Demand for safety-net care remains high in Massachusetts

Massachusetts, whose 2006 healthcare overhaul provided a template for the landmark national law signed by President Obama last year, has already demonstrated that it is possible to achieve almost universal health coverage.

Now, the trailblazing state is providing another clue about what may happen when the federal government begins guaranteeing health insurance for all citizens starting in 2014.

Massachusetts community health centers and so-called safety-net hospitals – originally created to serve the poor and uninsured – have seen no let-up in demand, even after the state’s reforms, according to new research published Monday in the Archives of Internal Medicine.

Researchers at George Washington University and the University of Minnesota found the number of patients receiving care from community health centers increased by 31% between 2005 and 2009.


Safety-net hospitals, meanwhile, saw a 9.2% increase in non-emergency ambulatory care visits and a 1.8% increase in inpatient admissions between 2006 and 2009.

The continued demand for services has not always been easy for providers, even as a growing share of their patients get insurance.

The reforms signed into law in 2006 by then-Gov. Mitt Romney have resulted in less than 2% of the state’s residents remaining uninsured, compared with more than 16% nationally.

Nonetheless, Massachusetts’ leading safety-net hospitals, including Boston Medical Center, have reported struggling financially as the state cut back payments in the wake of the recent recession.

But the loyalty of low-income patients to safety-net providers in Massachusetts suggests that similar institutions in places like Los Angeles and Chicago, which have built massive public healthcare systems, may have a continued role after 2014.

Local leaders in some places have worried that patients may flee these public hospitals and clinics when patients have more choice, potentially leaving local governments with very expensive, empty facilities unable to serve those left behind.

“This offers some potential comfort to safety-net systems in other parts of the country,” said Leighton Ku, a George Washington University health policy professor and lead author of the study. “It is good news in the sense that these providers are still valued.”

It also means that these providers face a challenge, according to Dr. Mitchell Katz, Los Angeles County’s new health director.

“Safety-net providers have more experience working in teams than most commercial providers because low reimbursement rates have forced them to learn to be more cost efficient,” Katz wrote in an editorial accompanying the new study. “The challenge will be proving that they can also be a system of choice for their patients, not just in Massachusetts, but across the country.”