Massachusetts mandate update

>> Announcer: THIS IS "NEED TO KNOW" WITH JEFF GREENFIELD MARIA HINOJOSA, RAY SUAREZ, AN THIS WEEK, SCOTT SIMON >> ON THIS EDITION - IN MASSACHUSETTS THE UNIVERSAL HEALTHCARE PLAN THERE HA CHANGED LIFE FOR PATIENTS, DOCTORS, AND INDUSTRY.

>> SO, WAS IT OVERWHELMING A FIRST?

>> YES, AND AT THE SAME TIME THERE WAS ACTUALLY TREMENDOU RELIEF IN KNOWING THAT YOU PATIENTS COULD GET ACCESS TO CARE >> WHEN MASSACHUSETTS PASSED THIS MANDATORY HEALTH CARE, IT WAS APPALLING TO ME.

I WAS TOLD, I HAD TO HAV INSURANCE.

IT WAS TAKING FREEDOMS AWAY FROM ME >> WHAT IT MIGHT MEAN FOR TH NATION NEXT ON "NEED TO KNOW.

>>> WELCOME TO "NEED TO KNOW," AND THANKS FOR JOINING US.

AT THIS TIME LAST YEAR, IN THE HEAT OF THE 2012 PRESIDENTIA RACE, MUCH OF THE NATION'S ATTENTION WAS FOCUSED ON A CAS BEFORE THE SUPREME COURT AT ISSUE WAS THE CONSTITUTIONALITY OF PRESIDENT OBAMA'S MOST SIGNIFICANT PIECE OF LEGISLATION, THE PATIEN PROTECTION AND AFFORDABLE CARE ACT.

AT THE HEART OF THE MATTER WAS THE MANDATE.

IT REQUIRES INDIVIDUALS WH AREN'T INSURED TO BUY HEALTH INSURANCE BY 2014 OR FAC PENALTIES.

SUPPORTERS OF THE PLAN SAY I PROVIDES A SAFETY NET TO THE NEARLY 50 MILLION UNINSURE AMERICANS AND, EVENTUALLY, WIL LOWER HEALTHCARE COSTS OPPONENTS SAY FORCING ANYONE T BUY MEDICAL INSURANCE INTRUDES ON PERSONAL FREEDOM, COSTS WIL WILDLY INCREASE, AND DETER EMPLOYERS FROM HIRING.

AND EVEN THOUGH THE COURT UPHELD THE CONSTITUTIONALITY OF THE MANDATE, THAT DOESN'T MEAN THE DEBATE IS OVER SO JUST HOW MIGHT THIS FEDERAL HEALTHCARE PLAN WORK OVER TIME YOU DON'T HAVE TO GUES ENTIRELY BECAUSE A VERY SIMILA PLAN, INCLUDING AN INDIVIDUA MANDATE, WAS ENACTED SEVEN YEARS AGO IN MASSACHUSETTS UNDER THEN-GOVERNOR MITT ROMNEY.

OUR MEDICAL CORRESPONDENT, DR. EMILY SENAY, TRAVELED TO MASSACHUSETTS LAST SPRING TO SEE HOW HEALTHCARE REFORM IS WORKING THERE.

>> THOUGH THEY LIVE ON OPPOSIT SIDES OF BOSTON AND LEAD VER DIFFERENT LIVES, 38-YEAR-OLD ALLIEA GROUPP AND 52-YEAR-OL PETER BROOK HAVE SOMETHING VER IMPORTANT IN COMMON, THEY BOTH KNOW WHAT IT'S LIKE TO BE SICK WITH LITTLE OR NO HEALTH INSURANCE.

ALLIEA HAS EPILEPSY.

AND IT CAUSED A PROBLEM WHEN SHE APPLIED FOR INSURANCE AT HER FIRST JOB OUT OF COLLEGE >> ONE WEEK INTO THE JOB I WAS NOTIFIED BY MY EMPLOYER THAT THE INSURANCE PROVIDER HAD DENIED ME COVERAGE BECAUSE OF MY PRE-EXISTING CONDITION AND SO, I WAS LEFT ALONE TO PA FOR MY CARE ON A VERY LO SALARY >> AT THE TIME, SHE WAS LOW-PAID COMMUNITY ORGANIZER TAKING HOME LESS THAN $1,000 A MONTH AND HAD TO PAY ABOUT 200 OF IT OUT-OF-POCKET FOR HE DAILY ANTI-SEIZURE MEDICATION.

IT WAS TOO BIG A BITE OUT OF HER CHECK.

>> SO, I TOOK IT ABOUT EVERY THIRD DAY.

JUST TO BE ABLE TO EKE OUT, MAKE IT MORE AFFORDABLE FOR MYSELF.

WHICH MEANT THAT I HAD SEIZURE ON OCCASION.

