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Romneycare could offer lessons to PPACA

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The New England Research Institutes has found that private health insurance coverage in the Romneycare era isn’t as widespread as supporters may have imagined.

Their findings, they said, may shed light on how PPACA could fare. 

“If what has happened with Massachusetts health care reform indicates what will occur nationwide with the Affordable Care Act, it will be a historic legislative achievement — expanding quality insurance to millions of Americans with unmet medical needs,” said John McKinlay, study author and NERI senior vice president. “But because of persistent health care inequalities, the ACA is obviously a work in progress.”

Massachusetts’ health care system is often cited as the model for the Patient Protection and Affordable Care Act.

Massachusetts’ 2006 health reform law was the brainchild of then-Gov. Mitt Romney. President Obama said he used the law as a template for his health care reforms, though Romney insisted there were differences between the two, and said during his presidential campaign that he would repeal Obamacare if elected.

In any case, in the study of roughly 3,050 adults in the Boston area, virtually all (97 percent) of participants interviewed after the law’s rollout reported having some kind of health insurance, compared to 87 percent interviewed pre-reform.

Among the working poor (defined as working for pay, whether full or part-time, but earning less than 200 percent of the federal poverty threshold), the number of people reporting that they had no health insurance at the beginning of the study was cut in half (from about 27 percent pre-reform to about 13 percent after the law was passed).

But despite the expanded health care coverage, gaps remain, and there are disparities in the type of health care insurance that is used, researchers say.

“For example, more than half of the working poor in the study are employed in service, construction, or repair jobs, compared to only 17 percent of those classified as ‘not-poor.’ Jobs in these industries are often part-time or seasonal in nature, and therefore the Massachusetts employer-mandated health insurance coverage may not apply,” the study found.

In addition, gains in insurance coverage among the working poor were overwhelmingly seen via public insurance programs, specifically Medicaid/MassHealth. Less than half of working poor reported private insurance coverage, compared to greater than 80 percent private coverage among the “not-poor.”

“Such trends highlight continuing needs for improvements in the Massachusetts health reform laws, and may signal the need for future adjustments to the nationwide-legislation,” the study said.

The bottom line? Despite being targeted by health care reform legislation, the working poor in Massachusetts continue to report lower rates of private insurance coverage compared to both the non-working poor and the not-poor.

“Disparities in insurance coverage persist among some subgroups following health care reform implementation in Massachusetts,” researchers concluded. “These results have important implications for health services researchers and policy makers, particularly in light of the ongoing implementation of the ACA.”

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