the urban institute on the road to universal coverage: impacts of health reform in massachusetts at...
TRANSCRIPT
![Page 1: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/1.jpg)
THE URBAN INSTITUTE
On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year
Sharon K. Long
Urban Institute
![Page 2: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/2.jpg)
THE URBAN INSTITUTE 2
Outline of the Presentation
• Overview of Legislation
• Data and Methods
• Findings:
– Insurance coverage
– Access to health care
– Affordability of health care
– Support for health reform
– The remaining uninsured
• Limitations
![Page 3: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/3.jpg)
THE URBAN INSTITUTE 3
Massachusetts Health Reform• Legislation passed in April 2006
• Many parts, including:
– Medicaid (MassHealth) expansions
– CommCare--new program that provides income-related subsidies for private coverage
– Commonwealth Choice-new purchasing arrangement
– More restrictions on care under the safety net
– Insurance market reforms
– Requirements for employers
– Individual mandate
![Page 4: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/4.jpg)
THE URBAN INSTITUTE 4
Timeline for implementation
• MassHealth expansion July 2006
• CommCare to adults <100% FPL in October 2006
• CommCare to adults <300% FPL in January 2007
• Commonwealth Choice in May 2007
• Individual mandate with small penalty in 2008 (based on coverage December 31, 2007), larger penalty goes into effect in 2009
• Minimum creditable coverage enforced in 2009
![Page 5: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/5.jpg)
THE URBAN INSTITUTE 5
Data and Methods
• Data: Massachusetts Health Reform Survey
– Fielded in Fall 2006, Fall 2007 & Fall 2008 (planned)
– Telephone interviews with sample of adults 18 to 64
– Sample sizes ~3000 in each year
• Methods: Estimate impact of health reform as changes over time using a “pre-post” comparison
– IMPACT = Fall 2007 – Fall 2006
![Page 6: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/6.jpg)
THE URBAN INSTITUTE 6
Uninsurance for working-age adults reduced by almost half in Massachusetts
13%
7%
0%
5%
10%
15%
20%
25%
30%
All Adults
Fall 2006
Fall 2007
Impact on insurance coverage
![Page 7: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/7.jpg)
THE URBAN INSTITUTE 7
Drop in uninsurance larger for low-income adults
24%
13%
5%
3%
0%
5%
10%
15%
20%
25%
30%
Low-income Adults Higher-income Adults
Fall 2006
Fall 2007
Impact on insurance coverage
![Page 8: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/8.jpg)
THE URBAN INSTITUTE 8
No evidence of crowd-out of ESI for low-income adults
38%42%
39%
45%
0%
10%
20%
30%
40%
50%
60%
Employer-sponsored insurance Other insurance
Fall 2006
Fall 2007
Impact on insurance coverage
![Page 9: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/9.jpg)
THE URBAN INSTITUTE 9
Low-income adults more likely to have a regular health care provider and to have had health care visits over the prior year
80% 83%
65%70%
49%
59%
0%
20%
40%
60%
80%
100%
Usual source of care Doctor visit forpreventive care
Dental visit
Fall 2006
Fall 2007
Impact on access to care
![Page 10: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/10.jpg)
THE URBAN INSTITUTE 10
Both low-income and higher-income adults less likely to have any unmet need for health care over the prior year
36%
30%
19%
15%
0%
10%
20%
30%
40%
Low-income Adults Higher-income Adults
Fall 2006
Fall 2007
Impact on access to care
![Page 11: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/11.jpg)
THE URBAN INSTITUTE 11
Both low-income and higher-income adults less likely to have unmet need for health care over the prior year because of cost of care
27%
17%
10%
7%
0%
10%
20%
30%
40%
Low-income Adults Higher-income Adults
Fall 2006
Fall 2007
Impact on affordability of care
![Page 12: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/12.jpg)
THE URBAN INSTITUTE 12
Drop in out-of-pocket health care costs over the prior year for low-income adults
48%
37%33%
24%
12%8%
0%
10%
20%
30%
40%
50%
60%
$500 or more $1000 or more $3000 or more
Fall 2006
Fall 2007
Impact on affordability of care
![Page 13: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/13.jpg)
THE URBAN INSTITUTE 13
Drop in problems paying medical bills and medical debt over the prior year for low-income adults
32%
24%27%
23%
0%
10%
20%
30%
40%
50%
Problems payingmedical bills
Paying medical bills offover time
Fall 2006
Fall 2007
Impact on affordability of care
![Page 14: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/14.jpg)
THE URBAN INSTITUTE 14
Most working-age adults in Massachusetts support health reform
68% 71%
0%
20%
40%
60%
80%
100%
All Adults
Fall 2006
Fall 2007
Support for health reform
![Page 15: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/15.jpg)
THE URBAN INSTITUTE 15
Support for health reform remained high across both low-income and higher-income adults
70% 73%67%
70%
0%
20%
40%
60%
80%
100%
Low-income Adults Higher-income Adults
Fall 2006
Fall 2007
Support for health reform
![Page 16: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/16.jpg)
THE URBAN INSTITUTE 16
However, support was lower among adults who remained uninsured in Fall 2007
69% 73%
63%
44%
0%
20%
40%
60%
80%
100%
Insured Adults Uninsured Adults
Fall 2006
Fall 2007
Support for health reform
![Page 17: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/17.jpg)
THE URBAN INSTITUTE 17
• The remaining uninsured may be difficult to convince to obtain
coverage
– Many are young, male, healthy, and low-income
– Most are working (68%), but few have access to ESI (11%)
– Most reported cost of coverage as reason not insured
– Sizable minority (32%) reported they were not aware of individual mandate in Fall 2007
Expanding insurance coverage
![Page 18: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/18.jpg)
THE URBAN INSTITUTE 18
Study Limitations
• One set of estimates of the impacts of reform
– Will be important to compare to other surveys as data become available
• Estimates are of early impacts of reform
– Another round of the survey will be fielded in Fall 2008
• “Pre-post” evaluation design
– Additional studies are being conducted using other data sources and methods
![Page 19: THE URBAN INSTITUTE On the Road to Universal Coverage: Impacts of Health Reform in Massachusetts at One Year Sharon K. Long Urban Institute](https://reader030.vdocuments.us/reader030/viewer/2022032608/56649edd5503460f94bee317/html5/thumbnails/19.jpg)
THE URBAN INSTITUTE 19
Summary: Early Impacts of Health Reform
in Massachusetts• Uninsurance among working-age adults reduced by
almost half • Access to care has improved
– More likely to have usual source of care– More likely to have health care visits– Less likely to have unmet need for care
• Health care is more affordable– Out-of-pocket health care costs are down– Problems paying medical bills and medical debt are down
• Support for health reform among Massachusetts residents remains high