pres health servicesny2010nov3_long
TRANSCRIPT
Getting Ready for Health Reform in New York: Lessons from Massachusetts
Sharon K. LongUniversity of Minnesota
Twenty-first Annual Symposium on Health Services in New York: Research and PracticeNovember 3, 2010
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Overview of the Presentation
• How Massachusetts’s 2006 health reform initiative compare to national reform?
• Can the experiences under health reform in Massachusetts provide lessons for New York?
• What were the impacts of health reform in Massachusetts?
• What are the challenges Massachusetts faces going forward?
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How does Massachusetts’s 2006 health reform initiative compare to national reform?
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National reform is modeled on Massachusetts’s 2006 legislation• Expansion of eligibility for public programs• Creation of health insurance exchanges• Subsidies for low- and moderate- income
individuals• Expansion of dependent coverage • Individual mandate• Requirements for employers• Standards for covered benefits
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However, there are some are important differences in national reform• Expands subsidies to higher income levels (400% FPL versus
300% FPL) but provides lower subsidies for some• Imposes lower standards for affordability under the individual
mandate • Provides more generous expansion of dependent coverage
(doesn’t require that child be claimed as dependent for tax purposes)
• Provides tax credits for small businesses• Limits penalties for employers who do not offer insurance
coverage to larger firms (>50 workers versus >10 workers)• Extends some insurance protections to workers in self-
insured plans which are not under the purview of state regulators
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Can the experiences under health reform in Massachusetts provide lessons for New York?
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Overview of Key Changes in Coverage Options Under Health Reform in Massachusetts
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Pre-Reform Post-Reform
Children
Public coverage < 200% FPL < 300% FPL
Parents
Public coverage < 133% FPL < 300% FPL
Premium support < 200% FPL < 300% FPL
Subsidized coverage -- < 300% FPL
Purchasing pool -- > 300% FPL
Childless Adults
Public coverage -- < 300% FPL
Premium support < 200% FPL < 300% FPL
Subsidized coverage -- < 300% FPL
Purchasing pool -- > 300% FPL
Note: FPL is federal poverty level
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Comparing Insurance Coverage in New York to Pre-Reform Massachusetts
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New York2009
Massachusetts 2005
All Residents
Any coverage 89.8% 94.5%
Private coverage 57.3% 66.5%
Public coverage 32.5% 28.0%
Non-elderly Adults
Any coverage 85.7% 90.8%
Private coverage 67.0% 76.4%
Public coverage 18.7% 14.4%
Source: 2006-2009 National Health Interview Survey from Cohen and Martinez (2006) and Cohen, Martinez and Ward (2010).Note: Individuals reporting both private and public coverage are assigned to public coverage.
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Comparing recent economic measures between New York and Massachusetts• Unemployment rate
– MA – 8.4%; NY – 8.3%• Average hourly earnings, private non-farm payroll
– MA – $27/hour; NY – $26/hour• Employees in firms with 50 or more workers
– MA – 74%; NY – 72%• Private-sector establishments offering health
insurance – MA – 62%; NY – 59%
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Comparing Coverage Options in New York to Pre-Reform Massachusetts
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New YorkPre-Reform
Massachusetts
Children
Public coverage < 400% FPL < 200% FPL
Parents
Public coverage < 150% FPL < 133% FPL
Premium support < 250% FPL < 200% FPL
Childless Adults
Public coverage < 100% FPL --
Premium support < 250% FPL < 200% FPL
Note: FPL is federal poverty level
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What were the impacts of health reform in Massachusetts?
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Data
• Massachusetts Health Reform Survey– Targets non-elderly adults 18-64– Conducted every fall from 2006 to 2010 (underway)– Oversamples of lower-income and uninsured adults– Telephone interviews, including cell-phones in 2010– Sample size ~3000
• Funded by Blue Cross Blue Shield of Massachusetts Foundation– Additional funding from Commonwealth Fund and
Robert Wood Johnson Foundation in earlier years
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Methods
• Estimate impact of health reform as change over time from fall 2006– Pre-post estimates will also capture recession &
health care cost trends– Consistent findings from studies using national data
• Multivariate regression models control for demographic characteristics, health and disability status, socioeconomic status and region of state– Estimate linear probability models, controlling for
complex survey design
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Summary of Findings on Impacts
• Increase in insurance coverage, with no crowd out of private coverage
• Improvements in access to and use of health care
• Improvements in affordability of health care for individuals
• Support for health reform remains strong in the state
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Health insurance coverage, 2006-2009
88%92%95% *** 98%***
0%
20%
40%
60%
80%
100%
Currently insured Ever insured over year
2006 2009
Source: 2006-2009 Massachusetts Health Reform SurveyNote: Regression-adjusted estimates* (**) (***) Significantly different from fall 2006 at the .10 (.05) (.01) level, two-tailed test.
Adults more likely to have health insurance under health reform.