>> EVEN WHEN SHE GOT INSURANCE AT ANOTHER JOB A FEW YEARS LATER, ALLIEA SAYS THE PLAN WA SO LIMITED, SHE STILL COULDN'T AFFORD THE CARE SHE NEEDED WHE SHE CAME DOWN WITH WHAT STARTE AS A MINOR INFECTION >> WHEN I WENT TO GO FILL TH PRESCRIPTION, I COULDN'T AFFOR IT BECAUSE IT WAS SO EXPENSIVE AN I HAD TO PAY FOR IT OUT OF POCKET SO, I SAID, OKAY, WELL, YO KNOW, AGAIN I'LL MAKE A CHOICE TO SAY I DON'T NEED IT I'LL GET BETTER ON MY OWN.

>> SHE DIDN'T GET BETTER, SH GOT WORSE AND ENDED UP IN TH EMERGENCY ROOM WITH A KIDNEY INFECTION.

IT ALL ADDED UP TO ABOUT $24,000 IN MEDICAL BILLS >> I WISH THAT I'D BEEN ABLE T MAKE A DIFFERENT CHOICE.

BUT I COULDN'T >> ABOUT FIVE MILES AWAY I SOUTH BOSTON, PETER BROOK ALSO KNOWS WHAT IT'S LIKE TO GO WITHOUT HEALTH CARE.

HE'S HAD TYPE ONE DIABETES SINCE HE WAS 14.

BUT AS A HANDYMAN WITHOUT STEADY WORK, HE SPENT YEARS UNINSURED AND HAD TROUBLE MANAGING HIS DISEASE.

>> BEFORE HEALTH CARE, I WOULD USE AN INSULIN NEEDLE, I'D USE IT FOR A MONTH, OR A MONTH AND A HALF I WOULD JUST HOLE UP IN MY LITTLE STUDIO APARTMENT HERE I SOUTHIE AND I'D BE SICK FO WEEKS ON END I WOULDN'T -- ABSOLUTELY WOULDN'T GO TO A DOCTOR, EVE WHEN I WAS SICK, I WOULDN'T GO TO A DOCTOR.

I WOULD GO THERE ON AN EXTREME WHEN I WAS ALMOST DEAD AND, YO KNOW, A NEIGHBOR WOULD CALL AN I -- THEY'D PICK ME UP LIKE WET TOWEL AND PUT ME ON A CO AND TAKE ME AWAY IN AN AMBULANCE AND THEN I'D LIVE IN A HOSPITA FOR A COUPLE WEEKS >> HE EVEN TREATED HIS OWN FINGERS THAT HAD BEEN BROKEN O THE JOB.

>> I'D JUST TAPE ONE FINGER TO THE OTHER AND IMMOBILIZE IT.

LET IT DO ITS HEALING THING BU OF COURSE YOU SEE THEN I DOESN'T HEAL CORRECTLY MY HAND DOESN'T FUNCTION LIKE IT USED TO FUNCTION SO.

SAVED ME $300 IN HOSPITAL BILLS.

>> THEIR EXPERIENCES LED BOT ALLIEA AND PETER TO HELP LOBBY THE STATE LEGISLATURE FO PASSAGE OF THE MASSACHUSETTS MANDATORY HEALTH CARE LAW IN 2006.

BOTH SAY THE BILL MADE THINGS CHANGE FOR THE BETTER >> IT IMPROVED MY LIFE DRASTICALLY BY ENSURING THAT I CAN GET THE CARE THAT I NEED AND MAKE SURE THAT MY SEIZUR DISORDER IS CARED FOR.

>> WOULD YOU SAY YOUR HEALTH I BETTER NOW SINCE REFORM?

>> OH -- OH, MY HEALTH IS MUCH BETTER NOW I HAVE CONSCIENTIOUS, VERY PROFESSIONAL, WHAT I CALL WORL CLASS HEALTH CARE NOW.

>> MASSACHUSETTS ONCE AGAIN IS TAKING A GIANT LEAP FORWARD.

>> THE GOAL OF THE HEALTH REFORM BILL ENACTED UNDER THEN-GOVERNOR MITT ROMNEY WAS SIMPLE, HEALTH INSURANCE FOR EVERYONE >> EVERY CITIZEN WIT AFFORDABLE, COMPREHENSIVE HEALTH INSURANCE, SMALL BUSINESSES ABLE TO CONVENIENTLY BUY INSURANC FOR THEIR EMPLOYEES AT A COS THAT'S COMPETITIVE WITH BI BUSINESSES >> THE LAW WAS CONSIDERED SUCH AN ACHIEVEMENT, THAT IN ROMNEY'S OFFICIAL PORTRAIT HANGING IN THE STATEHOUSE IN BOSTON, THERE ON THE DESK NEXT TO HIM IS A BOUN VOLUME WITH THE MEDICAL SEAL MEANT TO REPRESENT THE LAW THIS IS WHAT THE LAW REQUIRES OF THE STATE'S 6.5 MILLIO RESIDENTS.

EVERY ADULT MUST HAVE INSURANC OR PAY A FINE.

EVERY EMPLOYER WITH 11 OR MORE EMPLOYEES MUST OFFER INSURANCE OR ALSO PAY A FINE OF ABOU $300 PER WORKER.

