'State Has Accomplished Much, But There’s Work Left To Do' by Jarrett T. Barrios

The stakeholders who worked together for so long to pass a health care reform law in Massachusetts have much to be proud of. They set out to achieve near-universal coverage and, in just three years, that’s what they’ve accomplished.

At 97 percent, Massachusetts enjoys the lowest rate of uninsurance in the nation. The third annual Massachusetts Health Reform Survey conducted by The Urban Institute — the results of which are being released today — also shows that Massachusetts residents enjoy unparalleled access to health care. Ninety-one percent of state residents, regardless of income and regardless of whether they have public or private insurance, now say that they have a regular source of care. Before health care reform was enacted in Massachusetts, only 86 percent of state residents said the same. Meanwhile, the latest public data from the National Health Interview Study (2007) shows that only 82.7 percent of residents around the county say they have a usual source of care.

The survey of approximately 4,000 Massachusetts working-age adults also found that Massachusetts residents were more likely to have had doctor and dental visits in the previous 12 months than they were before the health care reform law was enacted. But the survey also shows that we have more work left to do.

Adults reported more difficulties in accessing care as demand for care has increased. And the percentage of adults who report having difficulties paying medical bills remains at pre-health care reform levels, as does the percentage of lower-income adults with out-of-pocket spending of 10 percent or more of income on care.

The survey found geographic disparities in access to care in Massachusetts. The Southeast region of the state is ranked fifth or sixth on 15 of the 18 access to care measures used in the study. And the Western region of the state is ranked last of the six state regions on 11 of 18 access to care measures. The survey also found evidence of racial/ethnic disparities in health care access. Black and Hispanic residents reported less dental care and more unmet needs related to prescription drug coverage than non-Hispanic white residents. Black residents reported more unmet need with regard to specialist care. And Hispanic residents reported more unmet need for doctor and preventive care visits.

All that said, it is critical that we keep this in context. The National Health Interview Study finds that nine percent of U.S. residents report having an unmet need for health care due to costs of care, while only 4.6 percent of Massachusetts residents surveyed last fall say the same. Massachusetts adults, including low-income adults, were no more likely to report having an unmet need for care due to cost, and the declines in unmet health care needs due to cost from 2006 to 2007 were sustained. Last, the Massachusetts Health Reform Survey was conducted in the Fall of 2008, just as the recession was taking hold. It is possible that these data on cost reflect the impact of the economic downturn.

Regardless, we are at an historic moment in Massachusetts. Nearly everyone has health insurance coverage. That means we can now delve into the reasons why some get better access to care than others. Are health care disparities rooted in economics? Can barriers to access be traced to race, language, location, and/or culture? Is it consumer awareness and involvement? Or is it some complex mix of all of the above?

None of the problems we face are unique to Massachusetts. Nor are they results of health care reform. But they must be addressed. Few believed we could accomplish what we have already achieved in Massachusetts. Our proudest achievement to date —near-universal health insurance coverage — means that we can move on to the next generation of health care reform: cost containment, eliminating health care disparities, and improving quality.

Today, Massachusetts is an incubator for health care reform. There are numerous public and private initiatives underway in the state to implement improvements in how the Commonwealth’s residents access health care. And that includes the Foundation’s Care Beyond Coverage policy program, a multi-year initiative designed to identify barriers to health care access and propose potential evidence-based policy solutions. There are no easy answers. And we are trying to do what no one else has done in the arena of cost and quality. But we’ve already accomplished something that many once thought impossible. Surely, working together, we can do it again.

Jarrett T. Barrios is the president of the Blue Cross Blue Shield of Massachusetts Foundation.