As part of the ongoing debate over the cost of medical coverage, Operation Clean Government's State of the State cable television program held a discussion on the pros and cons of the federal Patient Protection and Affordable Care Act, sometimes called Obamacare.
Critic Lisa Blais of Ocean State Tea Party in Action quoted a May 2012 Associated Press story from Massachusetts talking about "soaring premiums" in Massachusetts.
But Rhode Island Lt. Gov. Elizabeth Roberts, who has been working to implement some of the provisions of the Obama plan in Rhode Island, spoke in favor of the act and disagreed.
"Massachusetts is reporting a trend far below the national trend in the escalation of health-care costs in this year," she said.
We wondered if the increase in health-care costs in Massachusetts -- where residents are required to have health insurance or pay a penalty -- was really far below the U.S. trend this year.
When we asked Roberts for backup for her claim, her spokeswoman, Maria Tocco, sent us to several different sources.
The first was Page 16 of a May 2012 study by the Massachusetts Division of Health Care Finance and Policy reporting that total medical expenditures among the state's commercial insurers increased by 3 percent from 2009 to 2010.
The second was a table from the Centers for Medicare and Medicaid Services showing that health expenses increased across the U.S. by 3.9 percent from 2009 to 2010.
"Therefore, national expenditures increased from 2009 to 2010 by 30 percent more than in Massachusetts," Tocco said.
Not exactly. Those are two different sets of data, essentially comparing apples to oranges.
The first doesn't include Medicare and Medicaid costs. The second does. Medicare and Medicaid covers older and poorer Americans, and people in those groups tend to be sicker, and their health care is more costly. That’s an important distinction.
In 2009, for example, the per-person annual cost of the typical Medicare recipient was $9,736 -- three times higher than for someone under 65. In Massachusetts, Medicare and Medicaid account for 37 percent of what the state spends on health care.
So we looked for better comparisons. We contacted the Centers for Medicare & Medicaid Services, the agency behind the national data cited by Roberts' office, to see if they had state-by-state comparisons. They did, but only up to 2009, three years after then-Gov. Mitt Romney signed health-care reform.
We took the data and did some calculations. In 2009, the per-person cost for all health care in Massachusetts (including Medicare and Medicaid) rose by 3.94 percent, compared with the national average of 3.79 percent. Cost increases in Massachusetts were above the U.S. average in the two previous years as well.
A third document Tocco sent us -- a March 2012 report from the Blue Cross Blue Shield of Massachusetts Foundation -- provided limited support for Roberts’ statement. The foundation found that the average annual growth rate for family health insurance premiums from 2006 (when Romneycare passed) through 2010 rose by 4.5 percent in Massachusetts and by 5.1 percent nationally. That's lower, but not "far below" the national trend, as Roberts claimed.
What about costs for health insurance for individuals? Anna Gosline, director of policy and research for Blue Cross Blue Shield of Massachusetts Foundation, sent us comparable data for that same period showing that individual health insurance premium costs grew a bit faster under Romneycare, by 5.1 percent compared to 4.7 percent nationally.
But we did find data points for just one year in the Blue Cross numbers that support Roberts' claim. In 2010, the latest year for which data are available, family premiums in Massachusetts fell by 0.8 percent ($127 per year) versus a rise of 6.5 percent ($844) nationally. For individuals, premiums rose by 2.8 percent in Massachusetts and 5.8 percent nationally. So particularly for family plans, for that one year, Roberts is right on target.
But, again, there are problems with the data. The numbers are based on an annual nationwide survey of employers by the Agency for Healthcare Research and Quality.
"That doesn't include any out-of-pocket costs," Gosline warned. "What if that dip is caused by everyone doubling their deductibles?"
In other words, people might be spending less on their health insurance premiums but paying more out of pocket. The Massachusetts Division of Health Care Finance and Policy report says there’s evidence that such "benefit buy-down" is occurring.
Said Gosline: "I think the longer-period view shows that Massachusetts was growing at about the same rate as the U.S. before reform was implemented in 2007, and about the same rate after, with some evidence of a recent slowdown."
|PER PERSON COST INCREASES|
|All health costs||Mass.||U.S.|
|Insurance - individual|
|Insurance - family|
During a debate in which she argued that the health-care overhaul in Massachusetts has brought down costs, Lt. Governor Elizabeth Roberts said, "Massachusetts is reporting a trend far below the national trend in the escalation of healthcare costs in this year."
We couldn’t find state-by-state numbers for health-care costs for this year, last year, or 2010.
But in 2009, three years after Mitt Romney signed the legislation, total per-person spending in Massachusetts was slightly higher than the national average.
Only if you look at health insurance costs in 2010 -- particularly family plans -- do you see increases in Massachusetts far below the national average.
But one year does not make a trend. Other factors may have been at work to make 2010 a good year for insurance purchasers.
And during the other three years when health insurance reform was in effect in Massachusetts, the trend was that insurance rates and overall costs of health care went up faster than the national average.
As a result, we rate her statement "Mostly False."
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News.Yahoo.com, "Mass. House unveils health care payment bill," May 4, 2012, accessed May 30, 2012
E-mails, Maria Tocco, spokeswoman, Lt. Gov. Elizabeth Roberts, May 29-31, 2012
Mass.gov, "Massachusetts Health Care Cost Trends: Premiums and Expenditures," May 2012, accessed May 30, 2012
CMS.gov, "Table 1; National Health Expenditures Aggregate, Per Capita Amounts, Percent Distribution, and Average Annual Percent Change: Selected Calendar Years 1960-2010" accessed May 30, 2012
E-mails, Donald McLeod, spokesman, Centers for Medicare & Medicaid Services, May 31 and June 4, 2012
CMS.gov, "Total All Payers Per Capita State Estimates by State of Residence - Personal Health Care (Dollars)" accessed May 31, 2012
Interview and e-mail, Anna Gosline, director of policy and research, Blue Cross Blue Shield of Massachusetts Foundation, June 4, 2012
KFF.org, "Massachusetts Health Care Reform: Six Years Later," May 2012, accessed May 31, 2012
Email, Craig Palosky, spokesman, Kaiser Family Foundation, June 1, 2012
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