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Life Health > Health Insurance > Life Insurance Strategies

Massachusetts' Health Reform Program Improves Access, Researcher Finds

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The first phases of the Massachusetts health reform program seem to be succeeding at helping state residents get and pay for medical care, a researcher says.

Analysis of data from Massachusetts 2006 and 2007 health care surveys shows that the percentage of Massachusetts adults ages 18 to 64 who reported going without needed care in the past year because of cost fell to about 11%, from 17%, according to Sharon Long, a research associate at the Urban Institute, Washington.

For adults ages 18 to 64 with family incomes below 300% of the federal poverty level, the percentage of state residents going without needed care because of cost fell to 17% from 27%.

The overall rate of uninsurance among Massachusetts adults ages 18 to 64 fell to 7.1%, from 13%, and the uninsured rate for low-income adults in that age range dropped to 13%, from 24%, Long writes.

The Massachusetts health reform effort includes several components.

One is expansion of MassHealth, the state Medicaid program, and another is the creation of Commonwealth Care, a program that provides free coverage for residents with incomes under 150% of the federal poverty level and subsidized coverage for residents with incomes ranging from 150% to 300% of the federal poverty level.

For higher-income residents, Massachusetts has created the unsubsidized Commonwealth Choice program, which negotiates rates with private insurers for individuals and eventually will offer a similar “buying club” program for small groups.

Enrollment in MassHealth has increased by 64,000 since the health reform program started, and 177,000 residents are getting free or subsidized Commonwealth Care coverage, officials say.

About 18,000 residents have Commonwealth Choice coverage.

Massachusetts is supplementing the coverage programs by requiring employers with 11 or more employees to provide health coverage for employees or pay a $295 assessment per employee.

Individuals with access to affordable health coverage must have health coverage or else pay tax penalties.

“Among all adults, 7% reported that the individual mandate had influenced their insurance coverage decision in fall 2007,” Long writes.

But she notes that, although the popularity among all Massachusetts adults ages 18 to 64 increased to 71% in 2007, from 68% in 2006, support for the program fell to 44%, from 63%, among uninsured adults.

About 80% of the uninsured adults included in the 2007 survey said getting the money to pay for health coverage would be somewhat or very difficult, Long writes.

Jean Russell, a health insurance broker and president of the Massachusetts Association of Health Underwriters, Framingham, Mass., says the health reform program components aimed at low-income individuals and families have had little effect on MassAHU members.

In Massachusetts, “agents and brokers aren’t involved in selling individual products,” Russell says.

But MassAHU members have concerns about the Commonwealth Choice small group coverage purchasing pool the state is creating, Russell says.

Massachusetts has tried to lower rates for individuals by combining the individual and small group markets, and that change also has raised concerns, Russell says.

Some forecasts have shown combining the markets could increase small group costs 2% to 9%, Russell says.

Russell cites the relatively high cost of the unsubsidized coverage available through Commonwealth Choice as a challenge for consumers.

State officials need to focus more on wellness programs and other efforts to control the underlying cost of health care, Russell says.


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