What can Massachusetts Tell Us?

Based on the events and actions that took place in eastern Massachusetts in the colonial period and during our nation’s fight for independence, Boston has appropriately been called the Cradle of Liberty. As a result of its pioneering efforts in health care legislation, there’s a strong argument for calling the entire state the Cradle of Health Reform. The legislation that Massachusetts passed seven years ago, popularly called Romneycare by many of the state’s residents, has served the population effectively by most accounts.

In researching The Familiar Physician: Saving Your Doctor in the Era of Obamacare, I came across voluminous literature that compared and contrasted the state model with the nationally-directed Affordable Care Act, now widely known as Obamacare.  Jonathan Gruber, a leading health economist who consulted on both pieces of legislation said that they are markedly similar on most issues where they can be fairly compared.

At the same time, there are some noteworthy distinctions.  When Massachusetts adopted its health care law a large percentage of its residents already had health insurance. So part of the legislation’s objective was to cover nearly everyone by plugging as many holes as possible in the existing system, a task that is less daunting, by quite a few levels of magnitude, than the federal initiative. In addition, the tough issue of pre-existing condition exclusions had already been addressed at the time of the state reform efforts.  And of course, like any other individual state, Massachusetts is not a microcosm of America.

My intent is not to make a judgment on the relative merits of the state and the federal legislation, but rather to look at one potential correlation that may give us an insight into what to expect when the insured patient pool is expanded across the country.

According to the Huffington Post writer Steve LeBlanc, just half of primary care doctors in Boston, a city with 14 teaching hospitals, were taking new patients five years after the law went into effect, and average wait times for new patients seeking appointments grew considerably according to a Massachusetts Medical Society survey.

Alan H. Goroll, M.D., a professor of medicine at HarvardMedicalSchool and a practicing PCP, says this aspect of the Massachusetts health care initiative is an example of what can go wrong if the primary care system isn’t fixed simultaneously with the start of expanded coverage.

Specific provisions of the ACA will be phased in all the way through 2020, so it’s difficult at this point to speculate as to where the correlations lie. But one thing we can count on is this: if our goal as a nation is to provide medical coverage for as many people as possible, we have to make sure that a sufficient base of primary care medicine, as part of a larger, integrated system, is ready to care for those people.