Health Affairs, 28, no. 2 (2009): 605 doi: 10.1377/hlthaff.28.2.605 © 2009 by Project HOPE	New Online   Senate Health Reform Bill   Rewarding Providers   Public Option Policy Brief   Health Reform & Abortion   Delivery System Reform

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Letters

Massachusetts Reform: The Authors Respond

After 1988 passage, political opposition from employers, rising health care costs, and an economic recession contributed to suspension of the legislation. Although Massachusetts data are not available, the Health Insurance Association of America (now America’s Health Insurance Plans, or AHIP) reported an 18 percent national increase in premiums in 1989.¹ Premium increases remained at double digits until 1993. From 1994 to 1998, premium increases were at record lows.² Concurrently, Massachusetts unemployment rose from 3.5 percent in December 1988 to 9.1 percent in April 1992. By December 1993, unemployment fell to 6.3 percent and to 4.3 percent three years later.³ Hence, conditions for implementing the 1988 legislation were highly favorable when it was repealed in 1996.

We believe that Woolhandler and Himmelstein don’t sufficiently credit progress achieved in Massachusetts over the past two years. Compared to national statistics, the figures they cite from the Boston Globe/Blue Cross Blue Shield of Massachusetts Foundation survey are favorable. From a 2007 national household survey of adults ages 19–64, researchers reported that 31 percent of Americans "had a medical problem but did not visit the doctor," 31 percent "did not fill a prescription," and 27 percent "had problems paying medical bills."⁴ In the face of an economic downturn, public and employer support and a sympathetic Obama administration render the future of the Massachusetts plan "stable," not "grim."

Jon R. Gabel
NORC, Bethesda, Maryland

NOTES

 

1. J. Gabel et al., "Employer-Sponsored Health Insurance, 1989," Health Affairs 9, no. 3 (1990): 161–175.[CrossRef][Medline]
2. J. Gabel et al., "Job-Based Health Insurance in 2000: Premiums Rise Sharply while Coverage Grows," Health Affairs 19, no. 5 (2000): 144–151.[CrossRef][Medline]
3. Data available through query at the Massachusetts Executive Office of Labor and Workforce Development, "Labor Force and Unemployment Data," http://lmi2.detma.org/Lmi/lmi_lur_a.asp.
4. C. Schoen et al., "How Many Are Underinsured? Trends among U.S. Adults, 2003 and 2007," Health Affairs 27, no. 4 (2008): w298–309 (published online 10 June 2008; 10.1377/hlthaff.27.4.w298).[Abstract/Free Full Text]

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