The Massachusetts Experience with Universal Health Coverage - Term Paper Example

The Massachusetts experience with universal health coverage Introduction The healthy well being of any individual in a society is very important. The relevant policy makers in any jurisdiction are responsible for making healthcare policies to ensure that all people in that society have access to affordable health care. Different jurisdictions have varying healthcare policies. Some have been appreciated by people in a particular jurisdiction and beyond. Massachusetts is one of the jurisdictions that have made a landmark in having very good healthcare policies. The Universal Health Coverage in Massachusetts has been a success and has inspired the country to follow the same path. In fact, the Affordable Care Act on Obamacare universal insurance is based largely on the Massachusetts universal health care coverage (Kessler 1). Universal Health Care has an impact on the individuals of a society and implementing it guarantees better health of the people and productivity. Universal Health Care Universal health care is a system of health insurance in which the objective is to ensure that all individuals in the society or any jurisdiction have access to good health care. In most countries, health care is expensive to especially those who are considered below the poverty line - they are unable to access healthcare facilities as they cannot afford. The universal health-care plan promises to change all that by providing insurance to even the very poor. This healthcare is based on several principles, as discussed below. Provision to all Universal care is based on the fact that all people should have access to healthcare. This is regardless of whether they are rich, poor or are in the middle class. The plan has to be such that no person is unable to pay for healthcare services. The cost of the services is spread across all the people using the plan to ensure that all people can be able to make payment regardless of their social class. This is through several options provided to the individuals. Reduced direct spending: Direct payments made by individuals seeking healthcare services to providers are reduced. In this case, the individuals have to cost share the cost with the providers. This can be through co-payments, in which the individuals subscribe to be paying a specified fee per month, deductibles in which the individual is deducted a certain amount of money after a certain period like monthly, quarterly or half yearly depending on their specifications, coinsurance in which insurance is spread across several parties and unofficial payments to the provider at the time when seeking healthcare services (Universal health coverage 3). Prepayment Health care has to be financed by some individuals at some point. In the case of universal health care, individuals who can afford to make contributions every now and then are encouraged to continue making contributions. The payments are made before hand, and it is not necessarily that a person is seeking healthcare services to make the payment. Contributions are made through taxes, payroll deductions, contribution premiums and donor contributions. The contributions can be organized in different ways depending on the jurisdiction (Universal health coverage 4). Risk Pooling: Universal healthcare is based on sharing the cost of healthcare facilities and services. In this case, the cost incurred by any individual when seeking health care services is spread across all individuals that have subscribed to the universal health care services. For the system to be more effective, more people are required to subscribe and make payments. This reduces the chances of fluctuations when services are being provided. When few people subscribe, there are times when the facilities may lack funds, especially when many people are seeking medical interventions at the same time (Universal health coverage 5). Considerations for universal healthcare success Universal healthcare has to be well considered for it to work out properly. The political landscape of the country is important for the success of this plan. Politicians are critical in making laws and policies regarding healthcare. Considerate politicians care for their people and are likely to push forward such laws. They also push for reforms to ensure that all people have access to important facilities, for example, the healthcare. Massachusetts law makers have been critical, in the introduction of universal healthcare to not only Massachusetts but also in the United States. This has also inspired other countries to work towards the universal health care provision (Savedoff, Ferranti, Smith and Fan 1). Another consideration that has to be looked at is trend in demographics, social, economic and health of a society and jurisdiction. The changes have to be documented properly to estimate the future changes in these factors. Studies on these factors should be done in depth for proper estimations to be made on them. Changes in social status are important in universal health care. Improvement in the social status of people in a given jurisdiction makes it possible for more people to afford contributions. Universal healthcare requires many people to make contributions to provide financing to the services and facilities (Sankoh et al. 2). Importance of Universal Health Care in Massachusetts Universal healthcare in Massachusetts is considered one of the best not only in the United States but also across the world. For a long time, most countries have been claiming that they are committed to universal healthcare, but none took bold steps like Massachusetts. In Massachusetts, the universal healthcare provision was based on three phases. The first phase was to ensure that the extremely poor are covered. Implementation started with the people who were 100% below the American Poverty line. This phase took about one year and was followed by those above the poverty line up to 300% of the Federal poverty Line. This also took close o a year and was followed by implementation to all the others. The policy makers in Massachusetts were aware that some people could have challenges making payments proposed. They proposed that people in the low and middle-income salary range to have their premiums subsidized. The subsidy was to be those that are between 150% below the Federal Poverty line. Those below the 150% were not required to pay anything