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Massachusetts Manditory Healthcare Law Cuts Number Of Uninsured In Half, But Can It Last?

Posted Jun 4th, 2008 by Patient Assistance Team

In 2006, a law was passed that greatly improved the availability of insurance coverage for Massachusetts residents. The law imposed steep fines on all but the smallest businesses for a failure to provide their employees and their dependants with health insurance. In accordance with the new law, residents of Massachusetts where required to list their insurance status on their 2007 tax return. The result of not having insurance for this past year resulted in the loss of a $219 exemption, but could result in a penalty of up to $912 in the following year.

But what about those still uninsured in this situation?

Instead of using the over 1 billion spent each year on healthcare for the uninsured, the law utilized that money to develop a healthcare system provided by the state. Any resident making under $29,000 is eligible for a subsidized health insurance plan that offers full coverage with no deductibles and dental as well. Instead of over paying after the fact and covering fewer residents, this plan now catches nearly all those who would have otherwise stayed uninsured.

With two years having passed since this law was enacted, a study performed by the Urban Institute and funded by Blue Cross Blue Shield Massachusetts, the Commonwealth Fund, and the Robert Wood Johnson Foundation, contacted 3,000 working Massachusetts residents ages 18-64. has provided a very well written breakdown of the results found by this study:

  • 7% of Massachusetts residents ages 18 to 64 were uninsured in the fall of 2007, compared with 13% in 2006;
  • The remaining uninsured tend to be healthy, low-income and male, and about one-third of them said they did not know that health insurance was mandatory;
  • Uninsured rates among adults in families with incomes less than 300% of the federal poverty level decreased from 24% to 13%;
  • Uninsured rates decreased from 5% to 3% among adults in families with incomes greater than 300% of the poverty level;
  • Seventy percent of insured residents with income less than 300% of the poverty level said they had received preventive care in the past year, compared with 65% in 2006;
  • 59% of them had seen a dentist in the previous year, compared with 49% in 2006; and
  • The number of uninsured people with incomes below 300% of the poverty level who deferred necessary care because of costs declined from 27% to 17% (New York Times, 6/3).

  • When looking at figures like those above and noting that the increase in Massachusetts residents with employer-sponsored coverage is up 3% from 2006 while the rest of the country has seen a decrease in the number of employers offering such benefits, it's hard to view this as anything but a success. Unfortunately, the issue lies in the budgeting and financing of such a law.

    The major changes in unemployment status in Massachusetts have been primarily attributed to those taking advantage of the state-sponsored healthcare plan. Enrollment was so high at this programs launch that this years allocated budget is set at $869 million dollars, more than $150 million than was originally expected. As Massachusetts has some of the countries highest medical costs, covering 355,000 out of the estimated 500,000 uninsured residents will continue to become less economical unless treatment patterns are directly addressed.

    The idea of imposing a far reaching containment bill was proposed by Senate President Therese Murray (D) in an attempt to swing this cycle. A Boston Globe editorial stated that "Hospitals will need to make sure that expensive procedures actually produce results, [and] [i]nsurers will need to devise payment systems that reward quality, not just quantity of care."

    Another method of reducing this cost to the state and individual would be to take advantage of free prescription assistance cards. Regardless of where the coverage is coming from, the individual is still responsible for the co-pays associated with their medication. These prescription assistance cards provide the individual with the highest possible discount available when filling their prescriptions.

    As progress continues on building this form of insurance structure into a more effective model, there are still close to 150,000 uninsured individuals in Massachusetts. Whether they choose not to enroll or simply can't afford even the low subsidized healthcare plan, many of them will find themselves in need of a visit with a physician or requiring a prescription to be filled. For resources on how to help those still uninsured, be sure to visit our patient assistance program database and view our directory of free clinics by state.

    You can read Sharon K. Long's complete study here, entitled "On The Road To Universal Coverage: Impacts Of Reform In Massachusetts At One Year"