Lessons from Massachusetts: Health Reform is Good for Women

By Lauren Birchfield and Sharon Long

Good news for women's health from Massachusetts after state health reform implementation: national health reform is likely to bring important gains for women's access to insurance coverage and health care across the country.

A recent study by the Blue Cross Blue Shield of Massachusetts Foundation and the Urban Institute found that adult women in Massachusetts have achieved significant gains in insurance coverage and access to care since health reform in the state, as well as some significant improvements in the affordability of care. The report, The Impacts of Health Reform on Health Insurance Coverage and Health Care Access, Use, and Affordability for Women in Massachusetts, compared women's insurance coverage and access to care in fall 2006, the period just prior to health reform in the state, to fall 2009, three years after implementation.

National health reform is largely modeled off the Massachusetts health reform initiative and incorporated many key provisions of the Massachusetts reform into its framework. Thus, key findings from the Massachusetts report, which focused on the impacts of health reform on insurance coverage, access to and use of health care, and the affordability of care between fall 2006 and fall 2009, stand as important indicators of the impact that national health reform and the expansion of public subsidies could have on women's health nationwide.

Notable findings from the Massachusetts report include:

Women's access to care improved under Massachusetts health reform

97% of women in Massachusetts were insured in 2009, compared to 91% in 2006. Much of this gain was due to an increase in public coverage among women, which was 4 percentage points higher in 2009 than it was in 2006.

93% of women had a usual source of health care in 2009 (i.e., a place they usually went when they were sick or needed advice about their health), up from 90% in 2006.

In 2009, more than 90% of women had visited a doctor at least once during the prior year, and 82% had gone on a preventive care visit, as compared to 85% and 77%, respectively, in 2006.

In 2009, there were strong reductions in the number of women reporting unmet need for care, which decreased by nearly 6 percentage points overall between 2006 and 2009.

Women also demonstrated some affordability gains during reform

Under reform, there was a significant drop in the share of women reporting that they did not get needed care because of costs.  Specific unmet need for doctor care; medical tests, treatment, or follow-up care; prescription dugs; and dental care, also decreased.

However, some affordability barriers persist post-reform.  Roughly one in five women reported problems paying medical bills in both 2006 and 2009. Equivalent shares of women reported medical debt and high out of pocket costs for medical care.

Women within vulnerable populations showed strongest gains under reform

Gains under health reform were particularly strong for vulnerable subgroups of women, who started out with lower levels of insurance coverage, poorer access to and use of care, and more problems with the affordability of care prior to reform. These subgroups include lower-income women; racial/ethnic minority women; older women aged 50 to 64; and women without dependent children.

Insurance coverage for lower-income women increased from 85% in 2006 to 95% in 2009, and insurance coverage for racial/ethnic minority women increased from 90% to 96% over this period.

Lower-income women, racial/ethnic minority women, older women, and women without dependent children also saw marked improvements in access to and use of care and in the affordability of care under health reform.

These findings from Massachusetts are all the more impressive given that women tend to have a larger need for health care than men, due to their reproductive health needs and greater incidence of chronic conditions. When considered in the context of national reform, these gains suggest that national health reform has the potential to result in significant improvements in coverage and access to care for women across the nation. These findings also suggest that addressing affordability and costs of care at both national and state levels will be key to ensuring the sustainability of those gains for women. Affording care can often be a challenge for women. Women typically earn less than men, which can make it more difficult for them to afford care. In addition to being more likely to forego care because of costs, women spend a greater share of income on medical expenses and report higher levels of difficulty paying medical bills or debt. That some women in Massachusetts across all demographic and socioeconomic groups continued to report unmet need for care because of costs in 2009 suggests an ongoing need to address affordability of care in the state and indicates that cost containment must be a priority of national health reform, as well.

Lauren Birchfield of the Blue Cross Blue Shield of Massachusetts Foundation
 is a graduate of Harvard Law School. Her areas of research interest include food security, conflict prevention and peace-building and the promotion of the unique socio-economic rights (and needs) of women and children.

Sharon K. Long, Ph.D., is a senior fellow and an applied economist at the Health Policy Center of the Urban Institute who has studied health reform initiatives in Massachusetts and Florida as well as effects of Medicaid managed care on access and use for disabled beneficiaries, the effects of rising premiums on insurance coverage, the effectiveness and efficiency of care delivery in managed care, and child obesity.