State Report: Massachusetts

December 1, 2008

Commonwealth Fund State Performance Ranking 2007: 8

Two new studies by the Urban Institute examine how the Massachusetts health insurance law has affected uninsured residents in the state.

While the state has faced a number of challenges implementing the plan, it has been extremely successful in expanding coverage. The state's share of uninsured working-age adults (those between the ages 18 to 64) fell from 13% to 7% between Fall 2006 and Fall 2007, according to Urban Institute researchers. What's more, reform has led to better access to healthcare and reductions in the financial burden of obtaining healthcare.

The new studies, which were funded by the Robert Wood Johnson Foundation, the Blue Cross and Blue Shield of Massachusetts Foundation and the Commonwealth Fund, explore who has gained the most under the reform and whether people in the state are adequately insured.

The second study examines whether enforcing mandatory health insurance would force people-particularly those with low incomes-into plans that provide little financial protection. The study, which gauged underinsurance according to two different definitions, found the share of insured adults who were underinsured dropped by about two percentage points under both definitions between Fall 2006 and Fall 2007. Lower-income adults and insured adults with health problems-the two groups most vulnerable to the risks of uninsurance-saw the greatest reduction in underinsurance.

While healthcare reform has led to a reduction in underinsurance, the Massachusetts Commonwealth Health Insurance Connector Authority's board took additional steps to address the problem. The board voted unanimously to proceed with new minimum standards for health coverage. With some exceptions, the standards, which take effect Jan. 1, 2009, mandate that state-approved plans offer benefits for prescription drugs, preventive and primary care, hospitalization, mental health and substance use services, and emergency services. Those who do not have insurance, or cannot prove that their coverage meets these standards, will face an annual tax penalty.

MHE Sources: Centers for Medicare & Medicaid Services; Urban Institute; Kaiser Family Foundation; U.S. Census Bureau; The Commonwealth Fund.