New York Times examines Massachusetts health insurance law as model for U.S. health reform

"By tackling cost at the same time as access," the Obama administration and congressional lawmakers "have made their political challenge more difficult," the New York Times reports.

According to the Times, the only "real-life model in this country for the kind of sweeping change being considered in Washington" is Massachusetts' 2006 health insurance law, which has helped the state achieve near-universal coverage but could be jeopardized by rising health care costs.

The Times reports that Massachusetts lawmakers in developing the plan decided to "decouple access and cost, and to deal first with covering the uninsured." In recent interviews, people involved in crafting the law said that deferring decisions on cost containment was necessary to reach a consensus on the individual coverage mandate. Andrew Dreyfus, executive vice president of Blue Cross and Blue Shield of Massachusetts, said, "When you start talking about cost, you create winners and losers and that leads to a political challenge." Current efforts by state lawmakers to implement control costs, including a proposal to change the physician payment system, will more seriously test consensus on the law, "but the gamble is that stakeholders are now so invested they cannot back away," the Times reports.

According to the Times, the "times and the politics are different in Washington, where the recession has convinced both parties that cost containment cannot wait. But by addressing costs and access simultaneously, the White House and Congress risk alienating key interest groups from the get-go." Jon Kingsdale -- director of the Massachusetts Health Insurance Connector Authority, which oversees the state's subsidized health coverage program -- recommended that Congress pass legislation that would expand coverage and delegate cost containment decisions to a commission. He said, "The concept is to sequence reform in some way to do the really hard thing, which is expanding access, before we do the nearly impossible thing, which is containing costs. We don't want to end up holding 50 million uninsured hostage to cost containment."

John Sasso, a Massachusetts political strategist who represented the state's largest insurer and largest hospital network during negotiation of the Massachusetts law, said, "My experience has been that if you start out trying to design the perfect plan you will fail," adding, "The goal has got to be to deal with all the levers that affect cost and access and quality but to not overreach in any of those areas. Everybody had a certain responsibility but not so onerous, not so tough on the front end, that it would cause people to lose faith in the prospect of covering everybody" (Sack, New York Times, 3/29).