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Bay State Achieves Big Gains in Coverage

Massachusetts has achieved dramatic improvements in insurance coverage one year after implementing an ambitious health care reform plan, according to an evaluation of the plan that was supported in part by The Commonwealth Fund. The proportion of uninsured working-age adults was cut nearly in half, from 13 percent to 7 percent.

According to the Health Affairs study, the uninsured rate dropped by nearly 11 percentage points for adults with incomes below 300 percent of the federal poverty level—from 24 percent in the fall of 2006 to 13 percent a year later. For those with incomes below 100 percent of poverty, and therefore eligible for fully subsidized coverage, the rate dropped by more than two-thirds.

In addition to improvements in insurance coverage, there were significant gains in access to care, says Sharon K. Long, Ph.D., the Urban Institute researcher who led the evaluation. More adults reported having a usual source of care and having a preventive care visit, Long noted, and the share of adults reporting high out-of-pocket spending and medical bill problems dropped. Improvements were concentrated among low-income adults.

Moreover, employer coverage remained stable overall and actually increased by 5 percentage points for low-income adults—allaying concerns that the plan would "crowd out" existing employer coverage.

Passed into law in April 2006, the Massachusetts health reform expands the state's Medicaid program, establishes income-related subsidies, creates a new private insurance plan open to individuals, and requires that both individuals and employers participate in the health insurance system or pay a fine. Public support for the plan is strong, with 71 percent of Massachusetts residents in favor of it.

The evaluation, which was supported by The Commonwealth Fund, the Blue Cross Blue Shield of Massachusetts Foundation, and the Robert Wood Johnson Foundation, was based on two rounds of interviews with Massachusetts adults before and after the plan's implementation.

For more on the impact of the Massachusetts health reform, see our "In the Spotlight" interview with Sharon Long.

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