Sharon K. Long, Karen Stockley
S. K. Long and K. Stockley, "Massachusetts Health Reform: Employer Coverage from Employees' Perspective," Health Affairs Web Exclusive, Oct. 1, 2009, w1079–w1087.
Despite the economic downturn and rising health care costs, access to employer-based coverage in Massachusetts has increased, as has the scope and quality of coverage as assessed by workers, according to an analysis of the state’s health reform plan. However, some employees in small firms have seen a significant rise in premiums and out-of-pocket expenses.
As U.S. policymakers continue to debate national health reform measures, Massachusetts, which enacted its own ambitious health reform initiative in 2006, is proving to be an important testing ground. The Massachusetts reforms feature many of the same elements currently under consideration by Congress—including a requirement that larger employers offer their workers health benefits or face an assessment, and "minimum creditable coverage" standards for all insurance plans. Using data from three rounds of interviews with working-age adults in Massachusetts, this study assessed how employees have responded under the 2006 reforms.
In the years after the state instituted its health care reform, access to employer coverage in Massachusetts has increased, as has employees’ satisfaction with scope and quality of coverage. While there is evidence that some small-firm workers are facing high premium contributions and increased out-of-pocket spending because of trends in place prior to health reform, those workers are no more likely than others to report having a cost-related unmet need for health care. This may be, in part, the result of increased use of flexible spending accounts, the authors say.
The authors used data from a survey of working-age adults in Massachusetts in fall 2006, fall 2007, and fall 2008. Respondents with health insurance were asked about the characteristics of their coverage, access to care, out-of-pocket health expenses, medical debt, and more general financial problems. The concurrent economic downturn and general rise in health costs during this period likely also affected the study’s findings, the authors say, leading to an underestimate of the gains from health reform.
Despite the economic downturn and rising health care costs, Massachusetts adults have experienced expanded access to employer-sponsored coverage.