THE LAW REDIRECTED FUNDS PREVIOUSLY USED FOR CARE OF TH UNINSURED AND EXPANDED INSURANCE COVERAGE TO CHILDREN AND TO TH POOR IT ALSO SET UP A NEW SYSTEM FO INDIVIDUALS AND SMALL BUSINESSES TO BUY INSURANCE THE BILL PASSED ALMOST UNANIMOUSLY AND HAD THE SUPPOR OF EVERYONE FROM THE REPUBLICA GOVERNOR TO LIBERAL DEMOCRAT SENATOR TED KENNEDY AND FROM UNIONS TO BUSINESS >> MY SON SAID THAT HAVING SENATOR KENNEDY AND ME TOGETHE LIKE THIS ON THIS STAGE BEHIND THE SAME PIECE OF LANDMARK LEGISLATION WILL HELP SLOW GLOBAL WARMING THAT'S BECAUSE HELL HAS FROEK -- FROZEN OVER.

>> POLLS TODAY SHOW ALMOST TWO-THIRDS OF THE STATE' RESIDENTS SUPPORT THE LAW, AND THERE HAVE BEEN NO SERIOUS LEGAL CHALLENGES TO IT BUT, IT'S STILL PROVOKED SOM CONTROVERSY.

THAT'S BECAUSE IT SERVED AS TH TEMPLATE FOR THE 2010 FEDERA AFFORDABLE CARE ACT.

AND JUST AS THE FEDERA INDIVIDUAL MANDATE SPURRED A SUPREME COURT CHALLENGE AN FIERCE DEBATE.

THE INDIVIDUAL MANDATE I MASSACHUSETTS HAS SPARKED SOME CRITICISM, TOO >> IT WAS APPALLING TO ME.

BECAUSE I WAS TOLD, I HAD TO HAVE INSURANCE IT WAS TAKING FREEDOMS AWAY FROM ME I'M NOT ONE THAT EXPECTS SOMEONE ELSE TO PAY FOR MY HEALTH CARE THE SYSTEM HAS DEVELOPED WHERE PEOPLE ARE PAYING FOR OTHE PEOPLE'S HEALTH CARE THAT'S NOT RIGHT EITHER.

>> I'D RATHER HAVE A CHOICE.

I JUST WANT TO HAVE A CHOICE >> RICK AND ZUZANA LIVINGSTONE OF ANDOVER, MASSACHUSETTS AR SELF-DESCRIBED CONSERVATIVES THEY ARE AMONG THE 30% OF TH STATE'S RESIDENTS WHO OPPOSE THE HEALTHCARE PLAN.

>> THIS COUNTRY WAS FOUNDED ON FREEDOM OF CHOICE.

AND, YOU KNOW, YOU LIVE AND DI BY THOSE CHOICES SAME THING WITH HEALTH CARE.

IF YOU CHOOSE NOT TO HAVE HEALTH CARE, THEN YOU'RE GOING TO LIV AND DIE BY THAT DECISION >> AND THAT'S THE DECISION THE MADE WHILE THEIR THREE CHILDREN, AN ALL CHILDREN IN THE STATE, ARE INSURED EITHER PRIVATELY O PUBLICLY, ZUZANA AND RICK AR PART OF THE TWO PERCENT WH DON'T HAVE MEDICAL INSURANCE SOME CAN'T AFFORD IT OTHERS SIMPLY REFUSE TO PAY FO IT AND CAN BE FINED UP T $1200 A YEAR THE LIVINGSTONES' DECISION WAS ABOUT BOTH POLITICS AND COST THEY SAY THE SEVERAL HUNDRED DOLLARS A MONTH IT WOULD TAKE TO BUY INSURANCE IS A HARDSHI SINCE RICK'S HOME BUILDING BUSINESS DRIED UP, AND THE FAMILY IS LIVING ON ZUZANA'S INCOME OF JUST OVER $80,000 YEAR >> THAT PAYS THE MORTGAGE, THA FEEDS THE KIDS, PAYS THE CARS.

PAYS THE GAS WE'RE DIPPING INTO THE SAVINGS ALL THE TIME ALL THE TIME >> WE HAD TO REALLY HAD TO GET RIGID WITH WANTS, NEEDS AN DESIRES.

AND YOU KNOW, NEEDS IS, HAVE A ROOF OVER YOUR HEAD.

YOU KNOW A DESIRE IS TO HAVE HEALTH CARE.

IT'S NOT A NEED.

FORTUNATELY, WE ARE ALL HEALTHY.

WE HAVEN'T TAXED THE SYSTEM.

>> I CAN GO TO THE DOCTOR.

OF COURSE, I CAN GO TO THE DOCTOR I SHELL OUT $150, AND I GO HOME.

YOU KNOW, I PAY IT IT'S MUCH CHEAPER TO DO IT THA WAY THAN TO HAVE INSURANCE >> IN A WAY, THE LIVINGSTONES, PETER BROOK AND ALLIEA GROUP AREN'T TYPICAL AT ALL.

