Last week, the Blue Cross Blue Shield of Massachusetts Foundation and the University of Massachusetts Medical School released a report entitled “The Remaining Uninsured in MA: Experiences of Individuals Living without Health Insurance Coverage” (read the report here). Massachusetts continues to have the lowest uninsured rate in the nation, with some 97% of residents covered. However, about 200,000 people of diverse age, race and employment status remain uninsured. The goal of this study was to figure out the reasons why people remained uninsured and help inform policy suggestions which would help them receive coverage in the future.
The report authors spoke to a sample of uninsured people from seven counties in the state and developed the following key findings;
First, health care costs continue to be prohibitive. One of the most cited reasons that people gave for being uninsured was the cost. Some people weren’t eligible for their employer’s insurance, and other were not eligible for subsidies. Some 58% of respondents said they had had coverage at some point in their adult lives, but changing circumstances had dissuaded them from applying. Some said that they let their coverage lapse because they said they didn’t use it enough to justify the cost, while others simply became ineligible for employer-provided insurance. One respondent said that the cost of the penalty was less than the cost of insurance itself, and so they decided to simply pay the fine.
Another key point here is that a vast majority (73%) of the people surveyed said that they considered themselves to be in very good health, despite that slightly more than one third has one or more chronic conditions. Still, it would seem that some people were willing to hedge their bets by remaining uninsured, counting on good health to compensate for their lack of insurance.
Some other important aspects were related to communication; the process of applying was widely reported to be confusing and complex, and would be greatly simplified by having personal assistance, in people’s primary language. Having access to this would be even better if it is available in convenient location such as “health clinics, hospitals, nonprofit organizations, unemployment offices, and local businesses” that have evening and weekend operating hours, additional appointment times and more staff to assist.
Some respondents also reported losing their health insurance through state programs like MassHealth because they did not realize they needed to take any action to renew their membership. In this area, better communication with enrollees is necessary.
Secondly, the value of health insurance was lost on no one. Almost every person contacted indicated that they wanted health insurance coverage, and certainly understood the value of it to their overall wellbeing. Most people indicated that that the insurance provided a sense of security and that the lack on insurance was reflected in the way that people interacted with their care. People without insurance said that being uninsured limits “when they can get care, where they can get care, and what type of care they receive. Nearly a third said they were unable to get care when they needed it and that not having insurance limited their access to specialty care, routine tests, and preventive screenings”. Almost one third said that they were unable to get care when they needed it. While some people reported that they didn’t use it enough to justify the costs, the lack of insurance meant either not receiving or putting off necessary and preventative care.
The study notes that community health services such as free clinics and community health centers provide necessary access points for uninsured, especially undocumented, people in the Commonwealth. Additionally, the report supports the value of enrollment events and in-person assistance to help insure people and recommends possibly working with unemployment offices to help those who are looking for insurance outside of the open enrollment period.
The report closes with a note that lowering Massachusetts’ already low uninsured rate will be difficult, but that by learning from the experiences of those people, we can do what is possible to get the number down to 0% uninsured.