Residents Fall Through the Cracks Despite Mass. Health Care Reform

Massachusetts enacted a health care reform law in 2006 with the goals of reducing the number of state residents without health insurance, improving health care affordability, decreasing racial and ethnic disparities, and reducing the state’s reliance on safety-net hospitals.

The law became the model for the 2010 national reform law, the Patient Protection and Affordable Care Act (ACA), but that model may not work as well as expected, a new study has shown.

A new study has found that despite the plan, which was designed to strengthen employer-based insurance and provide no-cost or low-cost insurance to those unable to afford it, the uninsured in Massachusetts remain predominantly the working poor. The research, which was conducted by researchers at Harvard Medical School, was published online in the Journal of General Internal Medicine.

The intent of the 2006 law was to achieve universal coverage by requiring that employers with more than 10 employees offer insurance and that all state residents obtain insurance or pay a fine. The plan also provided free or low-cost, subsidized insurance to state residents with low incomes. But the Census Bureau just released a survey which found that 5.6% percent of the state’s population remained uninsured.

“Although many thought the Massachusetts health reform would eliminate or substantially reduce the need for a safety net by providing universal insurance that could be used with any provider, our study shows that under the current reform, patients continue to fall through the cracks of the insurance system,” the researchers, who were headed by Rachel Nardin, MD, wrote.

“Until the barriers to universal coverage that we identify here are addressed, safety-net hospitals will remain necessary in Massachusetts to provide care for those left uninsured who can be turned away from non-safety-net institutions.”

For the study, the researchers performed an in-person survey of a sample of patients visiting the emergency department of the state’s second largest safety net hospital between July 2009 and March 2010. They interviewed 431 patients age 18 to 64,

189 of whom were uninsured.

“The uninsured were largely employed (65.9%), but only a quarter (25.1%) of the employed uninsured had access to employer-sponsored insurance. The majority qualified for subsidized insurance (85.7% earned ≤300% of the federal poverty level), yet many reported being unable to find affordable insurance (32.7%). Over a third (35.2%) were uninsured because they had lost insurance due predominantly to job loss or policy cancellation,” the authors wrote.

“For nearly half of the uninsured (48.6%), the individual mandate had motivated them to try to find insurance, but they were unable to find insurance they could afford.”

SourceReasons Why Patients Remain Uninsured after Massachusetts’ Health Care Reform: A Survey of Patients at a Safety-Net Hospital [Journal of General Internal Medicine]