Massachusetts finds insurance gains on road to universal coverage

Study praises Massachusetts healthcare program. Source: Computer Sciences Corporation

Universal health insurance coverage, as required by a Massachusetts law enacted in 2006, has reduced the lack of insurance coverage among working-age adults in the state by almost half while access to care has improved, according to a study conducted by the Urban Institute. In addition, the share of adults with high out-of-pocket costs for healthcare, and consequent problems paying their medical bills, has dropped. 

In April 2006, Massachusetts passed legislation intended to move the state to near-universal coverage within three years and, in conjunction with that expansion, to improve access to affordable, high-quality healthcare, reported The New York Times (NY Times).

The study, conducted at the Urban Institute in Washington, D.C., found no evidence that residents were dropping private health coverage to take advantage of state-subsidized policies, or that employers viewed the availability of new public programs as a reason to eliminate health benefits, according to Sharon K. Long, principal research associate at the institute.

Health Affairs reported that in roughly the first year under reform, lack of insurance among working-age adults dropped from 13 percent in fall 2006 to 7 percent in fall 2007. Despite higher than anticipated costs, most residents of the state continued to support reform.
The decline in the share of residents without insurance was nearly equivalent for those with low or moderate incomes and those with higher incomes.

“The entire increase in coverage appears to have been drawn from the ranks of the uninsured, because there is no evidence that publicly funded programs are crowding out employer coverage,” wrote Long.

According to the NY Times, the share of residents receiving insurance through their employers increased in Massachusetts by nearly three percentage points from fall 2006 to fall 2007, contrary to U.S. trends which have shown percentages of employers that offer benefits and of workers who receive them have been sliding steadily throughout the decade.

Despite overall declines in the percentage of residents who said they were not receiving needed care, the study showed increases in the share who said they did not get care because they could not find a doctor, according to Long.

That finding may support reports from internists and family practitioners that they have been stretched by an influx of newly insured patients, causing long delays for some appointments. The study also found a slight increase in the share of low-income residents who sought treatment in hospital emergency rooms for conditions that were not urgent, the NY Times reported.

The 2006 state law required residents to obtain insurance beginning in 2007, and state subsidies were provided on a sliding scale to make policies affordable for low-income residents. The 86,000 residents who did not comply faced modest first-year tax penalties of $219, according to the study.

Jon M. Kingsdale, director of the state authority that oversees the health plan, said that more than 350,000 of the estimated 600,000 residents who were uninsured before the program began had since gained coverage. Exemptions were granted to about 60,000 people who demonstrated that they could not afford even subsidized insurance, reported the NY Times.

According to Long, the cost of reform to the state has exceeded initial cost projections, in part because the number of uninsured adults exceeded initial state projections.

“The long-run success of Massachusetts' efforts will hinge, in part, on sustaining support for the new policies in the face of these higher costs. At the end of 2007, 71 percent of working-age adults reported support for Massachusetts’ health reform efforts, with adults across a range of demographic and economic groups supporting reform,” Long concluded. “For now, it appears that broad-based support exists for Massachusetts to continue to pursue health reform.”