Mass. uninsured drop by nearly half

WASHINGTON – An Urban Institute study published last week in the journal Health Affairs shows that in roughly a year since Massachusetts implemented its sweeping health reform, the number of uninsured among working-age adults was reduced by almost half, dropping from 13 percent in the fall of 2006 to 7 percent in the fall of 2007.
At the same time, access to care improved, and the share of adults with high out-of-pocket costs and problems paying medical bills dropped, the study found. Moreover, despite higher-than-anticipated costs, most state residents still support the reform.
The study involved telephone surveys of about 3,000 working-age adults in Massachusetts. The project was led by Sharon Long, a principal research associate with the Urban Institute, and funded by the Blue Cross & Blue Shield of Massachusetts Foundation, the Commonwealth Fund and the Robert Wood Johnson Foundation.
Massachusetts passed legislation in April 2006 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 health care. To achieve that goal, the reform used a combination of Medicaid expansions, subsidized private insurance coverage, insurance market reforms, and new mandates for both individuals and employers.
Funding for the reform initiative includes federal and state dollars, along with assessments on hospitals, insurers, and employers, as well as consumer cost sharing.
The study found that those who still remain uninsured tend to be healthy, low-income and male, and about one-third of them said they did not know that health insurance was mandatory. Among families with incomes less than 300 percent of the federal poverty line, however, uninsured rates decreased from 24 to 13 percent, while among those with incomes greater than 300 percent of poverty, they dropped from 5 to 3 percent.
Seventy percent of insured residents with incomes less than 300 percent of poverty said they had received preventive care in the past year, compared with 65 percent in 2006, and 59 percent reported seeing a dentist in the previous year, versus 49 percent in 2006.
In its coverage of the report, The Boston Globe cited data from the Mass. Revenue Department that 86,000 residents who had been deemed able to get insurance but chose not to had forfeited their $219 personal tax exemption. The penalty next year for not obtaining coverage could be as much as $912 for a person who remains uninsured for the entire year. An additional 62,000 tax filers were uninsured but did not have to pay penalties because they were deemed not to be able to afford insurance.
The Urban Institute study found that 71 percent of residents who are already insured support the law, while 44 percent of uninsured residents support the law.
The full Health Affairs article is available online at content.healthaffairs.org.