But the Globe article hinted at something else the study found. Health insurance is expensive here, but incomes are higher here, too. As a percent of median household income, Massachusetts premiums are the 41st highest nationally. This means that in 40 states, the median family pays more for health insurance premiums than we do in Massachusetts. By this measure, we’re one of the better states, as illustrated in the second slide on the accompanying charts.
Of course, this finding is of little solace to families earning substantially below our median income of $63,867. We hear repeatedly from people in the 300%-400% of poverty range (about $32,000-$43,000 for an individual) that they can’t afford coverage. Commonwealth Care’s sliding scale help only goes up to 300% of the poverty level; we hope that national reform will up that to 400%.
The report’s authors used the study to advance the case for national reform. In a blog post that accompanied the study, Commonwealth Fund president Karen Davis writes that Congress needs to pay as much attention to the need to bring family costs down as it does to the cost to the government of the health reform program. She makes a strong, research-based argument for a public plan option that is able to control costs by reducing overhead, negotiating for prices, and using its leverage to improve the delivery system.
We think affordability has to be a top focus of health reformers. Kaiser Foundation President Drew Altman makes the point well in this summary of the affordability issues in reform. One of the lessons of Massachusetts for national reform is the need for significant subsidies and broad coverage as well as cost control in order to reach everyone.