the idea of “providing subsidized insurance” to state residents who “make less than 300 % of the federal poverty level.” There is a moral component to the state’s plan to provide affordable health insurance: access to health care should not be a privilege based on income.

Insurance costs too much for young, healthy adults, therefore they are not signing up for care and driving costs up for everyone else. Ninety-five percent of Massachusetts taxpayers have health insurance. Young adults have a number of options available to them, including the state’s new Young Adult Plans, offered through the Connector. About 4,000 have signed up for these plans, in addition to the thousands in Commonwealth Care and in the private market. By signing up, they are driving costs down for everyone else.

The program is over budget. Massachusetts health reform is indeed costing more money than originally projected—and that is because more individuals are signing up for the program. As we all know, the Romney administration used a low estimate for the number of uninsured, leading to a too-low budget projection for the subsidized plan. The Patrick administration foresaw this increase in enrollment and re-projected costs last fall. The current per member, per month costs in Commonwealth Care are actually lower than that projection. The budget issues are solely a function of success, not failure.

Although the state succeeded in keeping health care premium costs thus far, they are going to rise because the state is mandating prescription drug coverage. Much of the decrease in premium prices is due to our merging of the small and non-group markets. Before health reform, a 37-year-old would have carried a $5,000 deductible and paid about $355 per month in premiums, without prescription drug coverage. Thanks to the merger, this same individual can now purchase a plan with a $2,000 deductible for about $184 per month, with drug coverage.

The law has increased demand for providers and there simply aren’t enough doctors and nurse practitioners to go around. On this last point, you are correct. Massachusetts was in short supply of health care providers before health reform, and that’s only worsened with hundreds of thousands of newly insured people coming into the system. That said, the Governor just signed into law a bill introduced by Senate President Therese Murray that will, among other things, bring more primary care providers into the workforce.

It’s very easy to be a critic. It’s much harder to take a systemic problem like uninsurance and try to fix it. Yet that’s exactly what we’re doing in Massachusetts. And we’d recommend other states giving it a try. It’s the right thing to do.
Lindsey Tucker