Roadmap for Achieving Universal Coverage in Massachusetts
The Blue Cross Blue Shield of Massachusetts Foundation has contracted with the Urban Institute to
develop and analyze policy and financing options to achieve universal health coverage in Massachusetts.
The intent of this initiative, called the “Roadmap to Coverage,” is to inform and re-energize the debate
about how to best provide health coverage for the uninsured in Massachusetts and generate a practical
roadmap for extending health coverage to most, if not all, residents of the Commonwealth. Major
funding for the project is being provided by Blue Cross Blue Shield of Massachusetts with additional
support from Partners HealthCare.
The Problem of the Uninsured in Massachusetts
In early 2002, more than 400,000 residents of Massachusetts were uninsured, a 15 percent increase over
2000, according to a state survey. Census Bureau estimates put the number of uninsured in the state
even higher, at nearly 650,000 in 2002. Since then, Massachusetts, like most other state governments,
has experienced substantial budget shortfalls resulting in cuts to health care programs. As a result of
these cuts and the continued rise in health care costs, among other factors, the problem of the uninsured
in Massachusetts is growing.
Past attempts to expand coverage in Massachusetts and other states have met with political, financial,
legal and institutional obstacles. Despite these obstacles, the Foundation believes that the time is ripe for
development of a practical, phased-in solution to the problem of the uninsured in Massachusetts. Why?
The public strongly supports the value that everyone in Massachusetts should have health coverage.
Massachusetts residents believe everyone in the state should be able to get the medical care they need,
regardless of their ability to pay, according to a recent Foundation poll. Seventy-six percent agreed that
“people who are unemployed and poor should be able to get the same amount and quality of medical
services as people who have good jobs and are paying substantial taxes.”
We already pay a significant amount for health care for the uninsured. Employers and those with
insurance coverage contribute to the costs of care for the uninsured through direct and indirect
contributions to safety net programs and through higher health insurance premiums. A national study
estimated that achieving universal health coverage would cost only 40 percent more than is already
being spent on health care for the uninsured.
We should act now while the problem is still in reach. As the problem of the uninsured continues to
grow, so will the cost of solving the problem. Already, hospitals and community health centers are
reporting a dramatic increase in the demand for care from uninsured patients that exceeds available
funding resources and could threaten the fiscal viability of some health care institutions. If we do not act
now to protect existing coverage programs from further erosion, and advance options to fill in the
remaining gaps, the problem will grow and the health care system will become increasingly unstable.
Other states are proposing health reforms with a goal of expanding coverage. California recently
passed a law requiring large employers to provide health coverage to their workers or pay into a state
fund that will provide coverage. If implemented, the law would extend coverage to more than one
million Californians. Our neighbor Maine is implementing a private-based health insurance initiative
financed in part through a Medicaid expansion. The Dirigo Health Plan includes provisions to improve
quality and contain costs as it moves Maine toward universal coverage within the next five years.
Roadmap Reports and Timeline
The Roadmap project has three distinct, but related analytic components:
Analysis of the cost of medical care for the uninsured in Massachusetts. By estimating how
much medical care the uninsured currently receive and who pays for it, this analysis will identify
resources that are already in the health care system and potentially available to help pay for
expanded coverage. Release date: Foundation’s Annual Summit on Access - November 16, 2004
Development of options for coverage expansions and impact analysis. The project will
develop and examine options for expanding coverage and will estimate the cost and coverage
impacts of each. Following that analysis, a primary option will be selected and refined and more
extensive cost, coverage and economic impact modeling will be conducted. Release date:
Foundation’s Annual Summit on Access – November 16, 2004 with more extensive cost and
impact modeling to be released in Spring 2005
Development of a phased-in implementation plan. The final project report will include a
detailed, phased-in transition plan for implementation of the coverage expansion including
program financing and any necessary changes in existing state laws or regulations. Release date:
The Urban Institute
The Urban Institute is a Washington D.C.-based, nonprofit, nonpartisan policy research and educational
organization established to examine the social, economic, and governance problems facing the nation.
John Holahan, Ph.D., and Alan Weil, J.D., are the co-principal investigators of the project.
John Holahan is the Director of the Health Policy Center at the Urban Institute and has over 30 years of
research experience. His work has focused on Medicaid, state health policy, and issues of federalism and
health. He has researched the reasons for the growth in the uninsured over the past decade and the
effects of proposals to expand coverage. Alan Weil has recently been named executive director of the
National Academy for State Health Policy where he will continue to co-direct this project. Prior to his
new position, Weil served for the past seven years as director of the Urban Institute’s Assessing the New
Federalism (ANF), one of the largest privately funded social policy research projects ever undertaken in
the United States. Previously, he held a cabinet position as executive director of the Colorado
Department of Health Care Policy and Financing, was health policy advisor to Colorado Governor Roy
Romer, and was assistant general counsel in the Massachusetts Department of Medical Security.
If you have questions about the Roadmap project, call the Blue Cross Blue Shield of Massachusetts
Foundation at 617-246-3744.