1. Access and Affordability: An Update on Health Reform in Massachusetts as of Fall 2008 Sharon K. Long Urban Institute August 10, 2009 Alliance for Health Reform Briefing

2. THE URBAN INSTITUTE 2 Primary Goals of Health Reform Ensure access to good health coverage for as much of the population as possible Cover the uninsured Bend the health care cost curve

3. THE URBAN INSTITUTE 3 Massachusetts as of Fall 2008 Ensure access to good health coverage for as much of the population as possible – Significant improvements in access to carefor both lower-income and higher-income adults Cover the uninsured – Near universal health insurance coverage Bend the health care cost curve – Round II of health reform

4. THE URBAN INSTITUTE 4 Data and Methods Data: Massachusetts Health Reform Survey – Fielded in Fall 2006, Fall 2007 & Fall 2008 – Telephone interviews with samples of adults 18 to 64 – Sample sizes 3000+ in each year Methods: Estimate impact of health reform as change over time from Fall 2006

5. THE URBAN INSTITUTE 5 Adults are more likely to have health insurance coverage under health reform Health insurance coverage * (**) (***) Regression-adjusted estimate of difference from Fall 2006 significant at.10 (.05) (.01) level, two-tailed test.

6. THE URBAN INSTITUTE 6 Adults are more likely to have insurance for the full year under health reform Health insurance coverage * (**) (***) Regression-adjusted estimate of difference from Fall 2006 significant at.10 (.05) (.01) level, two-tailed test.

7. THE URBAN INSTITUTE 7 Adults are more likely to have a regular health care provider and to have had health care visits over the prior year Health care access and use * (**) (***) Regression-adjusted estimate of difference from Fall 2006 significant at.10 (.05) (.01) level, two-tailed test.

8. THE URBAN INSTITUTE 8 Some of t he reductions in unmet need from Fall 2007 had disappeared by Fall 2008 as demand for care increased Unmet need for care for any reason * (**) (***) Regression-adjusted estimate of difference from Fall 2006 significant at.10 (.05) (.01) level, two-tailed test.

9. THE URBAN INSTITUTE 9 About 1 in 5 adults reported difficulties obtaining care because providers were not accepting new patients or not accepting their insurance type Difficulties obtaining care in Fall 2008

10. THE URBAN INSTITUTE 10 Affordability of care for adults is still below that of Fall 2006; however, have lost some of the gains from Fall 2007 Affordability of health care * (**) (***) Regression-adjusted estimate of difference from Fall 2006 significant at.10 (.05) (.01) level, two-tailed test.

11. THE URBAN INSTITUTE 11 Adults in Massachusetts continued to support health reform in Fall 2008 Support for health reform

12. THE URBAN INSTITUTE 12 Summary of Findings as of Fall 2008 Continued gains in insurance coverage – Evidence of sustained coverage – No evidence of ESI crowd-out Continued improvements in access to and use of health care – Significant gains between Fall 2007 and Fall 2008 – Evidence of increased barriers to care as demand increased Improvements in affordability of care – Continued gains in affordability of care through Fall 2008 – However, some of the early gains have eroded with increasing health care costs Support for reform remains strong in the state