Session: Informing US Health Reform
Room: Upson 215
Time: Wed 12:00-13:30

Presenter: Sharon Long (Urban Institute. Health Policy Center)

Discussant: Norma CoeBoston College

Abstract

In April 2006, Massachusetts enacted an ambitious health care reform bill that sought to move the state to near universal health insurance coverage. Given the Commonwealth’s significant success at expanding coverage, many of the key features of Massachusetts’ initiative have been incorporated in national health reform, including expansions of public coverage, subsidies for private coverage, a health insurance exchange, insurance market reforms, requirements for employers and an individual mandate.

Using newly available data for 2009, this study combines annual survey data from 2006 through 2009 to provide an update on changes over time under health reform in insurance coverage, including continuity of coverage; access to and use of health care; out-of-pocket health care costs and financial stress from health care spending; and quality of care in Massachusetts. We examine changes for the overall non-elderly adult population in Massachusetts, as well as for low- and moderate-income adults, the target population for many of the changes in the state. The surveys, which are conducted every fall, are based on stratified random samples, with oversamples of the low and moderate-income adults and uninsured adults.

Preliminary findings show continued gains in insurance coverage, improvements in access to care, health care use, and quality of care in the state, despite the current economic recession. However, we also find evidence of continued barriers to care related to provider availability in the state and on-going issues with the affordability of health care as costs continue to rise in Massachusetts as in the rest of the country. Further, new survey questions added in the fall 2009 survey indicate substantial use of the health care safety net both by those with insurance coverage and the uninsured.

It is important to learn from health reform in Massachusetts as it is, by far, the closest any state has come to universal coverage. By following the experiences of Massachusetts, particularly the experiences of low-income and uninsured individuals in the state, study findings provide guidance to state and national policymakers as we begin to implement national health reform.

Key Terms

health reform, uninsurance, access to care, health care utilization,

Authors:

Sharon Long (Urban Institute. Health Policy Center) and Karen Stockley (Urban Institute. Health Policy Center)