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Type of health insurance coverage, 2006-2009
66%
22%
68% ***
27%***
0%
20%
40%
60%
80%
100%
Employer-sponsored insurance Public and other coverage
2006 2009
Source: 2006-2009 Massachusetts Health Reform SurveyNote: Regression-adjusted estimates* (**) (***) Significantly different from fall 2006 at the .10 (.05) (.01) level, two-tailed test.
Employer-sponsored insurance coverage increased under health reform.
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Employers’ insurance offer and employees’ take-up, 2005-2009
70%78%76% 80%
0%
20%
40%
60%
80%
100%
Employers offering coverage Employees taking up coverage
2005 2009
Source: 2006-2009 Massachusetts Division of Health Care Finance and Policy Employer Survey
Employers more likely to offer health insurance coverage to workers and workers more likely to take-up coverage under health reform.
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Type of health insurance coverage, 2006-2009
4,333
40
705
4,374
90
1,008
0
1,000
2,000
3,000
4,000
5,000
Private group Individual purchase Public
Thou
sand
s
2006 2009
Source: 2006-2009 Massachusetts Division of Health Care Finance and Policy enrollment data from health plans and programs.
No evidence of public coverage crowding out of employer-sponsored insurance coverage under health reform.
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Health care access and use, 2006-2009
86%80%
70% 68%
89%**86%***
78%*** 75%***
0%
20%
40%
60%
80%
100%
Usual source of care Any doctor visit Preventive care visit Dental care visit
2006 2009Source: 2006-2009 Massachusetts Health Reform SurveyNote: Regression-adjusted estimates*(**) (***) Significantly different from fall 2006 at .10, (.05) (.01) level, two tailed test
Adults more likely to have a regular health care provider and to have had health care visits over the prior year under health reform
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Unmet need for care, 2006-2009
24.9%
7.7%9.1% 7.9% 6.8%
19.0%***
5.3%** 5.7%*** 5.7%** 4.9%**
0%
5%
10%
15%
20%
25%
30%
Any unmet need for health care
Doctor care Medical tests, treatment, or
follow up care
Prescription drugs Preventive care screening
2006 2009
Source: 2006-2009 Massachusetts Health Reform SurveyNote: Regression-adjusted estimates*(**) (***) Significantly different from fall 2006 at .10, (.05) (.01) level, two-tailed test
Adults less likely to have unmet need for any reason under health reform
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Health care costs and affordability for individuals, 2006-2009
9.5%
19.1% 19.5%
16.3%
4.4%***
19.1% 20.3%
11.7%***
0%
10%
20%
30%
OOP health care costs=>10% of family
income
Problems paying medical bills
Medical debt Unmet need because of cost
2006 2009
Source: 2006-2009 Massachusetts Health Reform SurveyNote: Regression-adjusted estimates*(**) (***) Significantly different from fall 2006 at .10, (.05) (.01) level, two-tailed test
Improvements in affordability of care under health reform despite increasing health care costs and economic recession
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Residents support for health reform, 2006-2008
61%
52%
69%
58%
0%
20%
40%
60%
80%
100%
Support for health reform Support for the individual mandate
2006 2008
Source: Blendon et al. (2008)
Support for health reform among Massachusetts residents has remained strong
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Physicians support health reform, 2008
70%75%
13%7%
17% 18%
0%
20%
40%
60%
80%
100%
Support for the health reform law Support for continuing with reformFor Against Neither for nor against/Don't know
Source: SteeleFisher et al. (2009)
Support for health reform among Massachusetts physicians is strong
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What are the challenges Massachusetts faces going forward?
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Challenges in Massachusetts prior to health reform• Uninsurance, particularly among non-
elderly adults• Provider shortages in some areas,
particularly for primary care and populations with public coverage
• High and rapidly rising health care costs
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Reform addressed uninsurance, but access and, especially, costs remain issues
• Health insurance coverage does not guarantee access to care– 1 in 5 adults reported unmet need for care– 1 in 5 adults reported difficulty finding a doctor that
would see them• Health care costs continue to threaten gains
under health reform– 1 in 5 adults reported problems paying medical bills– Cost remains major reason for continued uninsurance
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Addressing continued increases in costs of care is “harder than expanding coverage”
• Passed 2006 legislation with knowledge that would need to address costs in future legislative efforts--“Round II” of health reform
• Considerable consensus in the state on the need to address continued escalating costs
• Less consensus as to how to address rising health care costs
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Massachusetts must also address differences under national reform
• Many new rules and regulations that affect state• Examples:
– Under current provisions, some Massachusetts residents will face both federal and state penalties under the individual mandate if they do not obtain coverage
– Under current provisions, some Massachusetts employers will face both federal and state penalties for not offering coverage to their workers
– May need to change structure of the exchanges
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Contact information
Sharon K. LongUniversity of [email protected]
©2002-2009 Regents of the University of Minnesota. All rights reserved.The University of Minnesota is an Equal Opportunity Employer