States Health System Popular

But backing dips in course of a year; Poll suggests costs worry the public

By Kay Lazar, Globe Staff  |  September 28, 2009

Public support for Massachusetts closely watched health insurance overhaul has slipped over the past year, a new poll indicates, but residents still support the path-breaking 2006 law by a 2-to-1 ratio.

Amid a severe recession that has led to cuts in state programs and unrelenting job losses, 59 percent of those surveyed said they favored the states multimillion-dollar insurance initiative, down from 69 percent a year ago. The poll, by the Harvard School of Public Health and The Boston Globe, found that opposition to the law stands at 28 percent, up slightly from 22 percent in a June 2008 survey.

Percolating throughout the poll findings is a gnawing concern over rising health care costs, suggesting that support could erode further if the state fails to slow the growth of medical spending.

With key features of the state law at the heart of the blistering national health care debate in Congress, architects and observers of the Massachusetts plan say the poll findings indicate that a national overhaul is not only possible, but politically viable.

Three years in operation, and with 97 percent of people covered, you have a majority of support, and that is a lesson for Washington, said Robert J. Blendon, a health policy professor at the Harvard School of Public Health and the polls co-director.

The poll found that 79 percent of those surveyed wanted the law to continue, though a majority said there should be some changes, with cost reductions cited as the single most important change that needs to be made.

Only 11 percent of state residents favored repealing the law, similar to last years finding.

In another question, residents were nearly evenly split over whether Massachusetts could afford to continue with the law as it stands: 43 percent said the state could not, and 40 percent said it could.

Double-digit increases in premiums have become almost routine in Massachusetts, with the states major insurers saying they will raise rates about 10 percent next year. This trend began well before the overhaul passed, however, and when asked whether the law was having an impact on the cost of their own care, only about one-quarter of those surveyed said the law was hurting their own costs.

The Massachusetts law requires nearly everyone to have health insurance or pay a penalty. All but the smallest companies must offer coverage to employees or pay a fine.

The law also created a new taxpayer-subsidized health insurance program for people who are not covered through an employer and earn too much to qualify for Medicaid.

To help balance the state budget earlier this year, lawmakers cut 70 percent of the funding for subsidized health insurance for about 30,000 legal immigrants, a move that sparked widespread debate.

In the poll, 43 percent of respondents favored fully restoring the funding for legal immigrants, while 28 percent said funding should be left at current levels and 19 percent said it should be eliminated entirely.

The telephone poll of 506 Massachusetts adults was conducted Sept. 14-16 by Pennsylvania-based Social Science Research Solutions. The margin of error is plus or minus 5.5 percentage points.

Im very encouraged to see there is still overwhelming support in Massachusetts for health care reform, despite all the confusion that seems to be going on about this in the national debate, said Jon Kingsdale, executive director of the Connector Authority, the quasi-state agency that oversees much of the Massachusetts law.

Most of those surveyed said they didnt think the law has had much of a direct impact on their lives. Roughly a quarter thought it had improved the quality of their health care and their ability to pay medical bills if they get sick.

Thats a striking finding, said Lindsey Tucker, health reform manager at Health Care for All, a large Boston-based consumer group.

The law was designed to help folks who didnt have coverage, but the majority of our residents already did, Tucker said. So, the fact that a quarter now said they are helped by this law is maybe more than we would have imagined.

Roughly 90 percent of Massachusetts residents had health coverage before the law went into effect and now state data show that about 97 percent do, the most nationwide. The path toward near-universal care featured delicate negotiations. Leaders hit many potholes before reaching consensus among businesses, health insurers, health care providers, consumer groups, and trade unions, and all sides agreed to put off the thorny debate about cost-control measures until later.

Public hearings are slated to begin next month on a state commissions recommendations to rein in costs by dramatically revamping the way doctors and hospitals are paid.

Blendon said the surveys findings on cost control suggest that perhaps leaders in Washington should consider following the Massachusetts formula: Aim for universal coverage first, and then tackle costs.

The fact that Massachusetts is still going along with a still relatively popular law, by doing it in pieces, may be the best piece of advice Massachusetts can give the nation, he said. This was politically doable here because all of the difficult choices of slowing costs werent on the table.

Drew Altman, president of the Kaiser Family Foundation, a nonprofit health care think tank, said Washington is paying more attention to cost control up front, but ultimately Massachusetts may get there faster. He said that although the various proposals in Washington contain measures to slow costs, much of the national savings wont be realized for years to come.

The fact that Massachusetts led with coverage and then turned aggressively to cost control will do more for costs in the next five years than national legislation will do in ten, Altman said, because in Massachusetts, you are staring a real affordability issue in the face.

A national survey by Kaiser released this month found that Massachusetts has the most expensive family health insurance premiums in the country, averaging $13,788 in 2008.

In the Harvard/Globe poll, residents who said the Massachusetts law should be continued were asked to name the most important change needed, and 30 percent of that group volunteered some cost-reduction measure. Another 11 percent suggested restricting eligibility for insurance benefits.

Kay Lazar can be reached at klazar@globe.com.