Mass. effort at cutting health spending

Dr. Ethan Brackett examines Cristina Valdez at the Codman Square Health Center in Dorchester, Mass.

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Scott Jagow: Massachusetts is trying to make sure every person in the state has health care. No easy task. But the Massachusetts plan reaches another milestone this weekend: People who don't have insurance and make too much money to get help from the state can start buying coverage. This is for individuals making more than $31,000, and families making more than $62,000.

Since Massachusetts won't be chipping in, the state's trying every which way to make this insurance affordable. Let's see how they're doing that. Helen Palmer reports from our Health Desk at WGBH.


Helen Palmer: Critics point out problems with Massachusetts's new system. The Health Connector Board — the folk who crafted it — point to success stories, like Cheryl Greco.

Cheryl Greco: I truly would say I believe that getting on the plan saved my life, and I will believe that to my dying day.

Greco's uncontrolled high blood pressure was causing heart problems — until she signed up with Network Health. That's one of the insurers providing coverage at rock-bottom prices to the state's low-income population.

So, how low are the monthly premiums for Boston?

Christina Severin, head of Network Health:

Christina Severin: The price that the Connector accepted from us was about $359 — and outside of Boston, the price was $327.

There are no state subsidies, though, for people who earn more than 300 percent of federal poverty.

But John Kingsdale, the head of the Health Connector Board, says monthly premiums are still affordable.

John Kingsdale: For the typical uninsured person in Massachusetts who's a 37-year-old living in Boston, the total premium would range from $184 at the lowest priced plan to about $290 for the higher-end premium.

The cheaper premiums come with deductibles and co-pays, but still undercut most work place-based health insurance.

Paul Hattis, a professor of health policy at Tufts University, tallied the cost of a high-end plan:

Paul Hattis: The plan through the Connector Board at the Gold level was actually about $500 less between what I and my employer pay. So it's $500 of savings over what I'm getting through work on an annual basis.

So how have they done that? John Kingsdale of the Connector Board says they used several strategies to lower prices.

John Kingsdale: We're getting a broader cross-section of everybody, not just primarily sick people enrolling. And therefore we're able to . . . the health plans are able to price it more competitively. Secondly, we've got . . . we went through a bid process, and we were able through that process to get the prices down a little bit.

And finally, says Kingsdale, they've set the system up a bit like Travelocity, so people can log on to the Connector's Web site and price their options one against another. For the health insurers, getting prices down is also a matter of commitment.

Deborah Enos of the insurer Neighborhood Health Plan says their strategy is to use a tight network of primary-care doctors.

Deborah Enos: We tend to work with a very defined, specialized primary-care network, and that is one way that we have found to deliver cost-effective care. But we really wanted to have plan designs that encouraged, again, people to get into that core primary care, care-management model.

Enos says investment up-front to manage chronic disease is the key to keeping people out of the emergency department and cutting costs later. It certainly worked for Cheryl Greco.

Cheryl Greco: After I met with the doctor, he gave me tremendous advice, set me up on a pill. And within a month after seeing him, I haven't had the heart problems at all with this new medication. I can't even believe it.

Some aspects of the Massachusetts scheme could serve as a model for other states to bring down health spending. Competition between health insurers to deliver value, for example, and to get access to a new market among the previously uninsured. And since the healthy as well as the sick must buy insurance, costs are lower for the whole pool.

But health policy expert Paul Hattis says there's a nationwide threat to the new system.

Hattis: Health care costs have continued to grow very near double-digit growth. And as that continues, it makes the entire health care costs to all of us just eminently unaffordable.

The latest figures predict U.S. health costs will rise almost 10 percent next year. As Hattis says, Massachusetts is only at first base so far. Getting to second will be a challenge.

In Boston, I'm Helen Palmer for Marketplace.

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