Massachusetts‘ landmark health reform law has been hailed for its success in reducing the percentage of state residents without health insurance. These gains were made largely through the expansion of public programs and the availability of subsidized coverage for low‐ to moderate‐income state residents. In this study, focus group participants who were uninsured prior to 2006 or who had lost private coverage since have clearly benefited. These individuals have affordable care through programs like Commonwealth Care that would not have been available to them before. In many cases, these individuals are self‐employed, work part‐time, or work for companies that do not offer coverage. Having health insurance that covers a wide range of benefits and protects them from high out‐of‐pocket costs has translated to better management of their health conditions and greater use of preventive services. 

Conversely, many with employer‐sponsored coverage seem to be struggling more than ever with health care costs. These tend to be people with serious or chronic health conditions like cancer or diabetes who see numerous doctors, require diagnostic tests and medical procedures, and who take medications regularly. They have difficulty shouldering heavy out‐of-pocket costs (e.g., copayments that can add up into the thousands over the course of the year) even when their employers pay most of their monthly premiums. They report going without recommended medical procedures and medications due to costs even though they have “good coverage.” The state’s decision to make individuals who have access to employer sponsored coverage ineligible for subsidies appears to have locked some individuals into inadequate coverage making it difficult for them to manage their health care costs on top of all of their other expenses. 

Other insights from the study reveal that awareness about both new and existing programs could be improved and the processes for enrolling in these programs could be simplified.  Enrolling in these programs seems difficult for some, particularly for those dealing with chronic illnesses, and confusion about program rules leads to gaps in coverage (for example, when people fail to follow procedures for re-enrolling in the program). Those who have used the Health Connector have found it useful but want it streamlined. Study participants support more investment in outreach so that people can learn about these programs and perhaps enroll in them. 

As the health reform debate continues at the national level, the important role public programs play in facilitating access to affordable coverage for low‐ and moderate‐income people in the Massachusetts reform effort warrants consideration. The public programs in Massachusetts work for people because premiums and cost‐sharing levels are affordable and benefits provide the range of services necessary for people to obtain preventive services and to manage their health conditions effectively. 

Full report: In Pursuit of Affordable Health Care: On the Ground Lessons from Families in Massachusetts (PDF | 459 KB)

Kaiser Family Foundation. (2009). In pursuit of affordable health care: on the ground lessons from families in Massachusetts. Perry,Michael; Lyons, Barbara; Tolbert, Jennifer.  

The KFF also updated its Massachusetts health care reform fact sheet, in September 2009, available here: http://www.kff.org/uninsured/upload/7777-02.pdf