for health insurance. It would be provided free of charge. Health care insurance was also expanded to include children, especially for the low and middle-income households. In that regard, families in the range of 150% to 200% of the poverty line paid an average of thirty-five dollars per adult while families above the poverty line paid an average of one hundred and five dollars per adult (Kessler 10). The universal healthcare plan in Massachusetts improved a lot of things within this state. The number of uninsured people decreased from 8% to about 6% after implementation. It also encouraged employers to cater for health insurance of their employees. The number of people discharged from hospitals uninsured decreased by 36% in Massachusetts with the universal healthcare. At the same time, the number of admissions on preventable conditions decreased remarkably signifying the well-being in health of the people in the state. The number of people waiting to see a doctor in Massachusetts had decreased from 25% prior to implementation of the universal health care in 2008, to 19% in 2012. That has made work very easy for the physicians in the state as they have more time for individual patients (Gengler 25). It was found out that there are a lot of correlations between good healthcare and improvement in health. More than 75% of Publications on health between 1990 and 2001 indicated that there was a positive impact on health care insurance on recovery from conditions such as trauma, cancer and other high-risk conditions. Such leads to low mortality in a society showing that the society is generally in good health. It can therefore be confirmed that good health insurance is important for the health and well-being of the population. However, the implementation of a universal health care plan was not that easy. Universal health care insurance would significantly add the number of patients to be checked and treated by individual doctors and physicians. There would be an increase of close to half a million people to the health care system in Massachusetts. That would be a bumpy ride even for this state that has the lowest physician to individuals’ ratio in the United States. The ratio would increase for a while before the system can be implemented fully and take shape (Gengler 27). In the case of Massachusetts, the State Government catered for the cost of the people under 150% of the Federal Poverty line. The cost of catering for the cost of the poor can have a toll on the state government. The money could range to the billions of dollars for every fiscal year. As such, the government should approach the strategy with caution to ensure that money to cater for this cost is available throughout. Increase in health insurance would increase health care spending and could have an impact on the GDP of a jurisdiction (Hadley and Holahan 1). On the other hand, the state government could not cater for the very rich. After all, they have the money and could afford to be treated anywhere even without the insurance. However, the Massachusetts health care insurance was to be mandatory for everyone. Any person who did not have health insurance would have to be fined for lack of the policy. At the same time, it is important to note that health care insurance is important to all individuals. It reduces the cost of treatment when an individual requires treatment procedures that are expensive. Andrew Herlihy appreciated the importance of the universal health care when he got an injury that required surgery in 2007. He did not like insurance but was paying about one hundred and fifty dollars towards the health insurance policy. The insurance catered for the cost of the surgery he underwent. If he did not have a health insurance policy, he would have parted with approximately 45,000 dollars for the surgery (Gengler 11). The Affordable Care Act The universal health care in Massachusetts has been very successful. More than 97% of individuals in the state are insured under the universal health insurance. The number of individuals with access to physicians has increased to 92% since the policy was enacted. A third of the physicians in the state are happy with the system the way it is while about 40% state that the health care insurance is good but can be improved. The success of the universal health care insurance in Massachusetts has an impact on the national health policies such as the affordable health act (Simmons 3). In fact, the Affordable Care Act was based on the Massachusetts Universal Health-Care policy. The Affordable Care Act is based on three principles; Coverage: There are many people in the United States that do not have access to medical insurance. This Act promises to ensure that all Americans have access to health care services regardless of their social status. All people, including children, the middle-aged and the elderly must have access to health care according to this act. As such, insurance companies that provide the policies do not have the right to cancel coverage to individuals. In the case, an individual lacks the money to make premium payments; they have the right to appeal to the insurance company to reconsider the denial of payment. Yung adults who may not be making money can be covered under their parents until they are able to earn to cater insurance on their own. Costs: The Affordable Care Act bans all limitations on coverage. At the same time, all the money insured have to be spent on health care related issues only. Insurance providers were put on notice not to use part of the premium on administrative issues. They are also regulated in that they cannot hike the prices of premiums without very good reasons that are confirmed and passed by the relevant governmental organizations. The aim is to reduce health care spending, which can have negative effects on the GDP, especially if they are very high. Care: Individuals across the United States can get access to free checkups for the preventive conditions at no cost from the doctor of their choice. The plan allows individuals to choose the doctor they would like to be consulting and getting treatment from. In addition, the government ensures that the insurance premiums guarantee access to emergency treatment services in hospitals that are outside the plans network. The policy makers of this plan were confident that this would allow patients to be treated anywhere with their policy guaranteeing good health (U.S