Great Job, But There’s Work to Do
Massachusetts achieved near-universal health insurance coverage with its ground-breaking 2006 health reform legislation (Chapter 58) and has maintained the lowest level of uninsurance in the nation ever since. Uninsurance in the Bay State was down to only 2.5 percent in 2015 following the rollout of the federal Affordable Care Act (ACA), as reported in a recent Health Affairs article by the two of us and colleagues at the Urban Institute and Blue Cross Blue Shield of Massachusetts Foundation. While expanding coverage to nearly 600,000 additional Bay Staters since 2006 is worthy of celebration, there is still work to be done.
Some in the state continue to find health insurance unaffordable. For example, in interviews conducted for the Foundation, one young woman reported having to choose between paying for health insurance coverage and paying her other expenses, including student loans, rent, and expenses for the car she uses to get to work. This 22-year-old chose to remain uninsured despite serious health issues that run in her family. She called it a calculated risk born of economic necessity. It’s a risk many young adults in Massachusetts take. As a result, young adults in the state are more likely to be uninsured than any other age group.
Convincing young adults to sign up for health insurance coverage can be hard, but a better understanding of the coverage options available to them can change that decision for some. Adults under age 26 are eligible for dependent coverage under a parent’s health insurance plan, while special lower-cost plans are available for adults up to age 30 through the Health Connector. And MassHealth is available to all low-income adults, regardless of age or family circumstances. Continued education and outreach efforts around health insurance coverage could help ensure that all Massachusetts residents find their most affordable health insurance options, including young adults who may be looking for coverage on their own for the first time.
Regrettably, health insurance coverage alone doesn’t guarantee access to affordable health care. Gaps in access to care and affordability of care persist for some Massachusetts residents despite their having health insurance coverage all year. In the 2015 Massachusetts Health Reform Survey, nearly one in five adults in the state who had coverage all year reported going without needed health care because of costs, and one in five reported reducing spending on other needs or making other trade-offs to afford their family’s health care. Those trade-offs can be hard. In another interview, a single mom diagnosed with Type I diabetes and high blood pressure reported out-of-pocket costs of $200 a month for the testing supplies, insulin, and the other prescription drugs she needed to manage her health. After struggling with this expense, she tried to cut back on insulin by eating less so her blood sugar would drop. But that strategy backfired when her lab results showed that she was no longer controlling her diabetes, raising the risk of serious complications. To cover the cost of managing her diabetes, the mom decided to give up her apartment and move in with her own mother—a trade-off she would have preferred not to have had to make.
The burden of high health care costs isn’t a surprise in Massachusetts; the state has been tracking costs for years, most recently through the Health Policy Commission. However, health care costs in Massachusetts continue to increase faster than the rate of inflation, and families across the state continue to struggle. Massachusetts needs to get even more diligent about addressing the burden of health care costs. This will mean tough trade-offs: one person’s medical expense is a health care provider’s paycheck.
We are hopeful that the state’s shift toward value-based purchasing in the private sector and, more recently, in MassHealth, will move Massachusetts toward a more cost-effective and efficient health care system that pays for the value of the care provided rather the volume of services delivered. Making that happen, however, will be challenging—even more challenging than the push toward universal coverage that began 10 years ago.
Massachusetts led the way in expanding health insurance coverage in 2006, providing the template for the ACA. Massachusetts can lead the way again by tackling health care costs so health insurance coverage can become a guarantee of access to affordable health care in the state.