In at least one crucial way, Romneycare isn’t succeeding in Massachusetts—which means Obamacare might not succeed in the same way, either. Wonkblog reports on a new study on hospitalizations in the Massachusetts system post-Romneycare. The study focused on twelve common medical conditions that don’t require hospitalization when they are well-managed—but do lead to hospitalization if the patient hasn’t gotten adequate primary care. Unnecessary hospitalizations are a big driver of costs in the U.S. system, so one important way to judge a reform is by how greatly it reduces these stays.
The study compared the rates of unnecessary hospitalizations for these conditions in post-Romneycare Massachusetts to the pre-Romneycare reality as well as to rates in three states that did not pass a reform like Romneycare. But though more people in Massachusetts gained coverage through Romneycare, they didn’t necessarily use hospitals less:
You would probably expect that more people having insurance means better access to primary care, meaning fewer people who would be hospitalized for avoidable conditions. However, the rates of preventable hospitalizations were practically the same in the first few years of the Massachusetts health reform, the researchers found. Further, blacks and Hispanics continued to have higher rates of hospitalization, and the disparity gap didn’t narrow in a meaningful way.
“Because the national reform is really closely based on the Massachusetts reform, the results are concerning,” said McCormick, also a primary care physician with the Cambridge Health Alliance system.
Wonkblog notes that part of the explanation for these results may be specific to Massachusetts: the state already had high coverage rates and a “robust safety net” before Romneycare took effect. But others may transcend the state. For example, “Out-of-pocket costs for doctor visits and drugs may be preventing many of the newly insured from affording necessary primary care that would have otherwise kept them out of the hospital.”
This study points to a key lesson that should govern health care policy in general: lowering costs must always come first. If you lower costs, it is easier to expand coverage. You can do it through any number of reforms—from breaking up big hospital chains to empowering nurse practitioners to increasing price transparency to supporting technology that allows for remote monitoring of chronic conditions. But if you expand coverage without lowering costs, sometimes that coverage won’t actually be that helpful. The cheaper health care is, the better the system works for everyone. Neither Romneycare or Obamacare is primarily oriented towards reducing costs, and as such we’re likely to see more problems like the ones highlighted by this study crop up in the coming years.