A cautionary tale: Massachusetts healthcare reform and Cambridge Health Alliance

In the winter of 2008-2009, Massachusetts' Healthcare reform, a deregulated healthcare marketplace and economic depression converged upon Cambridge Health Alliance (CHA) as a maelstrom. The maelstrom's forces included: healthcare reform financed by redirecting safety net funds; “market” deregulation enabling unrestrained growth and market control by academic health centers; undervalued psychiatric and addictions care; economic recession forcing “line item” cuts in the state budget. CHA, a public safety net institution was particularly vulnerable: it depended upon block grants to augment the below-cost rates it received for the primary and mental health care it provides to its indigent and immigrant communities.

Reconfiguration (consolidating community health centers, restricting the geographic breadth of psychiatric care, closing one hospital's inpatient units, laying-off hundreds of workers) and an interesting new partnership with the state may sustain the institution. While the consequences are not yet known, time will reveal the effects on the integrity of the institution and its ability to care and advocate for the health of the public. The story is of national interest and one of caution. While Washington appears to be embarking on a health care reform modeled upon that of Massachusetts, increasing numbers of Americans may slip through the fraying safety net.