A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Still More To Do: Blue Cross Foundation Report Shows Public Coverage In Mass Not As Good As Private [Updated]

Still More To Do: Blue Cross Foundation Report Shows Public Coverage In Mass Not As Good As Private [Updated]

July 5, 2015

Report Cover: Comparing Public Coverage in Massachusetts with Employer-Sponsored Insurance Coverage The Blue Cross Blue Shield Foundation released a report authored by Sharon K. Long and Thomas H. Dimmock of the Urban Institute that analyzes the 2013 Massachusetts Reform Survey by comparing the experience of adults with employer-sponsored insurance coverage (ESI) to adults with public coverage, mostly MassHealth, but some with Connector-sponsored coverage.

The conclusions of the report  remind us that gaps in access to care persist between those covered by public and private insurance, despite current rates of near-universal health insurance coverage. These disparities persist even after controlling for variations in health care needs and socioeconomic status between the two groups.

The report highlights ongoing problems of cost and access depending on whether a person has ESI or public coverage:

Comparing unmet need among Massachusetts residents with public and private ESI coverage

  1. When you adjust for health status and socioeconomic status, affordability of health care was less of an issue for full-year insured adults with public coverage than it was for adults with ESI coverage. If you look at the raw data, about half of full-year insured adults with other non-ESI coverage reported that health care costs were a problem over the past year, as compared with 33.5 percent of those with ESI coverage. But controlling for differences in health status and socio-economic status reverses the picture. Adjusted, adults with public coverage are doing better than similar adults with ESI when it comes to affordability of health care
  2. Those with lower incomes and those with public coverage were more likely to report not getting needed care in the past 12 months because of cost, with 20.3% percent of lower-income adults and 22.6% of those with public coverage reporting such problems. The most common types of care that were not received due to cost were dental services and prescription drugs.
  3. Among the insured adults, adults with ESI coverage were more likely than adults with public coverage, 78.4 versus 43.6 percent, to know how to obtain information about providers in tiered networks.
  4. Adults with public coverage are more likely than adults with ESI coverage to have had problems with a doctor’s office not accepting their insurance type, with more than 25% of those with public coverage reporting such access problems.
  5. Unmet need for health care was significantly higher for full-year insured adults with public coverage as compared with adults with ESI coverage. For example, 44.5% of insured adults with other non-ESI coverage reported unmet need, as compared with 23% of insured adults with ESI coverage. Similarly, 22.6% of the adults with other non-ESI coverage reported unmet need due to the cost of care, which was more than double the 9.8% for adults with ESI.

Overall, the report concludes that simply reducing the number of uninsured people in Massachusetts is not sufficient to claim that the goals of health care reform have been achieved. Many people continue to be burdened by health care costs and lower-income adults and adults with non-ESI coverage are most at risk for access and financial issues.  The hardest work is still to come - bringing affordable, quality care to all Massachusetts residents regardless of their income or insurance type.

       - Michelle Savuto

[update: edited point above to clarify that after adjusting factors to make a direct comparison, people with public coverage have fewer affordability problems than those with employer coverage]