Urban Institute researcher Sharon Long and colleagues released two studies today looking at a success and remaining challenge of Massachusetts health reform.
Did Young Adult Provisions Work?
First, the good news (pdf): The researchers looked at the impact of the various provisions in Chapter 58 aimed at getting young adults (age 19-26) to enroll in coverage. These include allowing children to remain on their parent’s family insurance plans, and the Young Adult Plans (YAP) offered by the Health Connector. They compared the drop in uninsurance rates between young adults in Massachusetts to slightly older adults (ages 27-33) in Massachusetts, and to young adults in New York state. The analytic model controlled for other demographic and socieconomic factors such as race/ethnicity, family size, income, etc.
The study found that the young adult provisions made a significant difference. Uninsurance among young adults dropped by over 60%, a decline much higher than for comparable populations. The comparable drop for slightly older adults was 45%, and the New York counterparts increased their level of uninsurance. Using regression analysis, the study concludes that the young adult provisions reduced uninsurance among the targets by around 5%-7%.
The authors noted a concern that we’ve raised about the skimpy benefits in the YAP plans:
Not addressed in this brief are the implications of the narrower benefit package and higher cost-sharing of the YAP options on access to and affordability of care for young adults. In assessing the overall success of the special provisions for young adults, it will be important to determine whether the gains in coverage for these individuals translated into better access to health care and financial protection from high health care costs.
However, in terms of reducing the uninsurance rate, the study shows unquestioned success so far.
Who’s Still Uninsured?
The second study (pdf) looked at who’s still uninsured in Massachusetts. The findings are not too much of a surprise. The approximately 223,000 uninsured adults aged 19-64 in 2008 are more likely than those with insurance coverage to be
- Male, young, and single
- Racial/ethnic minorities and non-citizens
- Unable to speak English well or very well
- Living in a household in which there was no adult able to speak English well or very well and;
- Have substantially lower educational attainment and less employment and had lower family income and greater financial stress.
The large sample size allowed the researchers to drill down and highlight the geographic differences in uninsurance rates within Massachusetts. Click on the map above to go to the full study where you can see the map more clearly.
The study found that at least 42 percent of those uninsured were eligible for MassHealth or Commonwealth Care in 2008. While enrollment in those programs has continued to grow since the time of the survey, there are surely many more eligibles to be reached. The authors pointed to the mismatch between the findings of low educational and English language attainment among the uninsured, and the complex materials associated with enrollment:
Outreach efforts to all nonelderly uninsured populations will need to take literacy issues into account, as nearly one-quarter of uninsured adults lack a high school education. Health insurance coverage is a complicated issue that can be difficult to communicate to those with limited literacy skills. A check on the reading level for introductory materials on the web pages for MassHealth and Commonwealth Care highlights this challenge: The materials on “What is MassHealth?” are rated at a 10.5 grade level, while the “Welcome to Commonwealth Care: Overview” materials are rated at a 12.1 grade level.17 Materials that address the criteria for eligibility for both programs are rated at even higher grade levels for reading (11.6 and 12.9, respectively). The National Institutes of Health recommends a reading level of 4th to 8th grade for materials meant for the general public, so many of those who are eligible for but not enrolled in MassHealth and Commonwealth Care may have difficulty understanding program materials.
We agree, and would add that this finding validates of the importance of aggressive expansion of Community Health Workers, and the extension of the outreach and enrollment grant program that funds on-the-ground community groups speaking directly to the uninsured in a style and language they can understand.