HEALTH INSURANCE COVERAGE AND HEALTH CARE ACCESS AND AFFORDABILITY FINDINGS FROM THE 2018 MASSACHUSETTS HEALTH REFORM SURVEY December 11, 2018 BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION and URBAN INSTITUTE 1
MASSACHUSETTS HEALTH REFORM SURVEY (MHRS) • Survey of nonelderly adults ages 19 to 64 in Massachusetts Telephone (landline and cell phone) interviews Core questions on health insurance coverage, health care access and use, and health care affordability for individuals and their families in all years New questions on mental health and substance use disorders (MH/SUDs) added in 2018 Conducted most years since 2006 As with all telephone surveys, a declining response rate over time • Reporting on data for 2006-2018 For consistency with prior years, summary measures for 2018 do not include data from new MH/SUDs questions for this part of the presentation December 11, 2018 BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION and URBAN INSTITUTE 2
PREVIEW OF KEY FINDINGS FROM 2018 MHRS Massachusetts has maintained near-universal health insurance coverage since the 2006 reforms However, gaps in health care access and affordability persist despite the sustained high levels of health insurance coverage Low- and moderate-income adults face the greatest challenges, with affordability issues most prevalent for moderate-income adults December 11, 2018 BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION and URBAN INSTITUTE 3
MASSACHUSETTS HAS MAINTAINED NEAR-UNIVERSAL HEALTH INSURANCE COVERAGE FOR MORE THAN 10 YEARS 96.0** 95.7** 100% 94.9** 94.7** 86.0 89.8** 88.6** 87.9** 87.6** 80% 80.0 60% 40% 20% 0% 2006 2009 2012 2015 2018 Insured at the time of the survey Insured for past 12 months SOURCE : 2006–2018 Massachusetts Health Reform Survey *(**) Significantly different from value in 2006 at the .05 (.01) level, two-tailed test. December 11, 2018 BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION and URBAN INSTITUTE 4
NEAR-UNIVERSAL COVERAGE CONTINUES FOR BOTH HIGHER- AND LOWER-INCOME ADULTS, ALTHOUGH A GAP IN COVERAGE PERSISTS 98.5** 98.0** 98.1** 98.1** 100% 93.8 93.7** 93.2** 90.8** 90.4** 80% 75.9 60% 40% 20% 0% 2006 2009 2012 2015 2018 Income at or above 300% of federal poverty level (FPL) Income below 300% FPL SOURCE : 2006–2018 Massachusetts Health Reform Survey *(**) Significantly different from value in 2006 at the .05 (.01) level, two-tailed test. December 11, 2018 BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION and URBAN INSTITUTE 5
DESPITE NEAR-UNIVERSAL COVERAGE, GAPS IN ACCESS TO HEALTH CARE PERSISTED IN 2018 • Will focus on two measures of health care access: – Difficulty finding providers and/or getting appointments for needed health care – Going without needed health care December 11, 2018 BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION and URBAN INSTITUTE 6
ALMOST HALF OF ADULTS REPORTED DIFFICULTY OBTAINING HEALTH CARE IN 2018 100% 80% 60% 49.1 39.0 40% 25.2 20% 0% Had difficulty obtaining health care in the past 12 months Difficulty finding a provider Difficulty getting an appointment for care as soon as needed SOURCE : 2018 Massachusetts Health Reform Survey. NOTE : These are unadjusted estimates. “Difficulty finding a provider” includes being told by doctor’s office or clinic that they were not accepting the respondent’s health insurance type, any health insurance or new patients. “Problem getting an appointment” is defined as “sometimes” or “never” getting an appointment as soon as needed. December 11, 2018 BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION and URBAN INSTITUTE 7
LOW- AND MODERATE-INCOME ADULTS WERE MOST LIKELY TO HAVE DIFFICULTY OBTAINING HEALTH CARE IN 2018 100% 80% 60.1 60% 56.2 46.3 45.8 40.9**^^ 40% 33.9 32.5 32.7**^^ 18.0**^^ 20% 0% Had difficulty obtaining health care in the past 12 months Difficulty finding a provider Difficulty getting an appointment for care as soon as needed Income at or below 138% of the federal poverty level (FPL) Income between 138 and 300% FPL Income at or above 300% FPL SOURCE : 2018 Massachusetts Health Reform Survey. *(**) Significantly different from value for low-income adults at the .05 (.01) level, two-tailed test. ^(^^) Significantly different from value for moderate-income adults at the .05 (.01) level, two-tailed test. December 11, 2018 BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION and URBAN INSTITUTE 8
MORE THAN 1 IN 3 ADULTS HAD UNMET NEED FOR HEALTH CARE IN 2018, MOST OFTEN FOR REASONS OTHER THAN COST 100% 80% 60% 38.1 40% 25.6 18.6 20% 0% Any unmet need for health care in past 12 months Unmet need due to cost Unmet need for reasons other than cost SOURCE : 2018 Massachusetts Health Reform Survey. NOTE : “Unmet need for reasons other than costs” includes problems with the availability of care, the accessibility of care, or personal issues. December 11, 2018 BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION and URBAN INSTITUTE 9
