Health Reform in Massachusetts as of Fall 2010: Getting Ready for the Affordable Care Act & Addressing Affordability

iHEALTH REFORM IN MASSACHUSETTSAS OF FALL 2010:GETTING READY FOR THE AFFORDABLE CARE ACT & ADDRESSING AFFORDABILITY Sharon K. Long, Karen Stockley, and Heather DahlenJANUARY 2012 iiEXECUTIVE SUMMARYIn April 2006, Massachusetts passed a comprehensive health care reform bill entitled An Act Providing Access To Affordable, Quality, Accountable Health Care (Chapter 58 of the Acts of 2006), that sought to move the state to near universal coverage. In order to track the impacts of Chapter 58, the Blue Cross Blue Shield of Massachusetts Foundation began funding an annual survey of nonelderly adults in the Commonwealth in fall 2006, just prior to the implementation of key elements of the law. That survey, called the Massachusetts Health Reform Survey (MHRS), has been fielded in the fall of most subsequent years.1 With the 2010 passage of the federal Patient Protection and Affordable Care Act (ACA), the focus of the MHRS was expanded to include the collection of additional data to help track the impacts of the ACA. Although the ACA draws heavily on the Commonwealth’s 2006 health reform initiative, including an expansion of publicly subsidized coverage, the creation of health insurance exchanges to facilitate access to cover-age, and the implementation of an individual mandate, there are key differences between the two laws.2 Most notably, under the ACA, Massa-chusetts will need to reassess its affordability standards, subsidy levels, and benefit packages, which do not currently match ACA requirements. 1 The first three years of the survey (2006, 2007, and 2008) were funded jointly with the Commonwealth Fund and the Robert Wood Johnson Foundation.2 A summary of the implications of the ACA for Massachusetts is provided in Seifert, R.W. and Cohen, A.P. Re-form-ing Reform: What the Patient Protection and Affordable Care Act Means for Massachusetts. Boston, MA: Blue Cross Blue Shield Foundation, 2011. Available at bluecrossfoundation.org/~/media/Files/Publications/Policypercent20Publications/062110NHRReportFINAL.pdf. iiiThis report provides an update on trends in the state since fall 2006, just prior to the implementation of Chapter 58, along with a more in-depth overview of the circumstances of working-age adults in the state as of fall 2010. The latter, which is prior to the implementation of key components of the ACA, provides a baseline for understanding changes under the ACA in Massachusetts. The outcomes examined include health insur-ance coverage, health care access and use, health care costs and affordability, and financial problems associated with health care costs, as well attitudes toward health reform in the state. We present estimates for working-age adults overall and, for some analyses, for higher- and lower-income working-age adults. Higher-income adults are defined as those with family income at or above 300 percent of the federal poverty level (FPL) and lower-income adults are those with family income less than 300 percent of the FPL. In 2010, 300 percent of the FPL was $54,930 for a family of three.3KEY FINDINGS: TRENDS FROM FALL 2006 TO FALL 2010Health Insurance Coverage Health insurance coverage continues at high levels in Massachusetts, with coverage among nonelderly adults at 94.2 percent in fall 2010. This is well above the 86.6 percent in fall 2006, and unchanged from the coverage rate in fall 2009. In contrast, insurance coverage for non-elderly adults in the nation as a whole is much lower (78.5 percent in 2010) and has declined since 2006 (80.2 percent). A key factor in the continued high levels of insurance coverage in Massachusetts is the sus-tained role of employer-sponsored insurance (ESI) coverage. ESI coverage in fall 2010, at 68.0 percent, was higher than in fall 2006 (64.4 percent) and higher than in fall 2009 (67.1 per-cent). There is no evidence of public coverage “crowding out” employer-sponsored coverage under health reform in Massachusetts. 3 https://www.cms.gov/medicaideligibility/downloads/POV10Combo.pdf. ivHealth Care Access and Use There were sustained gains in access to and use of health care between fall 2006 and fall 2010 for nonelderly adults in Massachusetts. For example, nonelderly adults were more likely to have a place they usually go to when they are sick or need advice about their health (up 4.7 percent-age points), more likely to have had a preventive care visit (up 5.9 percentage points), more likely to have had multiple doctor visits (up 5.0 percentage points), more likely to have had a specialist visit (up 3.7 percentage points), and more likely to have had a dental care visit (up 5.0 percentage points). Between fall 2006 and fall 2010, there were reductions in emergency department use overall (down 3.8 percentage points), frequent emergency department visits (down 1.9 percentage points), and the use of the emergency department for non-emergency conditions (down 3.8 percentage points). This is the first reduction in emergency department use am