Texas and Massachusetts: A Health Care Contrast

Published August 31, 2011

As the 2012 Republican presidential nomination race heats up, there are many readily apparent contrasts between former Massachusetts governor Mitt Romney and the nation’s longest-serving governor, Rick Perry of Texas. One area where the two can be judged by their governing actions, and not just their style, is health care policy.

Romney is the architect of a controversial universal coverage plan, based on an individual mandate, which he engineered in 2006. Perry’s signature health policy achievement is a 2003 tort reform package he supported, which capped noneconomic medical malpractice damages at $250,000 for physicians and $500,000 for hospitals. It was intended to cut back on wasteful health care spending while making Texas more inviting to the physicians needed to meet the needs of a dramatically expanding state population.

Health care premium costs have increased everywhere in the United States. But since the passage of Perry’s tort reform in 2003, premiums have risen at a significantly slower rate in Texas, well below the national average, than in Massachusetts, well above the national average. Today, the average health insurance premium cost in Massachusetts is the highest in the nation.

Before the 2003 reforms, Texas was incredibly low in its ranking in physicians per capita. Key areas such as the Rio Grande Valley were losing doctors. Under Perry’s reforms, the influx of physicians has been dramatic. According to the Texas Medical Board, more than 21,000 doctors have been added to active practice since tort reform passed with Perry’s support in 2003. With Texas’s population exploding as people immigrate from other states seeking jobs, there’s always going to be a lag in meeting that need–but thanks to the appealing business and legal climate, things are moving in the right direction.

Simple measures of the number of primary care physicians are sometimes unfair because they can make less-rural states appear to have dramatically better access than is the reality. Washington, DC, for instance, ranks atop any list that includes it, because of its small geographical area. But in terms of actual access to care, DC is a maw of horror stories–including one poor child who died of a toothache. Insurance coverage for the cost of care is not the same as access to a physician when you need one.

Massachusetts is a perfect example of this lesson. Where Romney’s plan excels is in insurance coverage–his individual mandate requires people to be covered. In Texas, rates of people without insurance are much higher, in large part because of the state’s massive Hispanic population. Four of the top six states in uninsurance are those that border Mexico. Texas Hispanics are almost twice as likely as others to be uninsured, at nearly every level of income–an indication that cultural factors, as opposed to economic ones, could be at issue.

Massachusetts does not have this problem, but it has others. Under Romney’s reforms, Massachusetts’s uninsured population declined from around 10 percent to 4.4 percent. Yet even though Massachusetts has the most active physicians per 10,000 population among the 50 states, several studies have shown a burgeoning access problem there, and it’s a rising concern as fewer doctors have been moving to the state.

A study released in May by the Massachusetts Medical Society showed persistent shortages of primary care physicians and significantly lengthening wait times for those seeking a doctor.

Even worse, the cost of Massachusetts’s plan, including its subsidized coverage, has significantly outpaced expectations. Today, 68 percent of the formerly uninsured who signed up for coverage are being paid for in part or in full by the taxpayers. As that number continues to grow over the next decade, it now appears Romney’s plan will cost more than $2 billion more than expected.

The contrast between the two Republicans is clear. Thanks in part to Perry’s 2003 reform, Texans have enjoyed much slower health insurance premium growth than the national average, a massive influx of new physicians, and more new health care jobs than any state. In Massachusetts, although Romney’s reform certainly decreased the uninsured population, it has only accelerated the problems of access and cost.

Perry and Romney targeted different health care problems in different ways. But today, only one of them can run on his state’s accomplishments.

Benjamin Domenech ([email protected]) is a research fellow at The Heartland Institute.