Public Program Reform

This paper provides a discussion of CDHC, what it is and how it can help constrain health care costs and increase patient engagement in Massachusetts. While supply-side approaches are also necessary for cost control, without engaged consumers, Massachusetts may find that it cannot accomplish its cost-containment goals as quickly or as successfully as desired.

This paper describes Massachusetts' existing medical liability system, including how it has failed to achieve its social objectives, the impact of the system on health care costs, and recent efforts towards reform. It presents policy options for medical liability reform. It examines both traditional and nontraditional avenues of reform along with strategies for advancing medical liability reform in Massachusetts.

While larger employers have engaged their employees in wellness initiatives and consumer-driven approaches, small employers have often lagged behind. Small businesses can, however, adopt these health benefit approaches to address their own rising health care costs.

The importance of this work is especially clear as the Patient Protection and Affordable Care Act of 2010 (ACA) requires a health benefit exchange to be operating in every state by 2014. The question of the Connector's effectiveness is of critical importance to other states as they try to plan and design what an exchange will look like in their own state' For Massachusetts, the ACA provides both opportunities and challenges moving forward.

This report is the final report in a series of four. Earlier reports in this series evaluated access to health insurance and health care, equitable and sustainable financing, and administrative efficiency. The focus of this report will be on cost-effective quality, and the analysis will be organized by the four "Scorecard Metric,' presented in Figure 1. 

This report is the third in a series of four. The focus of this report is on administrative efficiency.

As an alternative to analyzing the reform’s impact on isolated issues, in January 2009 the Pioneer Institute proposed a framework for evaluating the reform.

The focus of this report is on the reduction of barriers to access.

Health insurance markets are regulated by the states under the McCarran-Ferguson Act (15 U.S.C. 1011) of 1945. The 'purpose clause' of the Act states that regulation and taxation of the business of insurance by the states is in the public interest. As a result of McCarran-Ferguson, every health insurer must be licensed in the policyholder's state of residence. The states have responded with a complex patchwork of mandates and laws that vary widely across the country.

Passed in 2006, the Massachusetts healthcare reform bill represents an innovative approach to healthcare reform in the United States. The bill (Chapter 58 of the Massachusetts Laws of 2006) has four main goals: to use an individual mandate to expand access to near universal levels; to establish guidelines for employers' fair share' contribution and involvement; to reorganize insurance markets and manage the distribution and subsidization of several insurance plans through the new Massachusetts "Connector"; and to establish transparency that will aid in understanding and assessing the bill's cost and quality of care.