This week marks 20 years since Massachusetts passed a landmark health care reform law that reshaped how residents access medical care and helped pave the way for national changes.Signed on April 12, 2006, the Massachusetts health care reform law — often referred to as “Romneycare” — expanded insurance coverage through a combination of Medicaid expansion, subsidized private plans, and an individual mandate requiring most residents to carry insurance. According to the Commonwealth of Massachusetts, the law led to one of the highest insured rates in the country, with coverage now exceeding 97% of residents.Two decades later, doctors say the impact is still being felt, especially when it comes to how patients enter and navigate the health system.Dr. Daniel Chandler, a primary care physician and associate chief medical information officer at Tufts Medical Center, says the law fundamentally changed access to care.“Health insurance really allows people to have a primary care doctor and a medical home,” Chandler said. “And the alternative to that is often the emergency department, which can be very expensive.” With expanded coverage, more residents are now able to see primary care providers, allowing for earlier intervention and preventive care.Chandler says that shift can make a significant difference.“You can get some necessary screening done and preventive care when it’s relatively easy to fix and it’s less expensive,” he said.Despite high coverage rates, affordability remains a top issue for many patients.“Patients complain about cost all the time,” Chandler said, noting that premiums are only part of the financial burden. “Often, there’s a lot of co-pays that can add up if you choose the wrong plan.”For patients, navigating insurance options can be overwhelming, especially during limited enrollment periods.“The topic is incredibly complex,” Chandler said. “If you have resources like family members or friends who are knowledgeable, I always recommend that you ask them.” Doctors warn that financial pressure can lead patients to delay or skip treatment — a decision that can have long-term consequences.“It can be really catastrophic to avoid treatment,” Chandler said. “If a problem is easy to fix early, that can get more difficult and more expensive over time if you don’t fix it early.”To help address those challenges, many health systems — including Tufts Medicine — now offer support services such as social workers and pharmacy teams to help patients find lower-cost medications, financial assistance or other resources.

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