Although Massachusetts has successfully achieved the lowest rate of uninsurance in the nation, thousands of individuals and families still live with the potential adverse health effects and financial impacts of not having health insurance. In 2015, an estimated 200,000 individuals in Massachusetts did not have health insurance coverage. This report, prepared by a team led by Michael Chin and Deborah Gurewich of the University of Massachusetts Medical School, and Audrey Gasteier of the Commonwealth Health Insurance Connector Authority, summarizes the findings of a qualitative study in which 33 uninsured individuals were interviewed about their experience living without health insurance. Findings from this study can help to better understand the remaining barriers to coverage and inform future strategies aimed at reducing the number of uninsured in the state. The report concludes with the personal stories of five individuals who have experienced first-hand the challenges and consequences of being uninsured.

On November 5, 2015, the Blue Cross Blue Shield of Massachusetts Foundation hosted a symposium for non-governmental users of the Massachusetts All-Payer Claims Database (MA APCD) administered by the Center for Health Information and Analysis (CHIA). This symposium updated users on the current state of the MA APCD, highlighted research that has been made possible as a result of the MA APCD, provided an opportunity to share best practices, and encouraged discussion about future opportunities to enhance the MA APCD in an effort to continuously support data-driven research and policy development in the Massachusetts health care sector. As a follow-up to the event, this summary, prepared by Amy Willis, Business Writing and Editing, highlights key takeaways and recommendations generated from the discussion.

This report summarizes the results of a July 2015 poll conducted by a team led by Robert J. Blendon, Sc.D. of Harvard T.H. Chan School of Public Health. The poll was conducted to assess the perspectives of Massachusetts adults age 65 and over on the issues of affordability, access, and satisfaction with their health care coverage. The results show that while a large majority of seniors are satisfied with the health care they receive as patients, over one-quarter of older adults are dissatisfied with health care costs, and more than one in five report that it has gotten harder to pay for health care services or prescriptions drugs over the past five years. Both concerns are higher among seniors who report poor health or a disability.

There are almost one million seniors in Massachusetts and while most enjoy broad coverage and protection against the cost of many health care services through Medicare, they may also face significant gaps, finding themselves responsible for substantial deductibles, coinsurance and copayments. This report, prepared by Nancy Turnbull and Katherine Heflin of Harvard T.H. Chan School of Public Health, reviews the many private and public coverage options available to seniors to supplement Medicare coverage. Using publicly available data from state and federal sources, this report examines recent trends and issues in private health insurance coverage and public programs to support payment of out-of-pocket costs for Medicare beneficiaries in Massachusetts.

In March 2010, President Obama signed The Patient Protection and Affordable Care Act (ACA), which included significant changes impacting health insurance coverage across the United States. Although many elements of the ACA were based on Massachusetts’ health insurance reform, there were still many decisions and activities that Massachusetts needed to address in order to comply with the new federal Medicaid and health insurance marketplace requirements, most of which were required to be effective as of January 2014. This issue brief, prepared by Health Management Associates, focuses on the changes in eligibility, benefits, cost sharing (including premiums), and health plan options available to individuals receiving subsidized insurance in the Commonwealth before and after implementation of the ACA.

This report, prepared by Sharon Long and Thomas Dimmock of the Urban Institute, further analyzes the 2013 Massachusetts Health Reform Survey (MHRS) by comparing the experience of adults with public coverage to adults with employer-sponsored insurance (ESI) coverage across a number of access and affordability measures. Findings from the analysis show problems with access to care were more prevalent for adults with public coverage than for those with ESI. These disparities persist even after controlling for variations in health care needs and socioeconomic status between the two groups. The persistence of gaps in access to care for adults with public coverage raises concerns about systemic barriers to care within the Massachusetts health care system.

In conjunction with the full report, the authors developed a one-page summary highlighting key findings from the analysis.

In this issue brief, Patricia Boozang, Deborah Bachrach and Hailey Davis of Manatt Health Solutions, review the coverage and delivery system challenges that Massachusetts could address through sections 1331 (the Basic Health Program) and 1332 (Waivers for State Innovation) of the Affordable Care Act (ACA). This brief describes the federal requirements related to these sections of the law and identifies the options the Commonwealth could pursue to advance its coverage, fiscal, and policy priorities, including: improving affordability and ease of access to coverage for low-income residents, continuing the expansion of insurance coverage to hard-to-reach populations, and evaluating and revisiting policy decisions like the individual mandate to determine the best fit for Massachusetts.

In this report, Carol Gyurina, Jennifer Rosinkski and Robert Seifert of the University of Massachusetts Medical School, analyze several factors that help explain why health care affordability continues to be a challenge in Massachusetts, even after achieving near universal health insurance coverage. Beginning with an analysis of data largely collected through the Massachusetts Health Reform Survey (MHRS), the report provides an overview of the factors influencing health care affordability and summarizes the financial and access to care consequences for consumers struggling with health care costs. The remainder of the report is devoted to sharing the personal stories of four individuals in Massachusetts who have experienced first-hand the challenges and consequences of unmanageable health care costs.