WHAT MAKES THEM DIFFERENT THAN MOST IS HOW DIRECTLY THEY'VE BEEN AFFECTED BY THE HEALTHCAR REFORM WHAT'S NOT REPORTED AS OFTEN I HOW LITTLE HEALTHCARE HA CHANGED FOR THE MAJORITY O PEOPLE IN MASSACHUSETTS.

DOCTORS LIKE RICHARD DUPEE, AN INTERNIST AND GERIATRICIAN I THE AFFLUENT BOSTON SUBURB O WELLESLEY HILLS, ARE STILL PRACTICING MEDICINE AS MUCH AS THEY DID BEFORE THE REFORMS.

>> HOW BIG AN IMPACT DID HEALT REFORM HAVE ON YOUR PRACTICE >> YOU KNOW, IT'S INTERESTING.

IT REALLY HAS NOT HAD A HUGE IMPACT >> AND WOULD YOU SAY THAT'S TH CASE FOR THE VAST MAJORITY O PHYSICIANS LIKE YOURSELF >> IN PRIVATE PRACTICE, YES.

>> HIS PATIENTS AND MILLIONS O OTHERS ARE STILL ELIGIBLE FO THE SAME CARE.

ABOUT 90% OF THE STATE'S RESIDENTS HAD INSURANCE EVEN BEFORE THE LAW WAS PASSED, MOS OF THEM THROUGH EMPLOYERS, AND THEY'RE STILL COVERED TODAY.

JUST LIKE DANIELLE ESJUNIN DR. DUPEE'S ASSISTANT AND PATIENT IN HIS PRACTICE.

>> DID YOU EXPERIENCE ANY CHANGE AFTER THE PASSAGE OF THE LAW >> NO.

>> OF COURSE, THOSE OLD ENOUGH TO QUALIFY FOR MEDICARE BEFORE 2006, LIKE BOB AND JUNE MACDONALD, ARE STIL COVERED AS WELL.

>> IT DIDN'T AFFECT US AT AL BECAUSE WE ALREADY HAD HEALT INSURANCE.

>> SO, YOU DIDN'T FEEL A THING >> NO.

>> JUST LIKE WHAT'S INTENDED A THE FEDERAL LEVEL, THE BIGGEST IMPACT OF THE STATE LAW WAS ON THOSE WHO WEREN'T INSURED.

>> IT DIDN'T CHANGE HOW TH WHOLE SYSTEM WORKED.

IT JUST FILLED IN THE GAPS >> MICHAEL DOONAN, A POLITICAL SCIENCE PROFESSOR AT BRANDEI UNIVERSITY, HAS STUDIED TH IMPACT OF THE STATE'S HEALTH REFORM >> IT'S LIKE SWISS CHEESE.

AND WHAT MASSACHUSETTS DID IS IT FILLED IN THE HOLES.

>> FILLING THOSE HOLES MEANT COMING UP WITH NEW PROGRAMS AN SYSTEMS TO COVER THE UNINSURED SINCE THE MASSACHUSETTS LAW WA PASSED, ABOUT 439,000 OF THE GOT COVERAGE THE CHIEF BENEFICIARIES HAVE BEEN LOW INCOME WORKERS, LIK PETER BROOK, WHO EARNS LESS THAN 10 THOUSAND DOLLARS A YEAR DOING ODD JOBS >> THAT'S JUST TO KEEP THE DOG OFF OF THERE THAT'S THE ONLY REASON - >> NOW, HE IS INSURED THANKS T THE STATE'S EXPANDED MEDICAI PROGRAM, PART OF THE 2006 REFORM BILL HE PAYS NO MONTHLY PREMIUM, BU STILL SEES HIS DOCTORS REGULARLY AND GETS HIS PRESCRIPTIONS FOR JUST A FEW DOLLARS EACH.

>> IT'S LIKE ALL OF A SUDDEN YOU'RE DRIVING AROUND IN A MASERATI OR A PORSCHE ALL TH TIME AND EVERYONE'S, OH, YOU HAVE SUCH A BEAUTIFUL CAR.

OH, YOU MUST HAVE A GOOD JOB YOU MUST HAVE THIS BUT THAT'S NOT THE REAL TRUTH OF IT >> PETER BROOK IS ACTUALLY THE EXCEPTION.

ONLY ABOUT 20% OF AL MASSACHUSETTS RESIDENTS HAVE MEDICAL INSURANCE SUBSIDIZED B THE STATE.

NEARLY 80% GET THEIR INSURANCE FROM THEIR EMPLOYERS ALLIEA GROUPP IS PART OF THE SLIVER WHO BUY THEIR INSURANCE ON A WEB SITE CALLED THE HEALT CONNECTOR.

IT'S PART OF THE STATE'S NEW HEALTH INSURANCE EXCHANGE, A PLACE FOR THOSE NOT COVERED BY AN EMPLOYER TO GO SHOPPING FOR INSURANCE.

