State Report: Massachusetts

Immigrant, labor and healthcare advocates are pushing to have enough funds added as an attachment to the budget to ensure no loss of coverage next year, and Gov. Deval Patrick has proposed restoring $70 million to the program, which would partly restore the immigrants' coverage. But legislative leaders have balked, saying vital programs for other groups would have to be cut as a result.

Commonwealth Care plans to save an additional $63 million by no longer automatically enrolling low-income residents who fail to enroll themselves.

PAYMENT SYSTEM UNDER FIRE

A state commission has recommended that Massachusetts dramatically change how doctors and hospitals are paid, essentially putting providers on a budget as a way to control healthcare costs and improve the quality of care. The 10-member commission, which includes key legislators and members of the governor's administration, voted unanimously to scrap the current system, in which insurers typically pay doctors and hospitals a negotiated fee for individual procedures and visits. Instead, PCPs, specialists and hospitals would group into networks and be responsible for an individual's well-being and be compensated with a flat monthly or annual fee known as a "global payment."

The commission, which recommends the change be carried out over five years, stressed the importance of changing the way doctors and hospitals are paid not only by private insurers but also by Medicare and Medicaid, a change that would require federal approval. The legislature and governor must vote on the proposed change before it could take effect.In 2006, Massachusetts adopted a healthcare law that has attained near-universal coverage.?"But the plan has done little to control costs, which now are 33% higher than the U.S average and projected to grow faster than the rest of the country," the commission says.

Since implementation of healthcare reform, enrollment in private insurance has risen by 190,000, accounting for 45% of total growth in coverage.

MHE Sources: Centers for Medicare & Medicaid Services; Urban Institute; Kaiser Family Foundation; U.S. Census Bureau; The Commonwealth Fund; National Center for Health Statistics; Robert Wood Johnson Foundation; Health Care in Massachusetts: Key Indicators (May 2009) report