Continuing our week of statistics on Massachusetts uninsured, today brings the release by the Blue Cross Blue Shield Foundation of what may be the gold standard for analysis of Bay State health coverage.
The survey
The report (13-page summary here; 36-page full report here) is intended to provide a baseline for evaluating the impact of health reform. The Foundation engaged Urban Institute researchers who surveyed 3010 adults between October 2006 and January 2007. The survey “oversampled” low and moderate income residents to get a better picture of those most likely to be uninsured. They worked hard to get responses, including offering $10 to answer the questions, making at least 12 call attempts, and so on. They then adjusted the findings so the age, sex, race/ethnicity, and geographic distribution of the sample is consistent with the distribution of the population in Massachusetts.
The results provide a detailed picture of who was uninsured in Massachusetts just as health reform got underway. They also report on unmet care needs between those with and without coverage, the cost of coverage and out of pocket costs, underinsurance and more.
Some First Impressions
There’s a lot here to digest, but a quick glance provides these early impressions, both relating to the upcoming financing crunch for health reform:
- There’s a lot more uninsured adults than the administration, Connector and the legislature assumed. Like us, the survey warns against direct comparisons of surveys using different methodologies and time periods. But the inescapable conclusions, already borne out by the enrollment numbers, is that the state and federal governments need to budget for substantially more Commonwealth Care eligibles. The Urban survey’s 2006 uninsurance rate is estimated at 13.3% of adults (about 571,000 people), while the state survey used to plan health reform initially indicated a 2006 adult uninsurance rate of 8.7% (adjusted on Monday to 9.2% – about 395,000). That’s roughly 50% more uninsured than the original forecasts assumed.
- The uninsured get substantially less care than those with coverage, and their health suffers because of this. Gov. Romney still uses the point he made frequently while pushing health reform: we’re already paying for the care of the uninsured, so we just need to shift funds from uncompensated care reimbursements to insurance coverage. But in fact, new money will inevitably be needed. The new survey demonstrates that even with our strong safety net, and even after controlling for different needs, uninsured adults get less: “Overall, 52% of uninsured adults reported that they did not get needed health care because of the cost of that care, compared to 12% percent for insured adults. Similar differences are reported for unmet need for doctor care, specialist care, medical tests, treatment or follow-up recommended by a doctor, preventive care screenings, prescription drugs and dental care.” As a result, the uninsured are more likely to report their health status as fair or poor than insured adults.
Next Steps
The researchers will conduct a similar survey this fall, to assess the impact of health reform after one year. Those results won’t be available until summer 2008, though.
We commend the BCBS Foundation for supporting this effort. Please use the comments if you see anything else of interest in the report.
Brian Rosman