>> SO, WHAT'S YOUR FAMILY SIZE AS AN INDIVIDUAL, I CLICKED ONE.

IS YOUR HOUSEHOLD INCOME MOR THAN $33,516 A YEAR?

YES.

>> THE CONNECTOR TELLS ALLIEA, NOW A DIRECTOR OF A SMAL NONPROFIT, THAT HER INCOME I TOO HIGH TO QUALIFY FOR A PLAN SUBSIDIZED BY THE STATE.

SO IT SHOWS HER THE UNSUBSIDIZED OPTIONS, AND ALLOWS HER TO COMPARE PRICES AND BENEFITS TO CHOOSE THE ONE THAT BEST FIT HER NEEDS.

>> THESE ARE THE SEVEN COMPANIES THAT PROVIDE A GOLD PLAN AND YOU CAN SEE, EACH ONE OF THEIR MONTHLY PAYMENTS, AND WHAT THEIR CO-PAYS ARE.

>> ALLIEA CHOSE A MORE EXPENSIVE GOLD PLAN BECAUSE SHE HAS TO SEE HER NEUROLOGIST TWICE A YEAR REQUIRES REGULAR TESTING T MONITOR HER EPILEPSY, AND TAKE MEDICATION EVERY DAY HER EMPLOYER PAYS THE BULK O HER INSURANCE BILL, NEARLY $700 A MONTH, EVEN THOUGH IT'S NOT REQUIRED TO BECAUSE IT HAS SO FEW EMPLOYEES >> SO, THIS IS MY PLAN I HAVE NO ANNUAL DEDUCTIBLE.

>> NOWADAYS, ALLIEA IS TREATED BY DOCTORS IN THEIR PRIVAT OFFICES.

BUT MANY OF THE NEWLY INSURED, LOW EARNERS LIKE PETER BROOK ARE CARED FOR AT THE STATE'S 200-PLUS COMMUNITY HEALT CENTERS, WHICH SAW A SURGE O NEW PATIENTS WHEN THE LAW WENT INTO EFFECT.

D OCTORS AT THE REVERE FAMILY HEALTH CENTE NORTH OF BOSTON WERE ON TH FRONT LINES.

>> WE SUDDENLY SAW THI TREMENDOUS DEMAND FOR HEALTH CARE SERVICES, ESPECIALLY IN PRIMARY CARE >> DR. SOMAVA STOUT IS A PRIMARY CARE PHYSICIAN IN CHARGE O IMPROVING THE DELIVERY OF CARE AT A NETWORK OF HOSPITALS AN CLINICS FOR THE UNDERSERVED.

A FEW DAYS A WEEK, SHE ALS PRACTICES AT THE REVERE FAMILY HEALTH CENTER.

>> BEFORE HEALTH CARE REFORM HAPPENED WE HAD STARTED WITH 500 PATIENTS AND NOW, WE'RE AT ABOU 10,000 PATIENTS.

THE WAIT TIME FOR OUR NE PATIENT APPOINTMENT IN REVER BEFORE WAS ABOUT NINE MONTHS >> SO, WAS IT OVERWHELMING A FIRST?

>> YES AND AT THE SAME TIME, THERE WA ACTUALLY TREMENDOUS RELIEF I KNOWING THAT YOUR PATIENTS COULD GET ACCESS TO CARE WHEN YOU'RE A DOCTOR AND YOU SEE SOMEBODY IN FRONT OF YOU WHO HAS SOMETHING TOTALLY TREATABLE AN PREVENTABLE THAT YOU KNOW WILL KILL THEM AND YOU HAVE NO WAY OF GETTING THAT PERSON THE CARE THEY NEED, THAT IS THE WORST FEELING IN THE WORLD >> BEFORE REFORM, STOUT SAYS SHE AND OTHER DOCTORS OFTEN HAD TO IMPROVISE TO GET PATIENTS TH HELP THEY NEEDED >> WE WERE DOING ALL THESE CRAZY THINGS LIKE, WE WOULD CALL UP SPECIAL PROGRAMS FOR DRUG COMPANIES TO TRY TO GET PEOPLE MEDICINES.

OR YOU KNOW, TRY TO ASK FAVORS OF PEOPLE.

>> IT WAS CATCH AS CATCH CAN >> IT WAS CATCH AS CATCH CAN AND OFTEN THE CARE COULDN'T BE A GOOD BECAUSE OF THAT >> AFTER REFORM, THE SHEER NUMBER OF NEW PATIENTS NEEDING CARE MEANT THE SYSTEM HAD TO ADAPT.

>> IT REQUIRED FUNDAMENTAL CHANGE IN HOW WE DESIGN, HOW W PROVIDE CARE >> THESE DAYS, THE EMPHASIS IS ON STREAMLINING AND COORDINATING CARE, DOING THINGS LIK COMMUNICATING WITH PATIENT ONLINE AND KEEPING CLOSER TRAC OF PATIENTS BETWEEN VISITS >> AND THEN HE'S FOLLOW-UP BRONCHITIS AND ASTHMA, ALSO.

