0
Getting Ready for Health
Reform in New York:
Lessons from Massachusetts
Sharon K. Long
University of Minnesota
Twenty-firs...
www.shadac.org 2
Overview of the Presentation
• How Massachusetts’s 2006 health reform
initiative compare to national refo...
www.shadac.org
How does Massachusetts’s 2006 health
reform initiative compare to national
reform?
3
www.shadac.org 4
National reform is modeled on
Massachusetts’s 2006 legislation
• Expansion of eligibility for public prog...
www.shadac.org 5
However, there are some are important
differences in national reform
• Expands subsidies to higher income...
www.shadac.org
Can the experiences under health reform
in Massachusetts provide lessons for
New York?
6
www.shadac.org
Overview of Key Changes in Coverage Options
Under Health Reform in Massachusetts
7
Pre-Reform Post-Reform
C...
www.shadac.org
Comparing Insurance Coverage in New York to
Pre-Reform Massachusetts
8
New York
2009
Massachusetts
2005
All...
www.shadac.org
Comparing recent economic measures
between New York and Massachusetts
• Unemployment rate
– MA – 8.4%; NY –...
www.shadac.org
Comparing Coverage Options in New York to
Pre-Reform Massachusetts
10
New York
Pre-Reform
Massachusetts
Chi...
www.shadac.org
What were the impacts of health reform
in Massachusetts?
11
www.shadac.org 12
Data
• Massachusetts Health Reform Survey
– Targets non-elderly adults 18-64
– Conducted every fall from...
www.shadac.org 13
Methods
• Estimate impact of health reform as change over
time from fall 2006
– Pre-post estimates will ...
www.shadac.org 14
Summary of Findings on Impacts
• Increase in insurance coverage, with no crowd
out of private coverage
•...
www.shadac.org 15
Health insurance coverage, 2006-2009
88%
92%
95% ***
98%***
0%
20%
40%
60%
80%
100%
Currently insured Ev...
www.shadac.org 16
Type of health insurance coverage,
2006-2009
66%
22%
68% ***
27%***
0%
20%
40%
60%
80%
100%
Employer-spo...
www.shadac.org 17
Employers’ insurance offer and
employees’ take-up, 2005-2009
70%
78%76%
80%
0%
20%
40%
60%
80%
100%
Empl...
www.shadac.org 18
Type of health insurance coverage,
2006-2009
4,333
40
705
4,374
90
1,008
0
1,000
2,000
3,000
4,000
5,000...
www.shadac.org 19
Health care access and use, 2006-2009
86%
80%
70% 68%
89%**
86%***
78%***
75%***
0%
20%
40%
60%
80%
100%...
www.shadac.org 20
Unmet need for care, 2006-2009
24.9%
7.7%
9.1%
7.9%
6.8%
19.0%***
5.3%** 5.7%*** 5.7%**
4.9%**
0%
5%
10%...
www.shadac.org 21
Health care costs and affordability for
individuals, 2006-2009
9.5%
19.1% 19.5%
16.3%
4.4%***
19.1%
20.3...
www.shadac.org 22
Residents support for health reform,
2006-2008
61%
52%
69%
58%
0%
20%
40%
60%
80%
100%
Support for healt...
www.shadac.org 23
Physicians support health reform, 2008
70%
75%
13%
7%
17% 18%
0%
20%
40%
60%
80%
100%
Support for the he...
www.shadac.org
What are the challenges Massachusetts
faces going forward?
24
www.shadac.org
Challenges in Massachusetts prior to
health reform
• Uninsurance, particularly among non-
elderly adults
• ...
www.shadac.org 26
Reform addressed uninsurance, but
access and, especially, costs remain issues
• Health insurance coverag...
www.shadac.org 27
Addressing continued increases in costs of
care is “harder than expanding coverage”
• Passed 2006 legisl...
www.shadac.org 28
Massachusetts must also address differences
under national reform
• Many new rules and regulations that ...
www.shadac.org 29
Contact information
Sharon K. Long
University of Minnesota
slong@umn.edu
612-624-4802
©2002-2009 Regents...
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Transcript of "Pres health servicesny2010nov3_long"

  1. 1. Getting Ready for Health Reform in New York: Lessons from Massachusetts Sharon K. Long University of Minnesota Twenty-first Annual Symposium on Health Services in New York: Research and Practice November 3, 2010
  2. 2. www.shadac.org 2 Overview of the Presentation • How Massachusetts’s 2006 health reform initiative compare to national reform? • Can the experiences under health reform in Massachusetts provide lessons for New York? • What were the impacts of health reform in Massachusetts? • What are the challenges Massachusetts faces going forward?
