FOCUS on Health Reform

CONSUMERS' EXPERIENCE IN MASSACHUSETTS:
LESSONS FOR NATIONAL HEALTH REFORM

SEPTEMBER 2009 - KAISER FAMILY FOUNDATION

Carol Pryor and Andrew Cohen

The Access Project

In April 2006, Massachusetts enacted a comprehensive health care reform law. Its goal was to move the state towards universal health insurance coverage through a series of reform measures that included an individual mandate for insurance coverage, an expansion of public coverage programs, and the creation of a Connector that sets policies and facilitates access to insurance for state residents. As a possible model for national reform, the Massachusetts reform effort can provide useful lessons for how to make a restructured health care system work for consumers.

In partnership with the Kaiser Family Foundation, researchers from The Access Project conducted in-depth interviews with fifteen Massachusetts consumers, as well as with several key participants in the health reform effort, to better understand the impact of the Massachusetts health system reform on consumers. The study focused particularly on peoplefs ability to afford and access needed care. The following key findings emerged from the research:

Public programs have increased access and provided affordable insurance coverage options for low-income individuals. The expansion of the Massachusetts Medicaid program and the creation of Commonwealth Care, a program that subsidizes coverage for adults under 300% FPL, have reduced the uninsured rate for low- income residents and allowed many people to gain access to affordable coverage and obtain care.

However, some people are still struggling to afford coverage and care. Low-income workers with access to employer-sponsored coverage, as well as moderate-income individuals without access to employer- sponsored coverage, are both ineligible for state subsidized insurance. Coverage options for these individuals often remain unaffordable.

People with chronic conditions still face greater cost barriers to care. While nominal co-payments may be affordable for people who need care only occasionally, lower-income people who need ongoing care may quickly find the out-of-pocket costs unaffordable.

System complexities can lead to gaps in coverage. With the multitude of programs offered by Massachusetts, all with varying eligibility and programmatic rules, residents with fluctuating incomes and employment statuses can fall through the cracks. These individuals, and others who are ineligible for existing programs, still rely on a health safety net program to obtain services and aid in paying for needed care.

Fear of incurring unaffordable medical bills and medical debt remains a barrier to accessing needed health care. Unaffordable medical bills and pre-existing medical debt still create anxiety and cause many to delay or forgo needed services.