In the first year after Massachusetts implemented its landmark coverage expansion and health reforms, the uninsurance rate among adults in the state dropped by almost half, from 13 percent to 7.1 percent.
A new Urban Institute study published today by the health journal Health Affairs on its Web site also shows that access to care for low-income Massachusetts adults has increased, and the share of adults with high out-of-pocket health care costs and problems paying medical bills has dropped.
Study author Sharon Long, a principal research associate at Urban, found no evidence that the Bay State’s expansion of publicly subsidized coverage has “crowded out” employer-sponsored coverage.
The reforms, enacted in April 2006, included an expansion of the Massachusetts Medicaid program, MassHealth; the creation of new income-related state subsidies for the purchase of health insurance, Commonwealth Care; the creation of a new purchasing arrangement for private health insurance, Commonwealth Choice, via the Commonwealth Connector; an “individual mandate” requiring that state residents purchase “creditable” health insurance if “affordable” coverage is available; a requirement that employers with more than 10 workers either contribute to their employees’ coverage or pay into a state fund; and a consolidation of the individual and small-group private insurance markets.
Among low-income adults — those adults in families with incomes less than 300 percent of the federal poverty level, the group eligible for subsidized coverage under Commonwealth Care — 23.8 percent reported being uninsured in fall 2006, while only 12.9 percent said they lacked coverage in fall 2007, Long reports. Among adults with incomes below 100 percent of poverty, who were eligible for fully subsidized coverage under Commonwealth Care, the uninsurance rate dropped by nearly two-thirds, down to 10 percent in fall 2007.
Other key findings presented by Long include:
Increased Access To Care: In fall 2007, 83.1 percent of low-income adults said they had a usual source of medical care — an important factor in establishing care coordination and continuity — compared to 79.5 percent in fall 2006. In fall 2007, low-income adults were also more likely to report a dental visit and a visit to a physician for preventive care within the past 12 months than in fall 2006.
No Crowd-Out Of Employer Coverage: The share of adults overall and of working adults who reported an offer of employer-sponsored health coverage remained stable between fall 2006 and fall 2007. Indeed, among low-income adults — the group eligible for subsidized coverage under MassHealth and Commonwealth Care — employer coverage increased by five percentage points between fall 2006 and fall 2007.
Fewer Financial Barriers To Care: In fall 2007, 16.9 percent of low-income adults said that they had not received needed care in the past twelve months because of cost, compared to 27.3 percent in fall 2006. The proportion of low-income adults with more than $500 in out-of-pocket spending dropped from 48.2 percent in fall 2006 to 37.4 percent in fall 2007.
Long describes three major challenges to the continued success of the Massachusetts reforms. First, she notes that costs have exceeded expectations, in part because the number of uninsured adults exceeded initial state projections. Even in the face of these costs, however, 71 percent of adults in Massachusetts voiced support for the reforms in fall 2007.
Second, between fall 2006 and fall 2007, the percentage of low-income adults who did not receive care because of difficulty finding a health care provider went up, from 4.1 percent to 6.9 percent. “Combined with the fact that the Massachusetts reforms did not reduce nonemergency visits to hospital emergency departments, this indicates that the state must ensure that it has a sufficient supply of providers — particularly primary care providers — to meet new demands for care, and must help low-income residents navigate the health care system,” Long said.
Finally, Long warns that reaching the remaining uninsured adults in Massachusetts may be difficult. Based on the fall 2007 survey results, these adults tend to be young; male; low-income; and in good, very good, or excellent health. Of the adults still uninsured in fall 2007, 80.1 percent said it would be difficult for them to come up with the funds needed to purchase coverage.
Long’s findings are based on two rounds of telephone interviews with randomly selected Massachusetts adults (ages 18-64), in fall 2006 — just prior to implementation of key elements of the state’s reforms — and fall 2007.
Long’s work was supported by the Blue Cross Blue Shield of Massachusetts Foundation, The Commonwealth Fund, and the Robert Wood Johnson Foundation.
Source: Health Affairs
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