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At a recent public hearing on CCHIP affordability, health advocates expressed concern about the high cost of premiums offered by the Connector Authority. The percentage of income deducted for premium expenses depends on monthly income and family size, but it is a challenge to balance high individual expenses and exorbitant state costs within the six hundred billion dollar budget. Some community health advocates worry that individual contributions will exceed acceptable levels. High deductibles may deter low-income individuals and families from seeking care. Worse, if premium contributions prove too expensive, many low-income residents may be forced to pay the uninsurance penalty.

The rest of the nation will watch the successes and pitfalls of this legislation closely. The Massachusetts legislation has major implications for future initiatives. It offers valuable lessons and knowledge unobtainable through economic models. One expected problem is the capacity of the health system. Some have questioned the strength of Massachusetts's healthcare infrastructure and its ability to meet the demands of the newly insured population. If a heavy influx of patients seeks care in the first year of the program, healthcare services must be capable of meeting the need. Access to physicians is already sparse. The efficient use of medical resources is paramount to provide care to all state residents in a timely manner.

Another area of concern for the Connector Board is the quality of care. A Health Care Quality and Cost Council will be responsible for setting quality improvement and cost containment goals. The council will seek ways to lower costs and improve quality and will make cost data available to state residents. The Health Disparities Council will attempt to eliminate racial disparities in healthcare services, address the lack of diversity in the healthcare workforce, and improve environmental and housing conditions. Increased transparency within the medical profession corresponds to improved care, and many hope that promoting informed consumerism and innovation encourages the provision of high quality care. The legislation also calls for the creation of a Public Health Council that will direct larger public health initiatives. Lawmakers demonstrated a dedication to preventative health in legislating programs for breast and ovarian cancer prevention, osteoporosis prevention, infection control, and diabetes prevention. There are financial incentives behind these programs; the hope is that they will relieve stress on an inundated healthcare system.

Predicting the outcome of the Massachusetts healthcare reform is difficult. As the deadline rapidly approaches and residents begin to enroll, we must continue question the program. The experiment in Massachusetts provides an opportunity to address some of the thorniest problems in healthcare economics. Will insurers provide low-cost plans with adequate benefits? Will providers be capable of meeting the demands of a newly insured population? What is certain is that the successes and failures of this landmark Massachusetts effort will determine the course of future state and national level healthcare reforms for decades to come.