Massachusetts health system reform feeling the pinch

Leaders are trying to limit premium increases in light of high enrollment in state-subsidized plans. Physician pay cuts could be on the table.

By Doug Trapp, AMNews staff. Feb. 11, 2008.

Washington -- There's a four-letter word on the lips of the people in charge of Massachusetts' health system reform: cost.

Unexpectedly large health plan enrollment numbers, an influx of high-cost beneficiaries and high health care costs in general are leading the Connector Authority, manager of the reform program, to search for ways to cut back. Possibilities include prodding health insurers to limit premium increases and reducing physician pay under certain health plans.

Overall participation was higher than expected because even though enrollment in one part of the program fell below expectations, enrollment in another part far exceeded predictions. The state-subsidized, sliding-scale Commonwealth Care health plans enrolled 169,000 people as of Jan. 1. That figure is 33,000 more than anticipated for all of fiscal 2008, which ends June 30. The program is open to residents earning less than 300% of the federal poverty level who don't have access to work-based insurance.

Unsubsidized Commonwealth Choice plans, for those earning more than 300% of poverty, attracted 15,900 people, which is 19,100 fewer than expected for fiscal 2008.

Commonwealth Care also has been more costly than expected because of a higher-than-expected number of older enrollees with significant health needs, said Deborah Gordon, spokeswoman for Network Health, which has about 40% of Care members. About 10% of the company's enrollees have had medical costs that exceeded premium payments by 50%, she said.