Unless Congress acts, federal funding for the Children’s Health Insurance Program (CHIP) will run out soon after September 2015. On March 26, the U.S. House of Representatives passed legislation that would fund CHIP for two more years. The Senate is expected to take up the bill in mid-April. This report, written by Robert Seifert of the Center for Health Law and Economics at the University of Massachusetts Medical School, examines the serious implications for Massachusetts if federal funding for CHIP is not extended.

This brief and set of detailed tables, prepared by Sharon Long and Thomas Dimmock from the Urban Institute, provide estimates of the number and rate of uninsurance in Massachusetts by various geographic units ranging from congressional districts to counties to neighborhoods. The resource is based on the 2009 to 2013 five-year file of the American Community Survey (ACS), which included a sample of 140,001 people in Massachusetts.

The brief summarizes high level findings from the data and definitions for the geographic units of analysis. The appendices provide data on the estimates of the number and rate of uninsurance by the following categories: all persons, males, females, children (ages 0-17), non-elderly adults (ages 18-64), and elderly (ages 65+). Each appendix provides these results for 10 different geographic units ranging from congressional district to county to census tract.

This report, written by Robert Seifert, Michael Grenier, and Jean Sullivan of the Center for Health Law and Economics at the University of Massachusetts Medical School, summarizes the history of the MassHealth 1115 waiver and examines the key components of the new waiver extension, organized around five themes: coverage, services, delivery redesign, support for the safety net, and looking to the future. This most recent waiver extension, which the Centers for Medicare and Medicaid Services (CMS) granted in October 2014, is for five years (until June 30, 2019). However, a major component—the Safety Net Care Pool—was extended for only three years (until June 30, 2017), with the terms for the remaining two years subject to further negotiation.

In conjunction with the full report, the authors developed an abbreviated summary of the MassHealth 1115 waiver, which provides an overview of the new provisions approved under the waiver renewal.

Affordability Still a Challenge

This collection of reports and chart packs is the latest in a series by the Urban Institute analyzing the results of the Massachusetts Health Reform Survey (MHRS), which has been conducted annually since 2006. This round of the survey, which was fielded in the fall of 2013, was jointly funded by the Blue Cross Blue Shield of Massachusetts Foundation and the Robert Wood Johnson Foundation. These results provide a means for continuing to monitor the efforts in Massachusetts to sustain the coverage gains achieved through the 2006 health reform law. In addition, the 2013 MHRS provides a new baseline for assessing the impacts of the state's efforts to improve the affordability of care and reduce health care spending because it coincides with the first full year under the provisions of Chapter 224 of 2012 and precedes the roll-out of major changes under the Affordable Care Act (ACA) that began in January 2014. Findings show that while Massachusetts has maintained high levels of health insurance coverage and health care use, the cost of care continues to remain a significant burden, especially for low- and middle-income individuals and families.

This year’s results are presented in a variety of publications including:

• A five-page summary report;
• A full narrative report;
• A chart pack;
• A methodology report and a copy of the survey instrument.

In an effort to expand opportunities for researchers to understand the experience of Massachusetts consumers with accessing and affording health care, the Blue Cross Blue Shield of Massachusetts Foundation and the Robert Wood Johnson Foundation will be making available a public use file of the 2013 surveys as they did with the previous years' surveys (i.e., 2006 - 2010, 2012). The 2012 public use files will be available through the Inter-University Consortium for Political and Social Research.

This report includes findings from the evaluation of the 2011-2013 Connecting Consumers with Care grant program. The goals of the evaluation were to 1) assess progress made across grantee sites on select outreach and enrollment measures; 2) describe the practices grantees adopted to reach out to and enroll consumers in insurance, advance consumer self-sufficiency, and collaborate with other agencies; and 3) characterize the barriers experienced by grantees. 

For a one-page infographic of the 2011-2013 evaluation report, click here.

This report demonstrates how a general-operating-funds approach to grantmaking can forge stronger and more effective partnerships between the philanthropy and consumer health advocacy communities. It includes examples of the positive impact this approach has had on access to health care in Massachusetts and highlights some of the activities and achievements of 2011-2013 Strengthening the Voice for Access grantee organizations.

This chartpack summarizes the impact of the 2006 Massachusetts health reform law. The chartpack gathers data from surveys and analyses by state government agencies including the Massachusetts Center for Health Information and Analysis, the Massachusetts Department of Revenue, and the Massachusetts Health Insurance Connector Authority, as well as highlights from health reform tracking surveys conducted by the Urban Institute. This document has been designed to support the use of the charts in slide presentations, and we encourage readers to use them. We plan to update this chartpack regularly.