  3. 3. www.shadac.org How does Massachusetts’s 2006 health reform initiative compare to national reform? 3
  4. 4. www.shadac.org 4 National reform is modeled on Massachusetts’s 2006 legislation • Expansion of eligibility for public programs • Creation of health insurance exchanges • Subsidies for low- and moderate- income individuals • Expansion of dependent coverage • Individual mandate • Requirements for employers • Standards for covered benefits
  5. 5. www.shadac.org 5 However, there are some are important differences in national reform • Expands subsidies to higher income levels (400% FPL versus 300% FPL) but provides lower subsidies for some • Imposes lower standards for affordability under the individual mandate • Provides more generous expansion of dependent coverage (doesn’t require that child be claimed as dependent for tax purposes) • Provides tax credits for small businesses • Limits penalties for employers who do not offer insurance coverage to larger firms (>50 workers versus >10 workers) • Extends some insurance protections to workers in self- insured plans which are not under the purview of state regulators
  6. 6. www.shadac.org Can the experiences under health reform in Massachusetts provide lessons for New York? 6
  7. 7. www.shadac.org Overview of Key Changes in Coverage Options Under Health Reform in Massachusetts 7 Pre-Reform Post-Reform Children Public coverage < 200% FPL < 300% FPL Parents Public coverage < 133% FPL < 300% FPL Premium support < 200% FPL < 300% FPL Subsidized coverage -- < 300% FPL Purchasing pool -- > 300% FPL Childless Adults Public coverage -- < 300% FPL Premium support < 200% FPL < 300% FPL Subsidized coverage -- < 300% FPL Purchasing pool -- > 300% FPL Note: FPL is federal poverty level
  8. 8. www.shadac.org Comparing Insurance Coverage in New York to Pre-Reform Massachusetts 8 New York 2009 Massachusetts 2005 All Residents Any coverage 89.8% 94.5% Private coverage 57.3% 66.5% Public coverage 32.5% 28.0% Non-elderly Adults Any coverage 85.7% 90.8% Private coverage 67.0% 76.4% Public coverage 18.7% 14.4% Source: 2006-2009 National Health Interview Survey from Cohen and Martinez (2006) and Cohen, Martinez and Ward (2010). Note: Individuals reporting both private and public coverage are assigned to public coverage.
  9. 9. www.shadac.org Comparing recent economic measures between New York and Massachusetts • Unemployment rate – MA – 8.4%; NY – 8.3% • Average hourly earnings, private non-farm payroll – MA – $27/hour; NY – $26/hour • Employees in firms with 50 or more workers – MA – 74%; NY – 72% • Private-sector establishments offering health insurance – MA – 62%; NY – 59% 9
  10. 10. www.shadac.org Comparing Coverage Options in New York to Pre-Reform Massachusetts 10 New York Pre-Reform Massachusetts Children Public coverage < 400% FPL < 200% FPL Parents Public coverage < 150% FPL < 133% FPL Premium support < 250% FPL < 200% FPL Childless Adults Public coverage < 100% FPL -- Premium support < 250% FPL < 200% FPL Note: FPL is federal poverty level
  11. 11. www.shadac.org What were the impacts of health reform in Massachusetts? 11
  12. 12. www.shadac.org 12 Data • Massachusetts Health Reform Survey – Targets non-elderly adults 18-64 – Conducted every fall from 2006 to 2010 (underway) – Oversamples of lower-income and uninsured adults – Telephone interviews, including cell-phones in 2010 – Sample size ~3000 • Funded by Blue Cross Blue Shield of Massachusetts Foundation – Additional funding from Commonwealth Fund and Robert Wood Johnson Foundation in earlier years
  13. 13. www.shadac.org 13 Methods • Estimate impact of health reform as change over time from fall 2006 – Pre-post estimates will also capture recession & health care cost trends – Consistent findings from studies using national data • Multivariate regression models control for demographic characteristics, health and disability status, socioeconomic status and region of state – Estimate linear probability models, controlling for complex survey design
  14. 14. www.shadac.org 14 Summary of Findings on Impacts • Increase in insurance coverage, with no crowd out of private coverage • Improvements in access to and use of health care • Improvements in affordability of health care for individuals • Support for health reform remains strong in the state
  15. 15. www.shadac.org 15 Health insurance coverage, 2006-2009 88% 92% 95% *** 98%*** 0% 20% 40% 60% 80% 100% Currently insured Ever insured over year 2006 2009 Source: 2006-2009 Massachusetts Health Reform Survey Note: Regression-adjusted estimates * (**) (***) Significantly different from fall 2006 at the .10 (.05) (.01) level, two-tailed test. Adults more likely to have health insurance under health reform.
  16. 16. www.shadac.org 16 Type of health insurance coverage, 2006-2009 66% 22% 68% *** 27%*** 0% 20% 40% 60% 80% 100% Employer-sponsored insurance Public and other coverage 2006 2009 Source: 2006-2009 Massachusetts Health Reform Survey Note: Regression-adjusted estimates * (**) (***) Significantly different from fall 2006 at the .10 (.05) (.01) level, two-tailed test. Employer-sponsored insurance coverage increased under health reform.