LOW- AND MODERATE-INCOME ADULTS WERE MORE LIKELY TO HAVE UNMET NEED FOR CARE IN 2018 100% 80% 60% 46.6 46.1 40% 32.9 30.7**^^ 28.1 27.9 22.8 21.2** 20% 12.2**^^ 0% Any unmet need for health care in past 12 months Unmet need due to cost Unmet need for reasons other than cost Income at or below 138% of the federal poverty level (FPL) Income between 138 and 300% FPL Income at or above 300% FPL SOURCE : 2018 Massachusetts Health Reform Survey. *(**) Significantly different from value for low-income adults at the .05 (.01) level, two-tailed test. ^(^^) Significantly different from value for moderate-income adults at the .05 (.01) level, two-tailed test. December 11, 2018 BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION and URBAN INSTITUTE 10
DESPITE NEAR-UNIVERSAL COVERAGE, PROBLEMS WITH AFFORDABILITY OF HEALTH CARE PERSISTED IN 2018 • Will focus on problems with health care affordability that includes: – Going without needed health care due to cost – Problems paying family medical bills – Medical debt (defined as paying family medical bills off over time) December 11, 2018 BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION and URBAN INSTITUTE 11
MORE THAN ONE-THIRD OF ADULTS HAD PROBLEMS WITH HEALTH CARE AFFORDABILITY IN 2018 100% 80% 60% 40% 35.0 19.4 18.6 17.5 20% 0% Any problems with health care affordability in Unmet need due to cost Problems paying family medical bills Paying off family medical bills over time past 12 months SOURCE : 2018 Massachusetts Health Reform Survey. December 11, 2018 BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION and URBAN INSTITUTE 12
LOW- AND MODERATE-INCOME ADULTS WERE MORE LIKELY TO HAVE PROBLEMS WITH HEALTH CARE AFFORDABILITY IN 2018, WITH MODERATE-INCOME ADULTS FACING THE GREATEST CHALLENGE 100% 80% 60% 48.0* 37.8 40% 29.6** 27.6*^^ 24.9** 20.8 19.6**^^ 20% 12.2 10.2**^^ 0% Any problems with health care affordability in past 12 Problems paying family medical bills Paying off family medical bills over time months Income at or below 138% of the federal poverty level (FPL) Income between 138 and 300% FPL Income at or above 300% FPL SOURCE : 2018 Massachusetts Health Reform Survey. *(**) Significantly different from value for low-income adults at the .05 (.01) level, two-tailed test. ^(^^) Significantly different from value for moderate-income adults at the .05 (.01) level, two-tailed test. December 11, 2018 BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION and URBAN INSTITUTE 13
KEY FINDINGS FROM 2018 MHRS Massachusetts has maintained near-universal health insurance coverage since the 2006 reforms However, gaps in health care access and affordability persist despite the sustained high levels of health insurance coverage Low- and moderate-income adults face the greatest challenges, with affordability issues most prevalent for moderate-income adults December 11, 2018 BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION and URBAN INSTITUTE 14
HEALTH CARE ACCESS AND AFFORDABILITY FOR ADULTS SEEKING CARE FOR MENTAL HEALTH AND/OR SUBSTANCE USE DISORDERS (MH/SUDs) NEW DATA FROM THE 2018 MASSACHUSETTS HEALTH REFORM SURVEY December 11, 2018 BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION and URBAN INSTITUTE 15
NEW MH/SUDs QUESTIONS IN THE 2018 MASSACHUSETTS HEALTH REFORM SURVEY (MHRS) • Use of MH/SUDs care over the past year – MH/SUDs services and MH/SUDs prescription drugs • Unmet need for MH/SUDs care over the past year – Unmet need due to costs – Unmet need due to reasons other than costs • Difficulty obtaining MH/SUDs care over the past year – Difficulty finding a MH/SUDs provider – Problem getting an appointment for MH/SUDs care as soon as needed • Reporting on data for 2018 – Summary measures include data from new MH/SUDs questions for this part of the presentation December 11, 2018 BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION and URBAN INSTITUTE 16
PREVIEW OF KEY FINDINGS FROM THE 2018 MHRS ON MH/SUDs CARE The need for MH/SUDs care affects many in Massachusetts and crosses all age, sex, race/ethnicity, and income groups But is more common among younger, female, white/non-Hispanic, and lower- income adults Adults who seek care for MH/SUDs face significant barriers to obtaining health care overall and, especially, for MH/SUDs services and prescription drugs Health insurance coverage does not eliminate those barriers to care December 11, 2018 BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION and URBAN INSTITUTE 17
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