and waivers from the United States federal government. The Blue Cross funded research did not address the increased costs in premiums for employers and individuals or other market dynamics – such as increased providers' costs and increased co-pays/deductibles – necessary to meet minimum creditable coverage standards that were introduced in Massachusetts by other parts of the 2006 legislature and its resulting regulations. Separate research on Premiums and Expenditures found that fully adjusted premiums per member per month (PPMPM) for Massachusetts residents covered by comprehensive private insurance policies (approximately two thirds of the state population) increased approximately 9% in both 2009 and 2010 for subscribers in the "merged market", 7% in the midsized group market, and 5.4% in the large group market. These premium increase do not reflect actual resident experience particularly in the merged market because Massachusetts regulations allow age and other rating factors (e.g., even if premiums were held flat for 55-year-olds living on Cape Cod in construction work from year to year, the 55-year-old in 2009 would pay 10% more in 2010 for the same policy, possibly with lesser benefits). During the years before the changes in the state law related to the enactment of the federal PPACA, the state still used the free care pool—renamed the Health Safety Net—both as originally intended and to fund the subsidies for free (under 150% of FPL) and almost free (151–300% of FPL) networked health care insurance. In addition the state spent a substantial amount of general revenue on the insurance reform. Based on the combination of the increased Health Safety Net tax, general revenue (state income and sales taxes were increased 20%) and smaller additional taxes, the cost of the reform reached about 2% of the state's annual budget in fiscal year 2013, which ended June 30, 2013, up from 1.5% in fiscal 2011. Data following enactment of mandatory insurance showed total emergency visits and spending continued to increase, and low-severity emergency visits decreased less than 2%; researchers concluded, "To the extent that policymakers expected a substantial decrease in overall and low-severity ED visits, this study does not support those expectations." Other analysis concluded that preventable ED visits were reduced 5-8% for non-urgent or primary care ED visits relative to other states. A more complete report released in January 2012 found between 2006 and 2010 emergency department visits and non-urgent visits had dropped 1.9 and 3.8% respectively. A 2014 study