I am skeptical of Massachusetts' results as reported in this paper. Since initially signing up people for Commonwealth Care, there has been a steady trend of disenrolling people who are no longer eligible or who were not eligible in the first place. Also the state initially reported a 6% uninsured rate but this study refers to an 11% uninsured rate - which could be right but shows how slippery the true information is in evaluating the reform.

I agree that the downturn in the economy will have significant impact on the uninsured and the need/growth of public programs to the extent the money is there to fund such programs. I am concerned that if Massachusetts uninsured were underestimated, is that the case around the country where other states have notably higher uninsured rates like CA and TX? And by the way, are our illegal aliens counted in these totals because they also show up in our medical facilities for free care...

One last comment - in our hospitals no one is refused treatment based on their ability to pay. Public programs such as SCHIP are available and still people do not enroll for coverage. The reason people do not enroll? Maybe because they know they will get treatment at the hospital or Emergency Room if they need it, so they don't bother to sign up for subsidized plans that may require they see a primary care doctor and practice preventive health instead of treating a medical event. In essence, they are among the insured because they do have access to health care.

Add to that the shortage of primary care doctors in many parts of the country and consider that we really need to invest in our medical infrastructure in order to tackle the problem of the uninsured. That, plus patient education, realistic limits on what Medicaid covers, emphasis on preventive care and wellness... the list goes on!

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