Early Affordable Care Act Enrollment & The Massachusetts Experience

Massachusetts’s healthcare law, passed in 2006, served as a model for the Affordable Care Act, and the state’s experience during its first year of enrollment offers important lessons for what we can expect over the first six months for the ACA.

• For example, we know that most consumers buy health insurance close to the deadline for enrollment. In Massachusetts, 123 premium paying consumers – or 0.3 percent of the eventual premium paying enrollees – signed up in the first month they could enroll and over 20 percent enrolled in the last month. By the end of a year, 36,000 had purchased coverage.  And we know that young adults bought plans. In Massachusetts the number of uninsured young people plummeted from about 1 in 4 to 1 in 10 within 3 years.
• Today, Massachusetts residents have nearly universal health insurance coverage and the primary attacks against this law – many of which we are hearing again today about the ACA – never proved true.
• Before the Massachusetts plan was enacted, people without insurance coverage could only turn to emergency rooms or community health centers for care. The old Massachusetts Uncompensated Care Pool was a program that reimbursed hospitals, community health centers and providers for care that the poor and uninsured couldn't afford, but as the Massachusetts government makes clear, the program "is not health insurance."  As then-Governor Romney said in pushing for the Massachusetts reforms, "I believe that we should be able to provide for all of our citizens a basic, good, solid health care system and that means that we don't use the inefficient system we have now where half a million people without insurance go to emergency rooms."

Recently President Obama traveled to Massachusetts to discuss the Affordable Care Act, which expanded these principles nationwide.  As current Massachusetts Governor Deval Patrick explained in his introduction of the President, there were striking similarities in the roll-outs of the now very successful Massachusetts reforms and the Affordable Care Act in its first few weeks:

"But our launch seven years ago was not flawless. We asked an IT staffer who has been at our Connector since the beginning what the start of implementing reform was like.  And this is what he said, and I’m quoting:  “We didn’t have a complicated eligibility process back then, but we did have outages caused by traffic peaks.  We experienced some issues with data mapping of plan detail that carriers called us on.  Our provider searches were not good, and the website was a constant work in progress over the first few years.  But other than that, it was smooth.”

"Any of this sound familiar, Mr. President?

"So we started out with a website that needed work.  We had a lot of people with a lot of reasonable questions and not a good enough way to get them the answers.  But people were patient, we had good leadership, and that same coalition stuck with it and with us to work through the fixes, tech surge and all.  Why?  Why?  Because health reform in Massachusetts, like the Affordable Care Act, is not a website.  It’s a values statement.  (Applause.)  It's about insuring people against a medical catastrophe.  It's about being our brothers' and our sisters' keeper by helping others help themselves."