Massachusetts health insurance law has increased access to care, though residents' ability to obtain treatment hampered by provider supply

Since the implementation of the Massachusetts health insurance law in 2006, more residents have health coverage and increased access to care, but rising health care costs combined with the current economic recession could undermine some of the law's successes, according to the third annual "Update on Health Reform in Massachusetts" report by the Urban Institute, the Boston Globe reports.

The study was funded by the Blue Cross and Blue Shield of Massachusetts Foundation, the Robert Wood Johnson Foundation and the Commonwealth Fund, and published in the journal Health Affairs.

For the report, Sharon Long of the Urban Institute and colleagues surveyed about 4,000 Massachusetts adults in 2007 and 2008 and compared their health care habits with those of residents surveyed in 2006 -- just after the law went into effect. Researchers found that although there were initial gains in health care affordability, there are now some signs that an increasing number of state residents are reporting problems paying for medical bills, and an increasing number of people -- especially lower-income residents -- not seeking care because of costs (Lazar, Boston Globe, 5/28).

One in five adults reported being told in the past 12 months that a physician or clinic was not accepting new patients or would not see patients with their type of insurance (Sack, New York Times, 5/28). Lower-income residents had more difficulties finding a physician than higher-income residents, with 24% of residents enrolled in state-subsidized health plans, saying they were told that a physician did not accept their insurance, compared with 7% of residents with private coverage (Boston Globe, 5/28).

Additional Findings

The study also found that:

• 91% of state residents said they have a regular health care provider, compared with 86% in 2006;
• Three-quarters of residents surveyed said they had seen a dentist in the past year, compared with 68% in 2006;
• 18% of lower-income families did not receive needed care in 2008 because of costs, compared with 17% in 2007 and 27% in 2006 (New York Times, 5/28);
• 17.9% of residents in 2008 reported having difficulty paying their medical bills, compared with 16.5% in 2007 -- a change likely attributed more to the current economic recession than the law; and
• Public support for the law continues to be strong -- about 70% of people surveyed from 2006 through 2008 said they support the law (Boston Globe, 5/28).

Comments

According to Long and study co-author Paul Masi, "Although major expansions in coverage can be achieved without addressing health care costs, cost pressures have the potential to undermine the gains" (New York Times, 5/28).

Kaiser Family Foundation President and CEO Drew Altman said, "You can see Massachusetts as a kind of crystal ball for what some of the implementation challenges might look like in national health reform." He added, "If we get to a point where everyone is insured, then we can move on to worry about the affordability of care" (Boston Globe, 5/28).

The study is available online.

Report Projects Increases in Uninsured Population

Health Affairs on Thursday also published a report that projected that the number of uninsured residents will increase by at least 6.9 million by 2010. The projection -- by Todd Gilmer and Rick Kronick of the University of California-San Diego Department of Family and Preventive Medicine -- is based on increases in health spending compared to income. The authors note that their projections do not directly take into account the effects of high unemployment rates, which could add more people to the ranks of the uninsured (Gilmer/Kronick, Health Affairs, 5/28).

The report is available online.