Report Details State’s Healthcare Costs, Access, Affordability
BOSTON — The Massachusetts healthcare reform law of 2006 set in motion a number of important changes to the healthcare system, which have affected Bay State residents, businesses, healthcare providers, and others. Since 2006, the Massachusetts Health Reform Survey (MHRS) has been an important means of monitoring and understanding these impacts.
The most recent report, conducted in the fall of 2012, just after passage of the state’s healthcare cost-containment law, brings both good news and signs that warrant concern. As with previous versions of the MHRS, the just-released results of the 2012 survey provide promising evidence that the insurance provisions of the Affordable Care Act, which were modeled after the 2006 Massachusetts law, will improve coverage and access across the nation. However, the 2012 survey also shows that healthcare costs continue to be a burden for many individuals and families in Massachusetts.
Massachusetts continues to have the highest rate of insurance coverage for non-elderly adults of any state, 94.6{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}. This is a significant improvement over 2006, when 85.9{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of non-elderly adults had insurance, and much higher than the current national level of 79.7{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}. In addition, gaps in coverage have lessened: 88{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of adults in Massachusetts reported being covered for the entire year, much higher than the national level of just under 75{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}. The proportion of people in Massachusetts who are “persistently uninsured” has been cut by nearly three-quarters, falling from 9.3{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2006 to 2.7{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2012.
The survey indicates that respondents are generally satisfied with their healthcare coverage, with about two-thirds rating their coverage as very good or excellent on the range of services, choice of providers, and quality of care, up more than 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} from pre-reform.
Access to care is also very good; nearly nine in 10 respondents reported having a place, other than the emergency room, to go to when they are sick or need advice about their health. This is higher than national estimates for this measure, which top off at around 80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}. Use of physician services is also higher in Massachusetts than it is nationally. Eight in 10 non-elderly adults reported having visited a doctor in the past 12 months, compared with 63{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} nationally.
In terms of the ability to get an appointment in a timely fashion, 78{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} reported they could always or usually get an appointment with a general doctor as soon as they thought they needed it, and nearly 70{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} always or usually could get an appointment with a specialist as soon as they thought they needed it.
On the issue of affordability, the MHRS indicates that many individuals are feeling costs acutely. More than 40{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of non-elderly adults reported that healthcare costs had been a problem for them and their families over the previous year, including 37.1{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} who experienced problems with healthcare spending and 16.4{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} who reported going without needed care because of cost.
Having health-insurance coverage did not eliminate cost concerns, as 38.7{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of those who were insured for the full year reported that they had problems with healthcare spending. These problems were most acute for people with lower incomes, particularly those with incomes between 138{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} and 400{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the federal poverty level. Also, roughly half of those with public coverage reported problems with healthcare costs.
Although more people had health insurance in 2012 than in 2006, the financial burden of needing and using healthcare services was almost identical in 2012 to pre-reform levels. More 22{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} reported out-of-pocket healthcare spending of at least 5{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of gross family income, and nearly one in 10 (8.4{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}) had out-of-pocket expenses of at least 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of income.
One reason the burden of healthcare costs has not diminished with rising levels of coverage is the continuing trend among employers to shift costs onto workers and their families. For example, employers may purchase insurance products that have lower premiums but higher out-of-pocket obligations for the insured workers, such as high-deductible plans. Enrollment in high-deductible plans has risen significantly in the state since 2006.
One-third (33.5{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}) of respondents reported not getting care that they needed in the past 12 months, with nearly half of those — or 16.4{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all adults — citing the cost of care as posing a barrier to obtaining needed care. This is slightly lower than the national experience, where roughly 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of people reported going without needed doctor care due to cost.
Requiring individuals to shoulder a greater portion of the cost of their care may slow the overall growth in healthcare spending, but in some cases, it may be at the expense of people’s health and well-being, the report notes. Also, there is
a limit to how much of the costs can be shifted, as many consumers do not have the financial capacity to continue to shoulder more and more of the cost burden. This is
why the cost-containment and affordability initiatives now underway in Massachusetts — which look to solutions beyond shifting of costs to consumers — may be of critical importance to the long-term sustainability of the Commonwealth’s healthcare infrastructure.
a limit to how much of the costs can be shifted, as many consumers do not have the financial capacity to continue to shoulder more and more of the cost burden. This is
why the cost-containment and affordability initiatives now underway in Massachusetts — which look to solutions beyond shifting of costs to consumers — may be of critical importance to the long-term sustainability of the Commonwealth’s healthcare infrastructure.