A new report by the Urban Institute highlights some important milestones accomplished by the Massachusetts reform through the fall of 2007, before penalties for complying with the new law went into effect which then prompted a surge in enrollment.
The major findings show:
- Uninsurance among working-age adults was reduced by almost half among those surveyed, dropping from 13 percent in fall 2006 to 7 percent in fall 2007. Large declines were evident across income categories, for those earning above and below 300 percent of FPL.
- Access to care improved and the share of adults with high out-of-pocket costs and problems paying medical bills dropped, and use of preventive care services increased. Now, hundreds of thousands of people are able to address previously unmet medical needs in a much more affordable way.
- The public continues to be very supportive of the reform. The Urban Institute surveys in fall of 2006 and fall of 2007 show a rise in favorable opinion among working-age adults—from 68 percent to 71 percent—and those favorability ratings were similar for low-income and higher income respondents
In addition to these promising early indicators, the state has also released new data to supplement the Urban Institute’s findings, indicating, once again, that the state is reaching significant milestones.
- From April 2006 through December 2007, Massachusetts residents with health coverage grew by some 340,000 residents. Approximately one-third of these individuals joined commercial health insurance plans—the most significant increase of private, commercial insurance in Massachusetts in decades. According to the state, the Urban Institute’s results may understate the progress to date, as seniors and children (who were excluded from the survey) generally have far higher rates of insurance than working-age adults.
- The high level of coverage among adults is confirmed by state income tax filings for 2007: just 5 percent of some 3.2 million tax-filers reported being uninsured as of December 31, 2007. Three percent were deemed able to afford health insurance, but self-assessed a penalty for not having it. The remaining 2 percent were exempt from the requirement to have insurance, either because they could not afford to buy it or because of their religious beliefs.
- 98.6 percent of tax-payers properly completed this first-in-the-nation filing requirement in its very first year.
- In just six months following reform of the non-group market, enrollment in Massachusetts’ non-group market climbed by 50 percent. Before reform, a healthy 37-year-old— the median age for uninsured adults in Massachusetts—paid $335 in monthly premiums and had few market options. Post reform, that same 37-year-old has a broad range of options, including at least one plan for a little more than half the price, with twice the benefits.
- Health care reform in Massachusetts continues to maintain popularity. Surveys of likely voters conducted by the Harvard School of Public Health found high favorability ratings, which have increased over time: in September 2006, reform received a favorable rating of 3-to-1 (61 percent in favor versus 20 percent opposed), which rose by June 2007 to better than 4-to-1 (67 percent versus 16 percent).
- As a result of aggressive outreach, the costs of Commonwealth Care grew in tandem with enrollment, exceeding the original budget estimate of $472 million for FY 2008 by approximately $150 million. However, costs per enrollee actually came in under budget for FY 2008, at $352 per member per month, or 2 percent below the budget of $359 per member per month.
Jon Kingsdale, Executive Director of the Commonwealth Connector, has noted that “the costs of Commonwealth Care have grown solely in response to enrollment growth. From a budget perspective, the program is a victim of its own success in outreach and enrollment.” As noted above, while there has been significant enrollment in the Commonwealth Care program, employer-sponsored insurance and private, non-group insurance have experienced an increase as well. To date, the state has found no evidence of significant crowd-out.
