Nearly universal health care coverage in Massachusetts has helped increase the number of insured residents to 97 percent, according to a study by the Massachusetts Department of Public Health (MDPH). However, Hispanics and other underserved populations continue to have the lowest percentage of coverage despite showing the largest increases since the state enacted health care legislation in 2006. The study was published in the 12 March 2010 issue of Morbidity and Mortality Weekly Report.
Massachusetts now has the lowest rate of uninsured persons in the United States. From 2005 to 2008, health insurance coverage increased from 89 percent to 97 percent among all Massachusetts residents, including an estimated 300,000 newly insured persons aged 18-64 years.
The increase in health insurance coverage in Massachusetts is considered a success. “Anything over 95 percent is an example that coverage is verging toward universal,” study co-author Bruce Cohen, PhD, Director of the Bureau of Health Information, Statistics, Research and Evaluation (BHISRE) at MDPH said to Suite101.
“MDPH is using these results to target outreach more precisely to increase health insurance enrollment and health care access among state residents,” the study noted.
Health Care Legislation in Massachusetts
Massachusetts enacted legislation to provide health care coverage to all state residents in April 2006. One key component of the law required all Massachusetts residents to purchase health insurance by July 2007, either through private insurers or Commonwealth Care, a new state-subsidized health insurance program. Incentives for residents to obtain health insurance coverage include tax penalties for failing to obtain an insurance plan.
The law also mandated tobacco cessation coverage for all Massachusetts residents under the government-run Medicaid health insurance program.
The New Law Increased Health Insurance Coverage
The study compared the 18-month periods before and after the law was implemented. After implementation, health insurance coverage statewide increased by 5.5 percent, from 91.3 percent to 96.3 percent. The largest increases were observed among Hispanics (14.2 percent), persons with less than a high school diploma (12 percent) and persons with annual household incomes under $25,000 (11.9 percent).
Coverage after the law increased to 98.4 percent for Asians, 97.3 percent for whites, 92.7 percent for blacks and 89 percent for Hispanics.
The proportion of residents who said they lacked health insurance was approximately cut in half, and eight percent of publicly insured residents were obtaining health insurance through the state's new Commonwealth Care program. The percentage of insured residents with public health insurance (including those aged 18-64 years who were eligible for Medicare) increased 29.7 percent, from 14.8 percent to 19.2 percent.
Between 2006 and 2008, the number of uninsured working-age adults in Massachusetts was reduced by nearly 70 percent. In contrast, the proportion of adults in the United States with health insurance declined from 2007 to 2008, according to U.S. Census data.
“Clearly, health care reform in Massachusetts is reaching those who have the highest uninsured rates,” said Dr. Cohen.
Significant Improvement in Coverage for Hispanics
The 14.2 percent increase in health care coverage observed in Hispanics was attributed to their lower rate of coverage before the law was enacted: 77.9 percent, compared to 88.2 percent of blacks, 90.5 percent of Asians and 93 percent of whites.
“There was more room to grow for Hispanics since their initial coverage rates were lower,” said Dr. Cohen. He also speculated that low-income young adult communities, many of whom may also be Hispanic, were targeted for outreach by the Massachusetts Health Connector, the state agency which connects people with insurance plans.
Co-author Elena Hawk, PhD, Director of the Health Survey Program of BHISRE, suggested a correlation between Hispanics and persons without a high school diploma and those earning less than $25,000 a year, two populations that also saw large increases in health care coverage.
Additionally, Hispanics who responded to the study survey in Spanish saw an increase in coverage of more than 18 percent, from 69.1 percent to 81.8 percent.
"We can speculate that the significant improvement among people who responded in Spanish may be more proof of how health care reform has worked," said Dr. Hawk.
Underserved Populations Continue to Lag Behind in Coverage
Despite the significant increases in health care coverage among underserved populations, they continue to have the lowest percentages of health insurance coverage: 89 percent of Hispanics, 88.6 percent of persons with less than a high school diploma and 89 percent of persons with annual household incomes under $25,000.
“The message of our study is, [health care] gaps are closing but they still exist, so we still have a way to go. Policy makers need to use these data to close the gaps even more,” said Dr. Cohen.
Reference:
- Tinsley L, Andrews B, Hawk H, Cohen B. Short-term effects of health-care coverage legislation—Massachusetts, 2008. Morbidity and Mortality Weekly Report 2010; 59(09); 262-267.
Juan Ramos - Juan Ramos is a health communication specialist based in Boston, Massachusetts, USA. He has worked in the non-profit sector for more than ...
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