Based on Massachusetts' Health Overhaul, What Can the Nation Expect in 2014?

For providers, payors, patients and politicians gearing up for changes called for in the Patient Protection and Affordable Care Act taking place next year, Massachusetts may offer some clues into what they can expect, according to a webinar led by Judith Bentkover, PhD, academic director of Brown University executive master 's program in healthcare leadership and president and CEO of healthcare consulting firm Innovative Health Solutions. 

Four years before the PPACA was passed in 2010, Massachusetts signed its own massive health reform law, unprecedented anywhere else in the country at that point. That law, similar to the PPACA, required nearly every adult to purchase health insurance and introduced heavy government subsidies to help the poor afford coverage.

Dr. Bentkover says Massachusetts has since achieved near universal coverage — 98 percent of its residents are insured, she says, higher than any other state — with only "moderate" added cost to taxpayers, around  $91 million per year after reimbursements. She adds much of that money goes to fund private subsidies to pay for private insurance, but that expense is largely offset by increased payments for uncompensated care by providers across the state.

The annual rate of medical expense increase in Massachusetts declined from 7.5 percent in 2007 to 1.5 percent in 2011, which Dr. Bentkover says supports that the country can greatly expand access to healthcare without breaking the bank. She says it is clear to her that the coverage mandate will stay, and employers will continue to contribute to it.

"There's no doubt that the next year and the one after that will mark significant changes in the way healthcare is delivered and advanced," Dr. Bentkover says. It remains to be seen if the PPACA will save taxpayers and patients the billions its backers claim it will, but she says, "It almost doesn 't matter, because we know the industry is changing forever and is currently unsustainable."

Regarding the PPACA's optional provision for states to receive full federal funding to raise eligibility requirements for Medicaid, Dr. Bentkover says she thinks states are "hard-pressed to refuse" the additional federal money. Even after those funds taper off to 90 percent of the additional cost by 2020, states would still be better off, she says. She expects to see more Republican governors follow after Florida Gov. Rick Scott who publicly opposes the PPACA, but accepted the Medicaid expansion for his state last week. "From an ethical standpoint, it's hard to argue against it," Dr. Bentkover says.

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