>> YEAH.

>> AND THEN, SHE'S FOLLOW-UP NECK PAIN.

I KNOW SHE DIDN'T COME FOR HER LAST APPOINTMENT SHE MISSED HER LAST APPOINTMENT.

>> WAIT TIMES FOR NEW PATIENTS TO BOOK AN APPOINTMENT, WHIC WERE ONCE NINE MONTHS, ARE NOW NO LONGER THAN TWO WEEKS AND THE AFTERNOON WE VISITED THE WAITING ROOM WAS NEVER VER FULL >> ARE PEOPLE GETTING GOOD CAR AS A RESULT?

>> WELL, WE THINK SO SO, IF YOU LOOK AT THE COMMUNITY OF REVERE JUST AS AN EXAMPLE WE'VE BEEN ABLE TO INCREASE TH COLORECTAL SCREENING RATE FO THAT POPULATION OF PATIENTS FROM 30% UP TO 70% OR PAP SMEAR RATE, SIMILARLY, FROM ABOUT 40% TO 90%.

>> MEREDITH ROSENTHAL, A PROFESSOR AT THE HARVARD SCHOO OF PUBLIC HEALTH, SAYS THIS IS AN IMPORTANT OUTCOME OF REFORM >> IN MASSACHUSETTS, WE KNOW FOR EXAMPLE THAT AFTER THE REFORMS WERE PASSED AND PEOPLE TOOK UP NEW COVERAGE THAT INDIVIDUAL WERE MUCH MORE LIKELY TO HAVE REGULAR SOURCE OF CARE >> BUT ACROSS MASSACHUSETTS, THERE STILL AREN'T ENOUG PRIMARY CARE DOCTORS.

AND THAT MAY BE THE REASON WHY VISITS T EMERGENCY ROOMS HAVE NOT DROPPED SHARPLY, DESPITE IMPROVED ACCESS TO HEALTH CARE AND EVERY CONVERSATION ABOUT THE STATE'S PLAN ULTIMATELY LEADS TO THIS QUESTION, HOW WILL IT ALL GET PAID FOR SIX YEARS AFTER HEALTHCARE REFORM WAS ENACTED I MASSACHUSETTS, THE HIGH COST O HEALTH INSURANCE IS STILL CONCERN FOR MANY IN THE STATE, ESPECIALLY SMALL BUSINES OWNERS >> THIS JUST GOT ME REALLY UPSET!

I'M JUST LOOKING AT HOW MUCH MORE I'M SPENDING FOR HOW MUCH LESS >> DAVE RATNER OWNS A SMAL CHAIN OF PET SUPPLY STORES I WESTERN MASSACHUSETTS.

HE'S BEEN IN BUSINESS FOR MORE THA 30 YEARS AND HAS ALWAYS OFFERE HIS FULL-TIME EMPLOYEES HEALTH INSURANCE, BUT THESE DAYS, H SAYS, THAT'S GETTING MUCH MORE DIFFICULT TO DO.

>> WE HAVE MY MONTHLY CHECK TO MY HEALTH CARE PROVIDER.

$9,996 EVERY MONTH >> OVER THE LAST SEVERAL YEARS DAVE'S INSURANCE PREMIUMS HAVE RISEN STEADILY, SOMETIMES BY DOUBLE-DIGITS IN A SINGLE YEAR >> 2007, I DON'T KNOW WHAT HAPPENED THE RATE WAS GOING TO GO UP 20%.

>> TO PROTECT THE BOTTOM-LINE, DAVE HAS REPEATEDLY SWITCHED INSURANCE PLANS.

THAT, HE SAYS TURNS INTO AN ADMINISTRATIVE NIGHTMARE.

>> IT'S A HUGE AMOUNT OF BOO WORK IN THE OFFICE IT'S -- IT'S NEW MEETINGS WITH THE EMPLOYEES TO EXPLAIN TO THEM THIS IS WHAT'S HAPPENING THI YEAR HERE'S THE PLUSSES, HERE'S THE MINUSES.

>> ALL THIS, HE SAYS, MAKES HI LESS LIKELY TO HIRE.

>> SO, WHEN I LOOK TO SAY, "DO I NEED ANOTHER EMPLOYEE?

I HAVE TO FIGURE OUT HOW MUC EXTRA IS IT GOING TO COST ME PER HOUR FOR -- FOR THE HEALTH INSURANCE, RIGHT WELL, AREN'T I JUST BETTER OFF GETTING A REGULAR EMPLOYEE MOR HOURS AND EVEN IF I HAVE TO PA HIM OVERTIME DUH.

YEAH I'M WAY BETTER OFF SO, YES, THAT ABSOLUTELY AFFECTS OUR NEW HIRES.

