(Health Affairs) Health Affairs is out this afternoon with a four-year look back at Massachusetts health reform. It has some good news (coverage has gone up!) and not-so-good news (health care isn’t getting any cheaper). With the Massachusetts reforms serving as the model for the federal law, it’s worth taking a look at what has and hasn’t worked in the Bay State reforms.
The clearest effect is an increase in health insurance coverage, going from 86.6 percent of adults with health insurance in 2006 to 94.2 percent in 2010. As the above chart shows, most of the coverage gains came in the first two years of the health reform efforts, and have remained relatively stable ever since.
An increase in coverage has correlated with another encouraging trend: a decrease in more costly forms of health coverage, such as emergency room visits. That turns out to be a more recent development, with rates of emergency room visits dropping 3.5 percent between 2009 and 2010.
(Health Affairs) “This pattern, combined with increases in the use of specialists and preventive care over time, may imply a shift in use toward other providers for some needs,” study authors Sharon Long, Karen Stockley and Heather Dahlen write.
What Massachusetts health reform has not done, however, is bring down the cost of health care. The percent of adults who have delayed care because of cost in the past year has steadily crept upwards, while those who have had trouble paying medical bills increased for a few years, before dropping off in 2009: 
(Health Affairs) Part of this trend is likely tied up in the recession, which has made paying medical bills tougher for Americans across the country. So even as the amount of expensive, emergency room care goes down, health care remains costly. And that underscores the big health reform challenge that Massachusetts now faces: making universal coverage affordable. “Nearly one in four of these adults reported unmet need for care, often because of health care costs,” the study authors write. “Consistent with that finding, Massachusetts continues to struggle with escalating health care costs, reflecting the decision to defer addressing costs in the 2006 legislation so as not to hold up the expansion in coverage.”
In the coming year, you can expect more action on this front. Lead by Gov. Deval Patrick (D), there’s increasing attention paid toward global payments that compensate doctors for each patient they cover or condition they treat, rather than a traditional fee for every service they provide. That next round of reform will be a crucial test for Massachusetts’ efforts to move past its coverage solution, and onto its cost challenge.
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