In previous posts, I discussed various healthcare reform proposals under discussion in Congress, assessed the US healthcare system based on cost, quality and access, and compared it to the French and British healthcare systems. What most people don’t know though is that a healthcare reform bill has already passed in our country, albeit at the state level, as Massachusetts enacted in 2006 a landmark legislation to provide universal coverage to its residents.

In brief, the new legislation required all Massachusetts residents to purchase health insurance or pay a penalty of up to $912. Employers were also required to provide “fair and reasonable” contribution towards covering their employees or face similar penalties. The state Medicaid’s program was expanded, and a new program was developed to provide coverage for people that earn less than 300% of the federal income poverty level. An insurance exchange was created to allow individuals and small businesses to shop for and compare various health plans. Since many of these changes are similar to what is being discussed in Congress right now in terms of a mixed public-private system, it might be worthwhile to take a closer look at the impact of the new law on access, cost and quality.


The number of uninsured residents has dropped by 430,000 since 2006, making Massachusetts the state with the lowest percentage of uninsured in the country at 2.6%. However, while coverage and affordability have increased, still 21% of people did not receive care in the past year because they could not afford it.


Costs of healthcare have more than doubled since the law passed. While the state spent only $630 million on healthcare in 2007, it is now spending a whopping $1.3 billion. Several cost-containment strategies such as changes in how providers are getting paid will take effect soon.


Several quality improvement initiatives have been passed, such as requiring providers to adopt electronic medical records, developing medical homes, and enhancing the number of primary care doctors, but it is still too early to tell how successful these will be.

Overall, Massachusetts healthcare reform would earn a grade of “B+” on access, “C” on cost and “Incomplete” on quality. So the jury is still out, but there are many lessons for Congress to learn as it continues its debate on reform proposals.

This post was included in the latest Health Wonk Review carnival.