>> BUT SOME SAY THERE'S ANOTHE WAY TO LOOK AT HOW THE STATE'S HEALTH CARE REFORMS HAVE AFFECTED JOB CREATION, ENTREPRENEURS ARE NOW ABLE T SEEK OUT NEW OPPORTUNITIES WITHOUT WORRYING ABOUT HOW T STAY INSURED >> OH, I THINK IT'S HUGELY EMPOWERING >> IN 2010, ARLEN PLOTKIN LEFT A FIRM WITH A BENEFIT PLAN AND I NOW THE BUSINESS DIRECTOR OF "CONNECTED BITS," A COMPANY THAT DEVELOPS MOBILE APPS.

AFTER HI COBRA BENEFITS RAN OUT, HE BOUGHT AN INDIVIDUAL PLA THROUGH THE HEALTH CONNECTOR THAT COSTS ABOUT $200 A MONTH.

>> I HAVE THE FLEXIBILITY TO PURSUE WHATEVER I WANT T PURSUE I DON'T HAVE TO RELY ON AN EMPLOYER TO -- TO LITERALLY TO LIVE AND BE -- AND MAINTAIN M HEALTH YOU KNOW AND A LOT OF JOBS ARE CREATE THROUGH START-UPS AND SMAL ORGANIZATIONS.

AND THAT'S AN IMPORTANT PART O DRIVING THE ECONOMY.

>> STILL, EVEN THOSE WHO NOW HAVE ACCESS TO HEALTH INSURANCE, SOME FOR THE FIRST TIME, WORRY ABOUT HOW MUCH THE PLAN IS COSTING THE STATE.

>> I STILL HAVEN'T FIGURED OUT LIKE, HOW IT'S -- HOW IT'S ALL BEING PAID FOR I FEEL GUILTY BECAUSE I -- I'M NOT KIND OF PULLING MY WEIGHT.

>> THE SECOND PHASE OF HEALT REFORM NEEDS TO BE HOW DO WE REDUCE THE OVERALL COSTS O CARE, WHILE PROVIDING INCREASE IN QUALITY >> ALLIEA GROUPP HAS NOW TAKEN UP COST AS A CAUSE, SHE' LEADING A LOCAL INTERFAITH GROUP'S ADVOCACY WORK ON THE ISSUE.

>> WHILE WE HAVE SOME OF THE BEST HEALTH CARE AVAILABLE, IT'S STILL TOO EXPENSIVE AND IT'S GETTING WORSE.

>> MASSACHUSETTS HAD SOME OF THE HIGHEST HEALTH CARE COSTS IN THE COUNTRY BEFORE REFORM, AND STILL DOES TODAY SINCE THE STATE EMBRACED MANDATORY HEALTHCARE IN 2006 ANNUAL PREMIUMS CONTINUED TO CLIMB UP AN AVERAGE OF SIX PERCENT A YEAR EVEN SO, THE NATIONAL ANNUAL INCREASE HAS BEEN ABOUT 7% DURING THE SAME PERIOD >> MASSACHUSETTS IS STRUGGLING WITH THE SAME THING EVERY OTHE STATE IN THE NATION IS STRUGGLING WITH.

WHICH IS THE -- THESE FORCES THAT ARE CAUSING HEALTH CARE SPENDING TO INCREASE MOR RAPIDLY THAN THE REST OF OUR ECONOMY AND CAUSING THIS DILEMMA THAT WE HAVE NOW WITH TH FEDERAL DEFICIT, WITH THE STAT BUDGET DEFICITS AS WELL.

BUT THAT CRISIS PRE-DATE COVERAGE REFORM.

>> AND IS NOT CURED BY COVERAG REFORM >> AND IS NOT CURED BY COVERAG REFORM >> IS IT SOMETHING THOUGH THAT IS SUSTAINABLE >> NO.

IT'S NOT SUSTAINABLE AND IT'S NOT SUSTAINABLE FOR THE NATION EITHER.

WE CAN'T HAVE PREMIUMS GROWING AT SIX, SEVEN, EIGHT, 10% A YEAR WHEN WAGES ARE STAGNANT.

SOME -- SOMETHING'S GOTTA GIVE >> TACKLING THE COST OF HEALTH CARE HAS BEEN A PRIORITY FOR MASSACHUSETTS GOVERNOR DEVAL PATRICK, WHO CAME INTO OFFICE IN 2007, THE YEAR AFTER HEALTH REFORM WAS ENACTED.

>> WHEN THE FOLKS CREATED OU HEALTH CARE REFORM SIX YEARS AGO, THEY PURPOSEFULLY FOCUSED ON ACCESS AND PUT COST OFF FOR ANOTHER DAY.

SO, WE'RE TURNING TO COS CONTAINMENT NOW.

>> THE PATRICK ADMINISTRATIO CRACKED DOWN ON INSURANCE RATE INCREASES AND ENACTED A LAW TO HELP SMALL BUSINESSES OWNERS LIKE DAVE RATNER, BAND TOGETHE TO NEGOTIATE BETTER RATES.

IT'S ALSO BEEN WORKING WITH TH STATE'S INSURANCE COMPANIES ON NEW WAYS TO PAY DOCTORS AN HOSPITALS.

>> WE DESIGNED A NEW PAYMENT MODEL.