  17. 17. www.shadac.org 17 Employers’ insurance offer and employees’ take-up, 2005-2009 70% 78%76% 80% 0% 20% 40% 60% 80% 100% Employers offering coverage Employees taking up coverage 2005 2009 Source: 2006-2009 Massachusetts Division of Health Care Finance and Policy Employer Survey Employers more likely to offer health insurance coverage to workers and workers more likely to take-up coverage under health reform.
  18. 18. www.shadac.org 18 Type of health insurance coverage, 2006-2009 4,333 40 705 4,374 90 1,008 0 1,000 2,000 3,000 4,000 5,000 Private group Individual purchase Public Thousands 2006 2009 Source: 2006-2009 Massachusetts Division of Health Care Finance and Policy enrollment data from health plans and programs. No evidence of public coverage crowding out of employer-sponsored insurance coverage under health reform.
  19. 19. www.shadac.org 19 Health care access and use, 2006-2009 86% 80% 70% 68% 89%** 86%*** 78%*** 75%*** 0% 20% 40% 60% 80% 100% Usual source of care Any doctor visit Preventive care visit Dental care visit 2006 2009 Source: 2006-2009 Massachusetts Health Reform Survey Note: Regression-adjusted estimates *(**) (***) Significantly different from fall 2006 at .10, (.05) (.01) level, two tailed test Adults more likely to have a regular health care provider and to have had health care visits over the prior year under health reform
  20. 20. www.shadac.org 20 Unmet need for care, 2006-2009 24.9% 7.7% 9.1% 7.9% 6.8% 19.0%*** 5.3%** 5.7%*** 5.7%** 4.9%** 0% 5% 10% 15% 20% 25% 30% Any unmet need for health care Doctor care Medical tests, treatment, or follow up care Prescription drugs Preventive care screening 2006 2009 Source: 2006-2009 Massachusetts Health Reform Survey Note: Regression-adjusted estimates *(**) (***) Significantly different from fall 2006 at .10, (.05) (.01) level, two-tailed test Adults less likely to have unmet need for any reason under health reform
  21. 21. www.shadac.org 21 Health care costs and affordability for individuals, 2006-2009 9.5% 19.1% 19.5% 16.3% 4.4%*** 19.1% 20.3% 11.7%*** 0% 10% 20% 30% OOP health care costs=>10% of family income Problems paying medical bills Medical debt Unmet need because of cost 2006 2009 Source: 2006-2009 Massachusetts Health Reform Survey Note: Regression-adjusted estimates *(**) (***) Significantly different from fall 2006 at .10, (.05) (.01) level, two-tailed test Improvements in affordability of care under health reform despite increasing health care costs and economic recession
  22. 22. www.shadac.org 22 Residents support for health reform, 2006-2008 61% 52% 69% 58% 0% 20% 40% 60% 80% 100% Support for health reform Support for the individual mandate 2006 2008 Source: Blendon et al. (2008) Support for health reform among Massachusetts residents has remained strong
  23. 23. www.shadac.org 23 Physicians support health reform, 2008 70% 75% 13% 7% 17% 18% 0% 20% 40% 60% 80% 100% Support for the health reform law Support for continuing with reform For Against Neither for nor against/Don't know Source: SteeleFisher et al. (2009) Support for health reform among Massachusetts physicians is strong
  24. 24. www.shadac.org What are the challenges Massachusetts faces going forward? 24
  25. 25. www.shadac.org Challenges in Massachusetts prior to health reform • Uninsurance, particularly among non- elderly adults • Provider shortages in some areas, particularly for primary care and populations with public coverage • High and rapidly rising health care costs 25
  26. 26. www.shadac.org 26 Reform addressed uninsurance, but access and, especially, costs remain issues • Health insurance coverage does not guarantee access to care – 1 in 5 adults reported unmet need for care – 1 in 5 adults reported difficulty finding a doctor that would see them • Health care costs continue to threaten gains under health reform – 1 in 5 adults reported problems paying medical bills – Cost remains major reason for continued uninsurance
  27. 27. www.shadac.org 27 Addressing continued increases in costs of care is “harder than expanding coverage” • Passed 2006 legislation with knowledge that would need to address costs in future legislative efforts--“Round II” of health reform • Considerable consensus in the state on the need to address continued escalating costs • Less consensus as to how to address rising health care costs
  28. 28. www.shadac.org 28 Massachusetts must also address differences under national reform • Many new rules and regulations that affect state • Examples: – Under current provisions, some Massachusetts residents will face both federal and state penalties under the individual mandate if they do not obtain coverage – Under current provisions, some Massachusetts employers will face both federal and state penalties for not offering coverage to their workers – May need to change structure of the exchanges
  29. 29. www.shadac.org 29 Contact information Sharon K. Long University of Minnesota slong@umn.edu 612-624-4802 ©2002-2009 Regents of the University of Minnesota. All rights reserved. The University of Minnesota is an Equal Opportunity Employer
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