The On-Again, Off-Again Insured

Robert Seifert, Principal Associate, Center for Health Law and Economics, Umass Medical School, finds that the poor, the underemployed and the under-educated in Massachusetts are more likely to have intermittent health insurance:

The Division of Health Care Finance and Policy last month released detailed tables from its 2009 Massachusetts Health Insurance Survey, and the news was very encouraging. The survey estimates that 2.7 percent of Massachusetts residents were uninsured when surveyed, statistically unchanged from 2008. This is a remarkable statistic in light of the economic downturn in Massachusetts during 2009.

Twice as many people as were uninsured when surveyed were uninsured during some part of the year, however, and this is worthy of our attention. About 5.5 percent of Massachusetts residents (350,000 people) reported having been without insurance some time in the 12 months prior to the survey. This includes 7.7 percent of adults under age 65, or about 300,000. From the Division’s tables, it appears that someone is more likely to have had a spell of being uninsured if one:

--Is a non-citizen
--Has been in the state less than 5 years
--Has a family income less than 3 times the federal poverty level (about $55,000 for a family of three)
--Has less than a college education
--Is in a family with no full-time workers

In short, some of the same characteristics that are generally understood to be risk factors for being uninsured in the rest of the U.S. seem to be risk factors in Massachusetts for being intermittently insured.

While at least the opportunity for coverage exists for most people now, staying covered appears as if it might be a challenge for some. Some of the reasons for this may be changing economic or employment circumstances, the inability to keep up with premium payments, and administrative requirements of public programs.

We need to take note of this because on again, off again health insurance often means interrupted care, which can be dangerous especially for people with chronic conditions. National surveys by The Commonwealth Fund found that being intermittently insured hinders access to health care almost as severely as being continuously uninsured.

So as we continue to monitor the great gains in coverage that we have seen in Massachusetts since 2006, we should broaden our view to include not just a static point in time, but also the dynamics of coverage, because this measure also has important things to tell us about access.