David Seltz
David Seltz, executive director of the Massachusetts Health Policy Commission, spoke to health care and business leaders in Worcester on Tuesday, the 10th anniversary of the Massachusetts health care reform law. Seltz, who helped write the law, is holding the Boston Globe from that day in 2006.
(Michael D. Kane | MassLive)
WORCESTER -- Ten years after Massachusetts signed into law Chapter 58 of the Acts of 2006 -- which called for affordable health care for all -- the state is still struggling with how to deal with the cost of a law that has insured nearly everyone, but one that has also created the highest premiums for families in the country.
Today's issues with costs were not unexpected 10 years ago, according to the state's healthcare expert, David Seltz, who spoke before the Worcester Regional Chamber of Commerce on Tuesday.
Seltz heads up the Health Policy Commission, and independent state agency with a mission of developing policy to both improve patient care and control costs in the state. As the chief health care advisor to then-Senate Therese Murray, Seltz helped write the 2006 health care reform law, particularly when it came to financials.
Holding up a copy of the Boston Globe from 2006, when the law passed, Seltz noted the Globe noted the "joy" and "worries" of the law.
"We could write the same headline today," he said, noting the proponents of that 2006 law understood the difficulties the state faced trying to make sure all of its residents had health insurance.
In 2016, Massachusetts has the lowest rate of uninsured residents in the country and it consistently ranks highest among public health quality surveys, Seltz noted. But it also has the highest family premiums in the country, and health insurance costs are outpacing wage growth.
A family of four in Massachusetts, earning two times above the federal poverty level, spends roughly 40 percent of their income on health insurance premiums and co-pays, he said.
Seltz's numbers are also reflective of two earlier studies of Massachusetts' health care reform.
A 2012 report on the state of Massachusetts healthcare by the Kaiser Family Foundation found Massachusetts per capita spending on healthcare was 15 percent higher than the country's average and that Massachusetts consumers paid the highest premiums in the country. However, the same report noted rising costs in healthcare was not unique to Massachusetts.
A 2014 (taken from a late 2012 survey) study found many positives in the law, including increases to the number of people insured and the number of people who had access to places to go other than emergency rooms when sick. Also, fewer Massachusetts residents reported having trouble finding a primary care doctor in 2012 than in 2008, and the 2012 number is Massachusetts was better than the national average.
However, 40-percent of non-elderly respondents also told Blue Cross that health care costs had been a problem in the year prior to the survey. More than 16 percent of those surveyed said they had gone without needed care because of the costs.
Being insured did not eliminate problems with costs, with almost 39 percent of the insured polled reporting problems with health care spending in the prior year. Problems arising from costs were felt more by those with lower incomes, according to that study.
The Blue Cross report noted that part of cause was the shifting of costs onto employees by employers, including so-called high-deductible plans and requiring more services be paid for out-of-pocket.
Overall, the quest to accomplish sustainable, universal healthcare, is a group effort, and one that is beginning, Seltz noted.
Among the drivers of cost in Massachusetts is both the rising cost of medicines and more people seeking treatment at hospitals in places like Boston for routine services that could be provided in lower-cost markets.
"Many equate price with quality, saying 'it costs more, it must be better.' But that is not the case in healthcare," he said.
Among the actions being taken by the Health Policy Commission is offering innovation grants to groups who have come up with an innovative idea to reduce the cost of medical treatment.
Among the requirements is that the applying agency must have a partner. Partner agencies do not have to be health care providers, but they must be able to be part of the solution.
While Seltz expected about 40 groups to apply for the grants, more than 100 have sent letters of interest, 400 unique partner organizations have been identified. They include law enforcement agencies, specialty courts, housing agencies and employers, among others, he said.
Seltz said he is also advocating for the same type of coalition of government, healthcare providers, insurers and business/employers that helped write the 2006 law to reconvene to tackle the problems of costs.