Department of Health and Human Services 2-4). The Affordable Care Act also has several provisions to ensure that all people have access to the insurance. The low and middle-income individuals and households and individuals have tax subsidies in which they pay less amount compared to the rich. The federal government will be assisting those that earn 400% below the Federal Poverty Line to access insurance. Small companies and retails businesses also pay less compared to large companies. At the same time, this law compels the large companies to pay health care insurance for their employees. Access to insurance under this law eliminates all kinds of discrimination that have been used by insurers to hike premiums, for instance, gender, race, pre-existing conditions, industry and occupation (Kennedy 17). This act promises to reduce the number of uninsured and underinsured individuals and households in the United States by 70% soon. Currently, more than 80 million Americans are uninsured or underinsured. The number has been on the increase in the last five years, and the government feels that the number can reduce to just under twenty million in the next few years with the Affordable Care Act (Schoen et al. 1). This law is expected to improve prevention of preventable conditions significantly. It compels the insurance companies, the health care industry providers and the community to appreciate well being. At the same time, the law promotes partnerships between the federal government, state government and local community groups to work together towards wellness of the society (Koh and Sebelius 10). Experts believe that this law would be critical in moving states towards better health care for all including the disabled and those with chronic diseases and conditions (Reinhard, Kassner and Houser 3). Universal Healthcare Massachusetts versus Affordable Care Act The Massachusetts Universal Care Health and the Affordable Care Act have a lot of similarities. In fact, the founding principles of the two are more or less the same, though one of them was proposed and implemented earlier. The core principle of the two health care plans was to ensure that all people have access to healthcare regardless of their social status. However, they also vary in a number of things. While the universal health care in Massachusetts required all people to contribute to the health care funding, including the very poor, the Affordable Care Act would ensure that the very poor do not contribute to healthcare financing. At the same time, the ACA was focused on reducing the budget on healthcare, but the Massachusetts increased the budget in some ways. These disparities dictate the differences in the function and organization of each. Universal Healthcare Massachusetts Better than Affordable Care Act The Massachusetts Universal Health-care plan is considered better to Affordable Care Act for a number of reasons. One, the plan was executed in phases in which the most vulnerable were considered first. Phase two was implemented after successful implementation of phase one and phase three was implemented after phase two was completed successfully. This allowed the law makers to detect any loopholes in the system and address them accordingly. Secondly, the Massachusetts plan provided individuals with choices of exactly what kind of insurance would fit their needs, as long as they could afford the plan. Changes in social class and income would allow people to change their plans as they wished. These provisions are not available in the Affordable Care Act and could be limiting to the health care industry (Courtmance and Zapata 41). Conclusion Health care industry is very important for the well-being of the society. In the United States, the Massachusetts health-care plan and the Affordable Care Act are the laws that have been involved in ensuring the health of the people. The two have some similarities and differences as well. While the Massachusetts plan has worked effectively and seems to be better organized, the Affordable Care Act is in the process of implementation. Following the steps and strategies followed during the implementation of the Massachusetts plan would guarantee better implementation and success of the Affordable Care Act. Works Cited Courtmance, Charles, and Daniela Zapata. “Does universal coverage improve health? The Massachusetts experience.” National Bureau of Economic Research 1.1 (2012). Print. Gengler, Amanda. The Massachusetts (health care) experiment. CNN Money. 4 June 2013. Web. 17 November 2013. Hadley, Jack. “Sicker and Poorer—the Consequences of Being Uninsured: A Review of the Research on the Relationship between Health Insurance, Medical Care Use, Health, Work, and Income.” Medical Care Research and Review 60.2 (2003): 3-75. Print. Hadley, Jack, John Holahan. “Covering the uninsured: how much would it cost?” Health Affairs 1.1: (2003). Print. Kennedy, Chuck. Obamacare Facts: Facts on the Affordable Care Act. 2013. Web. 17 November 2013. Kessler, Glenn. Obama’s claim that the Massachusetts enrollment experience is relevant to Obamacare. The Washington Post. 1 November 2013. Web. 17 November 2013. Koh, Howard and Kathleen Sebelius. “Promoting Prevention through the Affordable Care Act.” The New England Journal of Medicine 363 (2010): 1296-1299. Sankoh, Osman, Zahr, Adami Hans, Tollma Stephen Byass Peter, and Turner Marcel. “Universal health coverage and reliable global health estimates.” The Lancet 382.9886 (2013), 26. Print. Reinhard, Susan, Enid Kassner, and Ari Houser. How the Affordable Care Act Can Help Move States toward A High-Performing System of Long-Term Services and Supports. Health Affairs 30.3 (2011): 447-453. Print. Savedoff, William, David Ferranti, Amy Smith, and Victoria Fan. “Political and economic aspects of the transition to universal health coverage.” The Lancet 380.9845: 924-932. Print. Simmons, Barry. The Massachusetts health care reform experience: What you need to know. Orthopedics Today, 1.1 (2010). Print. Schoen, Cathy, Doty Michelle, Robertson Ruth, and Collins Sara. “Affordable Care Act Reforms Could Reduce the Number of Underinsured US Adults By 70 Percent.” Health Affairs, 30.9 (2011). Print. Universal health coverage. What is Universal Health Coverage? N.d. Web. 17 November 2013. U.S Department of Health and Human Services. “Affordable Care Act: About the Law.” U.S Department of Health and Human Services. N.d. web. 17 November 2013. Read More