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Access and Affordability:An Update on Health Reform in Massachusetts as of Fall 2008
Sharon K. Long
Urban Institute
August 10, 2009
Alliance for Health Reform Briefing
THE URBAN INSTITUTE 2
Primary Goals of Health Reform
• Ensure access to good health coverage for as much of the population as possible
• Cover the uninsured
• Bend the health care cost curve
THE URBAN INSTITUTE 3
Massachusetts as of Fall 2008
• Ensure access to good health coverage for as much of the population as possible– Significant improvements in access to care—for both
lower-income and higher-income adults
• Cover the uninsured– Near universal health insurance coverage
• Bend the health care cost curve– “Round II” of health reform
THE URBAN INSTITUTE 4
Data and Methods
• Data: Massachusetts Health Reform Survey
– Fielded in Fall 2006, Fall 2007 & Fall 2008
– Telephone interviews with samples of adults 18 to 64
– Sample sizes 3000+ in each year
• Methods: Estimate impact of health reform as change over time from Fall 2006
THE URBAN INSTITUTE 5
Adults are more likely to have health insurance coverage under health reform
87%
93% ***
96%***
76%
87%***
92%***
95%97%***
99%***
0%
20%
40%
60%
80%
100%
All adults Lower-income adults Higher-income adults
Fall 2006
Fall 2007
Fall 2008
Health insurance coverage
* (**) (***) Regression-adjusted estimate of difference from Fall 2006 significant at .10 (.05) (.01) level, two-tailed test.
THE URBAN INSTITUTE 6
Adults are more likely to have insurance for the full year under health reform
81%
86%***
90%***
65%
76%***
82%***
93% 93%96%
0%
20%
40%
60%
80%
100%
All adults Lower-income adults Higher-income adults
Fall 2006
Fall 2007
Fall 2008
Health insurance coverage
* (**) (***) Regression-adjusted estimate of difference from Fall 2006 significant at .10 (.05) (.01) level, two-tailed test.
THE URBAN INSTITUTE 7
Adults are more likely to have a regular health care provider and to have had health care visits over the prior year
86%89%
*
92%***
80% 82%
85%***
66%64%
69%** 68%
72%**
76%***
0%
20%
40%
60%
80%
100%
Usual source of care Any doctor visit Multiple doctor visits Dental visit
Fall 2006
Fall 2007
Fall 2008
Health care access and use
* (**) (***) Regression-adjusted estimate of difference from Fall 2006 significant at .10 (.05) (.01) level, two-tailed test.
THE URBAN INSTITUTE 8
Some of the reductions in unmet need from Fall 2007 had disappeared by Fall 2008 as demand for care increased
25%
21%**
22%
8%6%*
6%*
7%4%***
7%9%
6%***
8%
0%
10%
20%
30%
40%
Any unmet need forhealth care
Doctor care Specialist care Medical tests,treatment or follow-up
care
Fall 2006
Fall 2007
Fall 2008
Unmet need for care for any reason
* (**) (***) Regression-adjusted estimate of difference from Fall 2006 significant at .10 (.05) (.01) level, two-tailed test.
THE URBAN INSTITUTE 9
About 1 in 5 adults reported difficulties obtaining care because providers were not accepting new patients or not accepting their insurance type
0%
10%
20%
30%
40%
Not accepting new patients Not accepting insurancetype
Not accepting patients foreither reason
Difficulties obtaining care in Fall 2008
THE URBAN INSTITUTE 10
Affordability of care for adults is still below that of Fall 2006; however, have lost some of the gains from Fall 2007
9%
5%***
7%
20%
17%**
18%
21%
18%*
20%
17%
11%***
11%***
0%
10%
20%
30%
40%
OOP => 10% of familyincome
Problems paying medicalbills
Medical debt Unmet need b/c cost
Fall 2006
Fall 2007
Fall 2008
Affordability of health care
* (**) (***) Regression-adjusted estimate of difference from Fall 2006 significant at .10 (.05) (.01) level, two-tailed test.
THE URBAN INSTITUTE 11
Adults in Massachusetts continued to support health reform in Fall 2008
68%71% 71%
0%
20%
40%
60%
80%
100%
Fall 2006
Fall 2007
Fall 2008
Support for health reform
THE URBAN INSTITUTE 12
Summary of Findings as of Fall 2008
• Continued gains in insurance coverage– Evidence of sustained coverage
– No evidence of ESI crowd-out
• Continued improvements in access to and use of health care– Significant gains between Fall 2007 and Fall 2008
– Evidence of increased barriers to care as demand increased
• Improvements in affordability of care– Continued gains in affordability of care through Fall 2008
– However, some of the early gains have eroded with increasing health care costs
• Support for reform remains strong in the state
