High health insured rate marred by access, cost concerns
PHOTO/Matt VOLPINI
Patient access to hospitals like UMass Medical Center has been hurt due to cost, according to a new survey.
More than one in six people in Massachusetts had an unmet health need due to the cost of care in 2015, according to a new report showcasing how despite the state's continued high rate of insurance coverage the cost of care continues to be an impediment to access.
The survey produced by the Center for Health Information and Analysis found that 96.4 percent of Massachusetts residents are covered by health insurance, virtually unchanged in 2015 from a year ago when 96.3 percent reported having coverage.
Nationally, only 90.8 percent of Americans reported having health coverage at the beginning of 2015.
"Massachusetts continues to be a leader nationally with the high insurance rate, but it does mask the experience of some struggling to gain access to care and cost is still a barrier," said Aron Boros, executive director of the Center for Health Information and Analysis (CHIA).
The findings, based on the Massachusetts Health Insurance Survey, also revealed that 17 percent of people reported having problems paying their medical bill over the past 12 months, with 16.1 percent spending $3,000 or more out-of-pocket for health care for their families to cover deductibles, copayments and procedures not covered by insurance.
The problems affording health coverage and accessing care were particularly acute among certain populations, including Hispanics. Boros said that despite the high rate of people reporting coverage, 8 percent experienced a gap in coverage at some point over the last year.
The uninsured were more likely to be low-income, single, males and Hispanic than the rest of population and Hispanics were found specifically to have higher rates of emergency room visits and difficulty getting appointments.
"The policies that are in place to expand coverage exclude certain populations," Boros said, suggesting that the transiency of certain populations as well as "immigration rules for access to subsidies for public health programs" create particular barriers for the Hispanic population.
Boros said those who choose not to have health coverage represent a "relatively small part of the population."
Of those still uninsured, 55 percent cited the high cost of the health insurance as the main barrier followed by lost eligibility for MassHealth and Connector Care (34.6 percent) and the loss of a job (31.5 percent) that disrupted their insurance. Twenty-nine percent of those uninsured said they didn't know how to obtain coverage.
"It's expensive. Some certainly are not being reached and some need direct help but we also know there are people who can't afford coverage," said Amy Whitcomb Slemmer, the executive director of Health Care for All.
Though Slemmer said it's important to celebrate the fact that Massachusetts hasn't lost ground on the number of insured across the state, she said reaching those pockets of residents still struggling to gain access remains the focus of her group and others.
In mid-November, Health Care for All set up a day in Chelsea to help individuals sign up for coverage. About 70 percent of those who walked in for assistance were without coverage, and staff and volunteers helped sign up 130 new people for coverage on the spot.
"Providing in person assistance to sign people up makes a tremendous difference and making sure it's Spanish speaking assistance makes a tremendous difference," Slemmer said. "If you've been through the experience of applying for health insurance lately it's time consuming and very complicated."
The report found that in families looking to decrease the financial burden of health care in 2015 over 31 percent reported trying to stay healthier as their response to the high-cost of care while one in eight people said someone in their family went without needed care.
"We see that having implications both for the family budget as well as access to care," Boros said.
Among the positive takeaways from the survey, officials pointed to the fact that 89 percent of respondents reported having a usual source of care and 88.6 percent said they had visited a general doctor or other non-physician practitioner in the past 12 months.
Visits to the emergency room, however, remain a somewhat common occurrence that can drive up the overall cost of care when patients choose to wait until they have an immediate and more expensive medical need rather than seeking out regular preventative care.
One-third of survey respondents said they had visited an emergency department in the past year, a slight uptick from 2014. Of those who visited an emergency room, 40 percent said they sought care for a non-emergency condition.
CHIA said that difficulty getting an appointment with a primary care provider may have been a contributing factor to the rate of ER visits with one in five respondents reporting difficulty getting an appointment when needed and one in seven being told that a doctor was not accepting new patients.
The emergency room statistics in the CHIA provided a counterpoint to the Health Policy Commission's recent report that found emergency room use dropped slightly in 2014 with avoidable ER visits declining 3.5 percent and overall visits dropping less than half a percent.
"On the one hand it demonstrates that Massachusetts has been able to maintain the gains in covering individuals in the state, but it also demonstrates cost continues to be a real challenge," said Eric Linzer, senior vice president of the Massachusetts Association of Health Plans. "If you think about premiums reflecting the cost of care, we've had over the last five or six years more than two dozen state reports pointing to the prices doctors and hospitals charge and more recently the cost of prescription drugs making it difficult to not only keep health care affordable but also meet the benchmarks of the cost containment law."
The uninsured rate in Massachusetts has risen from a low of 1.9 percent in 2009, but the report and Boros said that the 2014 and 2015 numbers could not be accurately compared with previous years due to changes in the methodology of the survey, including the introduction of more cell phones numbers in the sample.
The uninsurance rate for children in Massachusetts in 2015 was 1.6 percent compared to 4.6 percent nationally, while the rate of elderly residents in Massachusetts without insurance was 0.8 percent, slightly higher than the 0.5 percent rate countrywide.
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