>> ANDREW DREYFUS IS THE PRESIDENT AND CEO OF BLUE CROS BLUE SHIELD OF MASSACHUSETTS THE LARGEST INSURANCE COMPANY IN THE STATE.

>> THE OLD PAYMENT MODEL ESSENTIALLY REWARDS VOLUME, IT REWARDS ADMISSIONS AND TESTS AND VISITS AND TREATMENTS AND TH MORE COMPLEX AND TECHNOLOGICAL THOSE INTERVENTIONS, THE MORE WE PAY.

INSTEAD WE WANTED TO CREATE SYSTEM THAT WOULD REWARD QUALITY IN OUTCOMES AND VALUE.

>> NOW WE MUST MEET QUALIT MEASURES >> DR. RICHARD DUPEE I WELLESLEY HILLS, WHOM WE MET EARLIER, HAS STARTED OPERATING UNDER THIS NEW BLUE CROSS MODEL.

INSTEAD OF CHARGING FOR EVER VISIT AND EVERY TEST, HE'S GIVEN A BUDGET FOR EACH PATIENT, AND IS REWARDED IF HE KEEPS TH PATIENTS HEALTHY MORE THAN A MILLIO MASSACHUSETTS RESIDENTS ARE NO BEING TREATED BY DOCTORS PARTICIPATING IN THE BLUE CROS OR OTHER SIMILAR PLANS >> THINKING IT THROUGH AND SPENDING A LITTLE MORE TIME IN WHAT WE CALL A COGNITIVE SERVICE YOU CAN SAVE A WHOLE LOT O MONEY BY AVOIDING UNNECESSAR TESTING.

>> EVERY BUSINESS, EVERY MUNICIPALITY, CERTAINLY STAT GOVERNMENT, IS FOCUSED ON HEALTH CARE COST.

THAT ISSUE DOESN'T GO AWAY I YOU DON'T HAVE A UNIVERSAL CAR SYSTEM THAT ISSUE HAS TO BE DEALT WITH.

>> SO, MASSACHUSETTS IS -- I NOT COLLAPSING UNDER THE WEIGH OF - >> NO, NO.

IT'S -- IT'S BEEN A GREAT, GREAT, GREAT SUCCESS >> IN FACT, THE GOVERNOR SAY PREMIUMS THAT HAD BEEN RISING BY DOUBLE-DIGITS A FEW YEARS AG ARE NOW INCREASING LESS THAN TWO PERCENT A YEAR AND A STUDY SHOWS ADDITIONAL STATE SPENDING RELATED TO HEALTH CARE REFORM ACCOUNTED FOR ONLY 1.4% OF THE OVERALL STATE BUDGET LAST YEAR.

>> AND BECAUSE WE HAVE FOCUSED NOT JUST ON THE ACCESS, BUT NO ON COST CONTAINMENT, WHICH AS SAY, IS A -- IS A NATIONAL CHALLENGE, I THINK WE'RE GOING TO BE THE ONES HERE IN MASSACHUSETTS TO CRACK THA CODE, TOO.

>> THE MASSACHUSETTS LEGISLATURE IS ON THE VERGE OF PASSING HEALTH REFORM PART TWO TO CRAC DOWN ON HEALTH CARE COSTS.

EVEN SO, THE DEBATE ABOUT HEALTH CARE REFORM, BOTH PHILOSOPHICA AND PRACTICAL, CONTINUES >> I CERTAINLY THINK THAT WE HAVE A MAJOR ISSUE AND A MAJOR PROBLEM IN THIS COUNTRY.

BUT THIS IS CERTAINLY NOT TH ANSWER TO IT >> FROM THE PERSPECTIVE AS A DOCTOR, IT'S BEEN TREMENDOUSLY VALUABLE FROM THE PATIENTS' PERSPECTIVE IT'S BEEN INCREDIBLY IMPORTANT >> YES, I BELIEVE EVERYONE SHOULD HAVE HEALTH CARE, NO IFS, ANDS, OR BUTS.

BUT YOU KNOW WHAT?

MY GUYS AND I SHOULDN'T BE PAYING FOR SOMEBODY ELSE'S >> EVERY YEAR, WE DO POLLS T MAKE SURE THAT PEOPLE IN MASSACHUSETTS ARE STILL HAPP ABOUT THIS WE ARE PEOPLE STILL SUPPORT THIS AN IT'S AN EXPERIMENT THAT WORKED >> LAST SUMMER, MASSACHUSETT CONTINUED THE EXPERIMENT AND PASSED HEALTH CARE REFORM PART TWO, A HISTORIC COST-CONTAINMENT BILL THAT AIMS TO SAVE AROUN $200 BILLION OVER 15 YEARS SUPPORTERS SAY THEY HOPE THA BILL WILL ALSO SERVE AS A MODE FOR OTHER STATES TACKLING TH HIGH COSTS OF HEALTH CARE.

>>> THAT'S IT FOR ANOTHE EDITION OF "NEED TO KNOW."

I'M SCOTT SIMON.

THANKS FOR WATCHING.

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