Want to Know What Obamacare Will Really Be Like? Ask Someone in Massachusetts

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Four years after Jaclyn Michalos, now 28, graduated from college, she felt a lump in one of her breasts. Living in Norwood, Massachusetts, Michalos had no insurance, figuring, she says, that she was healthy and any ailments that hit her could be treated with over-the-counter medicines from the drugstore. But once she felt the lump, Michalos saved up some money so she could have it checked. The doctor examined the lump and told her she was fine and that it wasn’t cancer.

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But Michalos continued to worry.  A year later, she applied for health insurance through Healthconnector, Massachusetts’ health insurance exchange, opened in 2006 when the state passed health insurance reform requiring every adult in the state to be covered. Like the Affordable Care Act (ACA), whose “individual mandate” becomes effective in January 2014, Massachusetts offers assistance to people with low incomes. Michalos found out several surprising things: Comprehensive health insurance cost less than she expected; the HealthConnector exchange was able to easily help her find the best plan for her needs; and she did indeed have cancer. Now, a few years later, Michalos is cancer-free, and recently filmed a testimonial to urge others in her state to sign up for coverage.

If Michalos’ experience sounds a lot like what many of us expect from Obamacare, you’re right—there is a lot of overlap. Massachusetts’ seven-year-old health reform program is a model for what’s about to happen across the nation, says Vicky Pulos, a staff attorney with the Massachusetts Health Reform Institute (MHRI). “Massachusetts was successful in reducing the number of the uninsured, which we did through several different programs,” says Pulos.

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However, she adds that Massachusetts started out with a much lower rate of uninsured people than some other states, and a pretty high rate of employer insurance. “And we chose to expand [Medicaid] coverage, while some states are choosing not to expand Medicaid for 2014, or saying they won’t, and that includes a lot of states with the largest number of uninsured in the country,” Pulos explains. “So our success in reducing the number of uninsured may not be equaled across the country, at least not right away.”

Communication was also critical to Massachusetts’ success, says Pulos. The commonwealth sent a postcard about the new insurance opportunities to all tax filers and gave out millions of dollars to community organizations to create education programs to explain the new ways people could get coverage. “Both the carrot and the stick were certainly important,” says Pulos. “The ‘carrot’ of coverage, and the ‘stick’ of the penalty for those who didn’t sign up.” As with Obamacare, most people who don’t have health insurance by a specified time will face a penalty.

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A May 2012 report from the Kaiser Family Foundation gave kudos to several specific parts of the Massachusetts health reform program:

•  Expansion of coverage to nearly all state residents;

•  Within a year of implementation the state experienced an unprecedented drop in the number of uninsured and, despite the economic recession, it continues to retain the lowest rate of uninsured residents in the country; and

•  More adults in Massachusetts than before reform now get preventive care and report a regular source of healthcare (having a medical “home” is important for keeping people well, which in turn helps keeps healthcare costs down).

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But Masschusetts isn’t an unqualified success, according to the Kaiser report. With more people covered, the demand for health care—particularly in underserved communities—has increased. That means people often have to wait a lot longer to see a doctor, and may need to be routed to physicians farther from where they live. The state is working to increase the number of providers by creating loan repayment opportunities for doctors and other providers in underserved areas. Many Americans can probably expect a similar side effect once Obamacare kicks in fully in January 2014.

Another issue the state is facing according to the Kaiser report is rising healthcare costs, because so many more people are seeking preventive care and treatment. The result is that Massachusetts has the highest individual market premiums in the country. Some experts are also predicting that premiums under the ACA will climb—or even skyrocket, though it remains to be seen if this will in fact happen.

"Cost containment" for the national health reform program—meaning efforts to keep both the cost of care and the cost of insurance premiumds down—has been built into the ACA, though MHRI’s Vicky Pulos says it will take a few years to see how well that works. One important effort is the Patient-Centered Outcomes Research Institute aimed at finding and sharing the most appropriate treatment choices for best outcomes as well as shoring up costs.

On the whole, outside of a crystal ball, Massachusetts is as good a bellwether as we currently have to imagine what life under Obamacare will look like—both the strengths and the weaknesses of the program. That's because no other state has taken such a bold step in an attempt to offer more of its citizens quality healthcare and reform out-of-control healthcare costs.

Do you think Massachusetts is a good example for the rest of the country to follow? What do you think the pros and cons of the ACA are?

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Fran Kritz is a freelance writer specializing in health and health policy and lives in Silver Spring, Maryland. Takepart.com

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