Massachusetts offers health care example

NEWBURYPORT, Mass. -- Three years ago, Rebeccah Pearson was just another carefree 20-something who had no medical insurance. Healthy and working a retail job in this pretty seaside city, she couldn't afford insurance even if she had wanted it.

When Massachusetts passed legislation in 2006 requiring all residents to buy coverage, she signed up. "I didn't want to get fined," she said.

She went online to compare policies, mailed an application, and two weeks later had insurance for a subsidized premium of $34.60 per month.

Millions of other Americans could find themselves in Pearson's position if Congress passes the landmark health care legislation it is considering.

Massachusetts is the only state that has adopted the core elements of the plan outlined by President Barack Obama and congressional Democrats: an individual mandate, an employer mandate, subsidies for the poor, insurance market reforms, and an "exchange" under which consumers can shop for coverage.

It's also the example that advocates and skeptics of those ideas use in arguing their case. Democrats highlight the expansion of coverage; about 97 percent of Massachusetts residents have insurance, compared with 85 percent nationally.

Republicans knock it for spending too much; Massachusetts had to scale back its coverage goals this year in the face of a big state budget deficit.

Health experts, meanwhile, consider it a useful laboratory to study the effects of revamping the health care system.

On the streets around Boston, many say the state's health care overhaul has changed their lives. Linda Furey, 41, a part-time librarian in Beverly, got new glasses. Steve Jackson, 48, a classical clarinetist, got his first physical in years.

Others remain caught in a coverage gap. Nearly 200,000 residents still lack insurance, many because they make too much to qualify for subsidies but too little to afford private coverage.

They can get a "hardship exemption" from the mandate, but they illustrate the challenge involved in providing affordable coverage toeveryone.

In three years, 180,000 people have enrolled in Commonwealth Care, the state's subsidized plan. An additional 148,000 have obtained coverage from their employers, despite early worries that the public program would "crowd out" private insurance.

Add those who bought nonsubsidized insurance or enrolled in Medicaid, and a total of 432,000 individuals in Massachusetts are newly insured.

Success in expanding coverage has brought its own problems: rising costs and longer waiting times.

A survey this year of 15 cities found Boston at or near the top for longest physician wait times. It took on average 63 days to see a family doctor there for a routine physical, compared with seven in Miami, according to Merritt Hawkins, a physician recruitment firm.

State costs shot up too. Faced with a gaping state deficit, Gov. Deval Patrick recently backtracked on health benefits for green-card holders, legal residents who are not citizens: They now get medical care but not dental or vision coverage.