access and affordability: an update on health reform in massachusetts as of fall 2008 sharon k. long...
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![Page 1: Access and Affordability: An Update on Health Reform in Massachusetts as of Fall 2008 Sharon K. Long Urban Institute August 10, 2009 Alliance for Health](https://reader035.vdocuments.mx/reader035/viewer/2022070305/5514cd90550346935c8b4c6f/html5/thumbnails/1.jpg)
Access and Affordability:An Update on Health Reform in Massachusetts as of Fall 2008
Sharon K. Long
Urban Institute
August 10, 2009
Alliance for Health Reform Briefing
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THE URBAN INSTITUTE 2
Primary Goals of Health Reform
• Ensure access to good health coverage for as much of the population as possible
• Cover the uninsured
• Bend the health care cost curve
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THE URBAN INSTITUTE 3
Massachusetts as of Fall 2008
• Ensure access to good health coverage for as much of the population as possible– Significant improvements in access to care—for both
lower-income and higher-income adults
• Cover the uninsured– Near universal health insurance coverage
• Bend the health care cost curve– “Round II” of health reform
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THE URBAN INSTITUTE 4
Data and Methods
• Data: Massachusetts Health Reform Survey
– Fielded in Fall 2006, Fall 2007 & Fall 2008
– Telephone interviews with samples of adults 18 to 64
– Sample sizes 3000+ in each year
• Methods: Estimate impact of health reform as change over time from Fall 2006
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THE URBAN INSTITUTE 5
Adults are more likely to have health insurance coverage under health reform
87%
93% ***
96%***
76%
87%***
92%***
95%97%***
99%***
0%
20%
40%
60%
80%
100%
All adults Lower-income adults Higher-income adults
Fall 2006
Fall 2007
Fall 2008
Health insurance coverage
* (**) (***) Regression-adjusted estimate of difference from Fall 2006 significant at .10 (.05) (.01) level, two-tailed test.
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THE URBAN INSTITUTE 6
Adults are more likely to have insurance for the full year under health reform
81%
86%***
90%***
65%
76%***
82%***
93% 93%96%
0%
20%
40%
60%
80%
100%
All adults Lower-income adults Higher-income adults
Fall 2006
Fall 2007
Fall 2008
Health insurance coverage
* (**) (***) Regression-adjusted estimate of difference from Fall 2006 significant at .10 (.05) (.01) level, two-tailed test.
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THE URBAN INSTITUTE 7
Adults are more likely to have a regular health care provider and to have had health care visits over the prior year
86%89%
*
92%***
80% 82%
85%***
66%64%
69%** 68%
72%**
76%***
0%
20%
40%
60%
80%
100%
Usual source of care Any doctor visit Multiple doctor visits Dental visit
Fall 2006
Fall 2007
Fall 2008
Health care access and use
* (**) (***) Regression-adjusted estimate of difference from Fall 2006 significant at .10 (.05) (.01) level, two-tailed test.
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THE URBAN INSTITUTE 8
Some of the reductions in unmet need from Fall 2007 had disappeared by Fall 2008 as demand for care increased
25%
21%**
22%
8%6%*
6%*
7%4%***
7%9%
6%***
8%
0%
10%
20%
30%
40%
Any unmet need forhealth care
Doctor care Specialist care Medical tests,treatment or follow-up
care
Fall 2006
Fall 2007
Fall 2008
Unmet need for care for any reason
* (**) (***) Regression-adjusted estimate of difference from Fall 2006 significant at .10 (.05) (.01) level, two-tailed test.
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THE URBAN INSTITUTE 9
About 1 in 5 adults reported difficulties obtaining care because providers were not accepting new patients or not accepting their insurance type
0%
10%
20%
30%
40%
Not accepting new patients Not accepting insurancetype
Not accepting patients foreither reason
Difficulties obtaining care in Fall 2008
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THE URBAN INSTITUTE 10
Affordability of care for adults is still below that of Fall 2006; however, have lost some of the gains from Fall 2007
9%
5%***
7%
20%
17%**
18%
21%
18%*
20%
17%
11%***
11%***
0%
10%
20%
30%
40%
OOP => 10% of familyincome
Problems paying medicalbills
Medical debt Unmet need b/c cost
Fall 2006
Fall 2007
Fall 2008
Affordability of health care
* (**) (***) Regression-adjusted estimate of difference from Fall 2006 significant at .10 (.05) (.01) level, two-tailed test.
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THE URBAN INSTITUTE 11
Adults in Massachusetts continued to support health reform in Fall 2008
68%71% 71%
0%
20%
40%
60%
80%
100%
Fall 2006
Fall 2007
Fall 2008
Support for health reform
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THE URBAN INSTITUTE 12
Summary of Findings as of Fall 2008
• Continued gains in insurance coverage– Evidence of sustained coverage
– No evidence of ESI crowd-out
• Continued improvements in access to and use of health care– Significant gains between Fall 2007 and Fall 2008
– Evidence of increased barriers to care as demand increased
• Improvements in affordability of care– Continued gains in affordability of care through Fall 2008
– However, some of the early gains have eroded with increasing health care costs
• Support for reform remains strong in the state