Community Partnership Day: Progress on Health Care Reform and Health Equity, September 28, 2007, Harvard Public Health NOW

A law passed last year in Massachusetts that set a goal of making sure that most residents have health care insurance. "We're off to a great start, but we have a significant way to go in enrolling more people," said Nancy Turnbull, HSPH senior lecturer on health policy, who worked on the development of the law and who recently was appointed to the Massachusetts Health Insurance Connector Authority.

John McDonough and Nancy Turnbull

She and other invited speakers discussed "Health Care Reform and Health Equity: The Promise of Massachusetts and the U.S. One Year Later" on September 17. The forum was part of the 17th annual Community Partnership Day, sponsored by the HSPH Division of Public Health Practice and MassCONECT. Howard Koh, director of the Division and Harvey V. Fineberg Professor of the Practice of Public Health, moderated the talk.

Recent data from the Urban Institute put the number of uninsured people in Massachusetts at 571,000. That's about 200,000 more than originally thought, said Turnbull, "which makes our challenge even more formidable." The most success so far has been enrolling people who are eligible for free or subsidized insurance. Most adults will have to prove they have health insurance by the end of 2007 or face a penalty.

Howard Koh

Affordability of coverage and financing are big issues, she said. Other issues: Are employers being asked to contribute enough? Will there be enough clinicians for all the newly insured? How can health care costs be kept under control? Will the economy remain strong enough to support this?

Health care reform hasn't been on the national agenda since the 1990s. "States are leading the way this time," said Turnbull. "It is absolutely clear that the [Massachusetts] law is having an effect on the presidential race. Several candidates have plans that look a lot like ours."

John McDonough, executive director of the NGO Health Care for All, pointed to elements of the Massachusetts law that begin to address racial and ethnic disparities in health care. But, he said, more needs to be done. McDonough is an adjunct lecturer in the HSPH Department of Health Policy and Management.

Gadyflor St. Clair

Data about disparities have been gathered the past decade. However, McDonough noted, what is missing from the picture is a robust social strategy to produce change and the political will to make it happen. Health Care for All and 40 other organizations have filed a bill in Massachusetts to do more to eliminate health care disparities. They are also sponsoring a lobby day at the Massachusetts State House on October 3.

Three panelists - Clara Savage, coordinator of Common Pathways of Worcester; Barbara Keller, director of public affairs at Lawrence General Hospital and of the Mayor's Health Task Force; and Gadyflor St. Clair, director of the Mayor's Health Line of the Boston Public Health Commission - described the challenges on reaching out to the uninsured.

Barriers include difficulty understanding the law and paperwork, high use of emergency room care, and fear of being identified as an illegal immigrant. Scarce money goes first to food, rent, and transportation. Some health centers are already at full capacity.

Barbara Keller (l) and Clara Savage

The talk was followed by an Agency Information Fair in the Kresge Cafeteria.

—EB