Sustaining Health Reform In A Recession: An Update On Massachusetts As Of Fall 2009

Abstract

With the passage of national health reform legislation modeled on Massachusetts' 2006 reform initiative, the Bay State continues to provide important lessons for the nation. Most recently, Massachusetts has shown that although it is difficult, sustaining the gains of health reform in a severe recession is possible. The state's uninsurance rate, 4.8 percent for nonelderly adults, remained at a record low in fall 2009. Access to health care improved, and the burden of high health care costs on individuals was reduced. However, challenges remain, as some barriers to care persist and escalating health care costs continue to be an issue.

Reasons Why Patients Remain Uninsured after Massachusetts’ Health Care Reform: A Survey of Patients at a Safety-Net Hospital

“…This may explain why only 31.5% of our uninsured sample thought the reform had been good for Massachusetts, compared to the support of 67% reported for unselected nonelderly adults surveyed state-wide, which is more similar to the support for the reform we found among our privately insured patients (53.6%). 4 The major limitation of our study is that the sample is drawn from a single safety-net ED. The uninsured are more likely to seek care in safety-net institutions, so this strategy allowed us to locate the uninsured efficiently, to obtain a high response rate, and to focus our investigation on persons actually requiring medical care.…”

“…The statewide Massachusetts Health Reform Survey found uninsurance rates of 4.0% in 2008 and 4.8% in 2009. 4 The Massachusetts Department of Revenue (DOR) reported that 5% of income tax filers were uninsured for the 2008 tax year. 5 The Behavioral Risk Factor Surveillance System and the U.S. Census Bureau found uninsurance rates for non-elderly adults of 5.0% and 7.3% respectively in 2008 and 6.2% in 2009.…”

“…[6][7][8][9] Based on current population estimates from the Census Bureau, and the uninsurance rate estimate from the only peer-reviewed publication on this topic, approximately 316,492 non-elderly adults remain uninsured after full implementation of the reform. 4,10 Previous studies have assessed the demographics of uninsured residents, suggesting that the uninsured in Massachusetts post-reform are more likely to be young, male, single, minority and either non-citizens or nonEnglish speaking. 4,11,12 However, there have been no published studies that examine why Massachusetts residents remain uninsured four years into health reform, and particularly why the most policy-relevant group of uninsured, i.e.…”

“…4,10 Previous studies have assessed the demographics of uninsured residents, suggesting that the uninsured in Massachusetts post-reform are more likely to be young, male, single, minority and either non-citizens or nonEnglish speaking. 4,11,12 However, there have been no published studies that examine why Massachusetts residents remain uninsured four years into health reform, and particularly why the most policy-relevant group of uninsured, i.e. those requiring medical treatment, remain uncovered.…”

Assessing Health Reform’s Impact On Four Key Groups Of Americans

“…Compliance with the Massachusetts individual mandate has been high, although the state's subsidy and penalty structure differs somewhat from that set forth in the federal law. Estimates of the postreform uninsurance rate in Massachusetts vary from 2.6 percent 10 to 3.7 percent 11 to 4.8 percent, 12 depending on the year. More than 90 percent of Massachusetts residents, however, had coverage prior to the mandate.…”