Data Day – New Numbers Show Health Reform Progress

Today was an edifying data dump day. As the Census released its 2008 findings of its survey of insurance coverage and poverty, the Urban Institute released further results of its fall 2008 Massachusetts Health Reform Survey.

All the reports point to the ongoing success of Massachusetts health reform.

Census: The Census data confirms that Massachusetts is by far the national leader in covering the uninsured. The chart below shows the combined 2007-2008 state uninsurance rates (because of sample sizes, the Census data combines two years’ results). Massachusetts, on the far left, is lowest in the country, at 5.4%. The national average was just over 15%.

State Uninsurance Rates 2007-2008

State Uninsurance Rates 2007-2008

(Click on the chart to see a larger version)

The Census also looked at the change in uninsurance rates between 2005-2006 and 2007-2008. This captures the impact of health reform. The study found that Massachusetts was one of only 5 states that showed a significant improvement in its uninsurance rate. Again, the Massachusetts gains, a drop in the uninsurance rate of 4.4%, was the best in country. The national average dropped just .2%. The chart below shows the change in each state’s rate, with Massachusetts way off on the left.

Change in State Uninsurance Rates: 2005-6 to 2007-8

Change in State Uninsurance Rates: 2005-6 to 2007-8

The Massachusetts Budget and Policy Center published a concise briefing on the Census report, looking at the Massachusetts-specific findings and their context and interpretation.

Urban Institute: The Urban report is part of an ongoing tracking survey funded by the Blue Cross Blue Shield of Massachusetts Foundation, Commonwealth Fund, and The Robert Wood Johnson Foundation. Based on a fall 2008 survey, the key findings look at coverage gains, employer coverage and public support, all trending strong:

We find that the 2006 health reform initiative in Massachusetts has accomplished much of what it set out to do: Nearly all adults in the state have health insurance. Between Fall 2006 and Fall 2008, uninsurance among working-age adults in Massachusetts was reduced by nearly 70%—down to only 4%. The gains in insurance coverage reflect gains in employer-sponsored insurance (ESI) coverage and the expansion of public coverage. We find no evidence of public coverage crowding out employer-sponsored coverage under health reform in Massachusetts. The continued gains in coverage under health reform, including the gains in ESI coverage, occurred despite the economic downturn that began in December 2007.

While most of the gains in insurance coverage were concentrated among lower-income adults, a target population for many of the reform efforts, there were also significant gains among higher-income adults under health reform. In Fall 2008, the uninsurance rate was down to 7.6% among lower-income adults and 1.4% among higher-income adults. The remaining uninsured adults in Massachusetts are disproportionately young, male, single and/or healthy—populations that can be difficult to convince to obtain coverage.

Finally, support for reform in Massachusetts remains quite strong, with the levels in 2008 comparable to those of 2006. This support continued despite concerns in the state about the long-term financing of the coverage expansion and the economic downturn.

The findings on political support should be highlighted, in light of the questionable polling data used by others. The study concluded that “support for health reform among working-age adults in Massachusetts remains high—about 72% of adults reported support for reform in Fall 2008. Support also remains widespread, including men and women, younger and older adults, higher- and lower-income adults, working and non-working adults, and adults across the state. Further, support for health reform among uninsured adults, which had dropped from 63% in Fall 2006 to 44% in Fall 2007, rebounded to 53% by Fall 2008.”

The study also identifies who were the remaining uninsured. They were more likely to be young (55% less than 35), male (73%), single (55%) and healthy (54%). Over half of the uninsured live in Metrowest or the Southeast regions. Enrolling the remaining uninsured remains a challenge.

Because of differences in timing, methodology and samples, the two data sources findings are not directly comparable. Their similar conclusions reinforce each other, and should buoy the national debate just when it’s needed.

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