The State of Health of Massachusetts

by Namita Agarwal

Before we can effectively engage in a discussion regarding health care law in Massachusetts, it is important we understand generally where we were, where we are, and where we are going in regards to health care.  On April 12, 2006, Massachusetts enacted legislation, often referred to as Chapter 58 which would provide almost universal health care coverage for state residents.  The goal of this reform was / is to improve the health of Massachusetts residents by providing greater access to health care and preventive services, and to control medical care costs with early diagnosis and treatment of illness.  This law required the following: (1) adults to purchase health insurance by July 1, 2007 or face a financial penalty; (2) employers with 11 or more employees to offer health insurance; (3) Commonwealth Care Program created as a low-cost insurance alternative for low-income families and individuals; and (4) dental coverage for MassHealth adults and certain income-eligible members of Commonwealth Care.¹

By the numbers, as of March 2009, there were 406,000 more Massachusetts residents with health insurance coverage than before the health care reform was passed.²  This is an almost 53% decrease in the number of uninsured individuals in the state.  As reflected in this number, the percentage of uninsured adults has also dropped quite significantly from 9% in 2005 before the legislation to about 3% in 2008.³  It is important to keep in mind that simply obtaining health insurance may make it more likely state residents will access health care; it by no means guarantees such access.

Other factors such as access to Personal Health Care Providers (PHCP) and the socioeconomic / geographic characteristics of citizens are important to consider when determining the extent of the “access” the Health Care Reform intends to affect.  For instance, although only 3% of adults are uninsured, 11% report that they do not have a PHCP.⁴  Further, whereas fewer White residents report not having a PHCP, a higher percentage of Black and Hispanic residents continue to report not having access to PHCPs.  Also in terms of locations, Boston, which has the highest rate of physicians per 100,000 population, has a higher percentage of residents without a PHCP at 18% than even the percentage of the entire state at 11%.⁵  Interestingly, the city of Fall River, with a relatively low concentration of physicians is comparable to the state of Massachusetts with regards to those without a PHCP.⁶  Thus, it has been argued, in order to tackle the continued discrepancies in providing different types of health care access, addressing geographical differences such as those mentioned above, is important.

Overall, there have been a number of improvements in health care access and utilization in Massachusetts.  From a strictly numbers perspective, large numbers of young males (aged 18-34) and Hispanics obtained health insurance, as did residents of seven large Massachusetts cities with significant minority populations.⁷  Additionally, dental care for Massachusetts Medicaid program and for some Commonwealth Care members was made more readily available.  Finally, preventive care services for individuals below Medicare age, flu vaccinations, and various screenings (most notably colorectal), increased significantly.⁸

Given the short term for which data is available, it is difficult to extrapolate and predict the long-term impact of Massachusetts’ health care reform, let alone its success.  With regards to PHCPs, it has been argued that the reform could actually lead to “crowd out,” where although there is greater access to health insurance coverage, there is an insufficient number of health care providers.⁹  Further, even with improvements in racial disparities in health care access, important differences remain.  Thus, as citizens and informed members of the state, it is crucial to remain aware of the long-term effects of the Health Care Reform law in Massachusetts to insure far-reaching effects which are inclusive of all ages, communities, and populations in the state.

Namita Agarwal is AyerHoffman’s Health Law & Policy Contributor.  Ms. Agarwal is currently a J.D. candidate at Northeastern University School of Law where she concentrates her studies on domestic and international health care, welfare, and immigration law.