Mass. Health Connector, Other Innovations Honored

(Updated 9:52 a.m. EDT, Sept. 15, 2009)

As the Obama administration and Congress debate the 
details of a national health care plan, the state that paved the way for universal coverage was honored in Washington, D.C. (Sept. 14).

The Commonwealth Health Insurance Connector Authority - a key component of Massachusetts' landmark universal health care program - is among six government initiatives that received awards from Harvard University.

"The Commonwealth Connector has been the capstone of health reform in Massachusetts. It is the arch between public and private insurance and it was politically instrumental in bridging liberal and conservative policy goals," said Urban Institute health care expert Randall Bovbjerg, who analyzed the program for Harvard.

The awards, which highlight successful programs with the hope of replicating them elsewhere, are given by the Ash Institute for Democratic Governance and Innovation of Harvard University's John F. Kennedy School of Government. Idaho, Chicago, Milwaukee, Wis., Kingsport, Tenn., and Washington, D.C., also took prizes, which included a $100,000 grant each to cover the costs of spreading the word about their innovations. Their programs range from a mental health system for youth in Milwaukee to a cost-effective satellite mapping program that measures water evaporation in Idaho. This year's winners were chosen from more than 1,000 applicants.

Since the Innovations in American Government Awards were created in 1986, states have won 71 prizes, and many award-winning programs have been widely adopted in other places.

Three states already are emulating the Commonwealth Connector, which allows Massachusetts residents to choose from a wide range of public and private health care options, in developing their own universal health care plans.

California, Utah and, most recently, Oregon have sought guidance from the Connector, its chief executive Jon Kinsdale told Stateline.org. Oregon is one of 13 states recently announced as winners of a new $71 million federal grant for health reform from the U.S. Department of Health and Human Services. "I wouldn't be surprised if other selected states reach out to us for advice," Kinsdale said.

Launched in 2006 when Massachusetts began requiring all adults to purchase health insurance, the Connector combines funding from Medicaid, the federal-state health insurance program for the poor, with private insurance support to offer a full range of options to meet the needs of Massachusetts residents at every income level.

"There's no cliff like you have with Medicaid," Bovbjerg said. Instead, the Connector provides a smooth transition from fully-subsidized health coverage to partially covered options and programs that are fully funded by individuals or businesses.

The Connector is similar to the so-called Exchange under the Obama administration's proposal, designed to allow uninsured individuals and small businesses to compare plans and buy coverage at competitive prices, in some cases with federal tax credits.

The idea of an exchange is not new. Hawaii created one for businesses in the 1980s and many companies and governments use exchanges to offer employees multiple-choice health plans. What makes the Massachusetts exchange unique is that it combines public and private insurance and offers choices for all people, not just those who are employed.

"It was politically influential because it allowed conservatives and liberals to come together," Bovbjerg said. Conservatives liked the Connector approach because it involved individual responsibility, competition and choice. Liberals approved because it did not exclude those with pre-existing health conditions, it was affordable and flexible - anyone could sign up at any time.

Like elsewhere in the country and currently in Congress, it would have been difficult, if not impossible, for Massachusetts politicians to hammer out the complex details of what constitutes universal coverage and how it should be priced. But because the Connector's 10-member board is made up of public and private practitioners who buy health insurance for a living, politics was set aside and the interest of purchasers was in the forefront.

Massachusetts law calls for board members to be appointed by the governor and attorney general and to include an actuarial economist, an employee benefits specialist, a health economist, and representatives from a small business, a health consumer organization and a labor union. Four members serve ex-officio: the secretary of administration, insurance commissioner, state Medicaid director and group insurance commission director.

Since the Connector's inception, the state's uninsured rate has dropped from 10.4 percent in 2006 to 2.6 percent in 2008, while the national average remains at 15.3 percent. In addition, use of free care at clinics and emergency rooms decreased by 37 percent between 2006 and 2007.

Last year, the Connector estimated that more than 200,000 adults could not afford health coverage and were not eligible for either job-related insurance or Medicaid; to date 160,000 of those individuals have enrolled.

Going forward, the Connector's Kinsdale said the biggest challenge will be holding down health care costs, which are rising faster in Massachusetts than elsewhere in the country. In addition, he said national reform - if enacted - could require changes in the commonwealth's plan.

But he said he was confident the staff and board would make the needed adjustments. "We have recruited staff who combine a devotion to public service with a passion for innovation. This team was energized by doing a start-up, and will meet the next set of challenges with the gusto equal to what we have already demonstrated," Kinsdale said.

Five other awards were presented for the following innovations:

  • Idaho improved water use throughout the state by providing satellite-produced images of evaporation from all sources and transpiration from farm crops and other vegetation.
  • The Chicago Public School District, through a partnership with a non-profit organization, created an organization - New Leaders for New Schools - that nurtures school principals in an effort to improve performance in the city's public schools.
  • Kingsport, Tenn., revitalized its ailing economy by improving access to higher education for its labor force.
  • Milwaukee County, Wis., created a program called Wraparound Milwaukee that provided home-based mental health care for troubled youth and their families.
  • The District of Columbia, under a program called Democratization of Government Data, delivered real-time information such as crime reports, school data and real estate developments, to a central location that anyone can access to provide customized reports for citizens.

A documentary film titled Visionaries provides more detail on all six award-winning programs.