With the Supreme Court ruling in June and the re-election of President Obama, the Affordable Care Act is unlikely to be overturned. In 2006, the state of Massachusetts implemented its own universal healthcare bill. Looking back at the Massachusetts experience may help us to predict certain aspects of the future of the overall U.S. healthcare market.

With the advent of universal healthcare in MA, the uninsured rate dropped dramatically. In 2010, it is estimated that 94.2 percent of non-elderly residents had coverage vs. 86.6 percent in 2006. Since this expansion, the two main issues plaguing the healthcare system in Massachusetts have been rising healthcare costs and a shortage of primary care physicians.

As approximately 40 percent of the state's budget is already dedicated to healthcare expenditures, the Massachusetts legislature passed a bill in July 2012 in an attempt to curb further costs. Key features of this bill are limiting growth of healthcare spending, implementing global payment models (vs. fee-for-service), supporting formation of accountable care organizations, supporting formation of patient-centered medical homes, and expanded reporting of healthcare quality.

Secondly, the PCP shortages have led to a decline in the number of physicians accepting new patients and long wait times for appointments. These were both problems in MA before universal coverage but they have been further exacerbated by the flood of newly insured patients.

Looking now to the country-wide universal expansion of healthcare, the growth of the overall patient pool that can access care will most likely bring with it an increase of legislated cost controls on a state-by-state or national basis. Additionally, we expect that payers will require even stronger economic arguments regarding the use of expensive therapies while the cost-effectiveness bar will be set higher as state budgets are increasingly tightened.

Jessica Church, Ph.D. is a Senior Consultant with the DRG Consulting group.

New England Journal of Medicine, 2012; 367: 790-793.

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