Massachusetts Health Reform: Good for women? A model for the U.S.? Tracey Hyams, JD, MPH Director, Women’s Health Policy and Advocacy Program Connors Center for Women’s Health and Gender Biology Brigham and Women’s Hospital, Boston Academy Health Annual Research Meeting July 27, 2009

Outline of Massachusetts health reform Impact of Massachusetts reform, especially for women Compare Massachusetts with efforts in Washington Goals for today:

Elements of Health Care Reform in Massachusetts Universal Coverage (2006) Expanded Medicaid Individual mandate Employer mandate Established Commonwealth Connector → Commonwealth Care (sliding subsidies for private coverage <300% FPL) → Commonwealth Choice (>300% FPL) → Benefits → Affordability

Elements of Health Care Reform in Massachusetts Costs, Quality, Delivery (2008) Established Mass. Health Care Quality and Cost Council FFS  P4P  Global payments Expands primary care Statewide health IT Medicaid Medical home demonstration

What’s Working in Massachusetts Preventive and primary care Emergency services Hospitalization Ambulatory services Prescription drugs Mental Health Contraceptives Pap smears Infertility treatment Mammography Maternity care Hormone replacement therapy Near-universal coverage 97.4 percent insured Most uninsured “young invincibles” Improved access overall  premiums for individuals and small groups High public support (74 percent) Employer support Robust benefit package, including

Challenges in Massachusetts High cost / financing Rising enrollment → rising costs → new cuts Affordability Increasing premiums, deductibles, co-pays Medical debt Racial, ethnic, and (likely) gender disparities Access to primary care Geographic, racial, ethnic disparities 24% subsidized coverage vs. 7% privately insured report challenges Continued reliance on emergency room (continued…)

Challenges in Massachusetts (continued) Gaps in coverage → inconsistent access Erosion of the safety net $150 million cut from largest “safety net” hospitals Women remain vulnerable: Age 45 – 64 are increasingly underinsured Are 3.5 times more likely to forego services

Meet Louise… Age 26, earns $35,000/year Overall good health Suffers from anxiety; began seeing a psychotherapist and taking Effexor Received HPV vaccinations Birth control failed, had an abortion Plan (with Rx)Total Annual Cost* Young Adult$6,713 Bronze$4,844 Silver$4,554 *For health plans with prescription coverage. Source: Sered, Susan et al. “Women and Health Care Reform in Massachusetts.” Policy Brief, Spring Center for Women’s Health and Human Rights, Suffolk University. Accessed at  Louise’s total out of pocket health costs for premiums, deductibles, co-pays:

Baseline Conditions in Massachusetts Low rate of uninsured (10 – 12%) Free Care Pool Robust benefit mandates, including reproductive health Non-profit insurers Trust among stakeholders Health care as economic driver Public Support Employer buy-in Legislative and executive approval (but no CBO)

Lessons from Massachusetts for Women’s Health Policy Consolidation, regulation of the individual and small group markets is effective Coverage ≠ access Affordability Continuity of coverage Workforce shortages Women, poor, and racial/ethnic minorities remain vulnerable

Contact Tracey Hyams, JD, MPH Director, Women’s Health Policy and Advocacy Connors Center for Women’s Health and Gender Biology Brigham and Women’s Hospital 75 Francis Street, OBC3-34A Boston, MA – 525 – Thank you!