BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
MASSACHUSETTS HEALTH REFORM:
IMPACT ON WOMEN’S HEALTH
Paula A. Johnson, MD, MPH
Chief, Division of Women’s Health
x
v Director,, M
Mary
y Horrigan
g nC
Connors
nn
C
Center
n for
Executive
Women’s Health
Brigham and Women’s Hospital
1
Women’s Health Policy and Advocacy Program
MASSACHUSETTS
BEFORE HEALTH REFORM
• Strong consumer protections
• No pre
pre-existing
existing condition limitations
• Pro-choice legislature
g
and government
g
• 26 mandated benefits including:
maternity, mammography, contraceptive services, HRT,
pap smears, infertility treatment, mental health
2
BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
OVERVIEW
• Remaining Challenges
– Access to Care
– Affordability
g and Eligibility
g
y Transitions
– Coverage
• Research
– O
Ongoing
i R
Research
h
– Research Infrastructure
– Future Research Opportunities
• State and National Health Reform Opportunities
3
BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
Access to Care
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BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
THE NUMBERS
• As of Fall 2009, 97.1% of Massachusetts women
were insured,
insured up fr
from
m 91
91.4%
4% in 2006
• 92.8% of Massachusetts women had a usual source
of health care in 2009
• 90% had a general doctor visit and 82% had a
preventative care visit
Long SK and Stockley. The Impacts of Health Reform. June 2010. The BCBS Foundation.
5
BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
ACCESS AMONG WOMEN IN MA
• Essential Women’s Health Benefits
– Reproductive Health
– Primary
y Care (Ob/Gyn)
y
– Mental Health, Dental Care, Preventive Screenings
• Vulnerable Populations
– Younger Women
– Racial
R i l and
d Ethnic
Eth i Minorities
Mi iti
– Immigrants
6
BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
REPRODUCTIVE HEALTH
• In general, health reform has expanded access to contraceptives
• Barriers to Accessing contraceptives
- New ways of obtaining contraceptives
- Some Young Adult Plans and Student Health Plans do not have prescription drug
coverage–-- State student plans must now provide prescription coverage
- Difficulty understand what contraceptive services plans will cover
- Frequent
F
changes
h
in
i insurance
i
status impact
i
cost and
d continuity
i i off contraceptive
i
use
• Cost does not appear to be a barrier to contraceptive use after
health reform
• MA funds
f d medically
di ll necessary abortions
b ti
for
f M
Medicaid
di id
7
recipients --Coverage for abortion as extension of necessary maternity benefits
Ibis Reproductive Health; 2010
BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
THE PHYSICIAN
S O AG C
SHORTAGE
CHALLENGE
A
G
• Responses from 2009 MHIS data indicated
difficulty finding a provider accepting new patients
p populations
p p
of women
amongg multiple
– 2009-- one in five women reported difficulty finding a provider
• The
h 2009 Physician
h
Workforce
kf
Study
d placed
l d
OB/GYN physicians on the shortage list for the
fi t ti
first
time since
i
2002
– Many women use their OB/GYN as their main source
of primary care
Long SK and Stockley. The Impacts of Health Reform. June 2010.
MA Med Society 2009 Physician Workforce Study
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BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
ACCESS TO PRIMARY CARE
PROVIDERS
Percent off Massachusetts
h
Primary Care Providers
d
Accepting New Patients
Service
Family Medicine
I
Internal
lM
Medicine
di i
Obstetrics and
Gynecology
2008
2009
65%
52%
92%
60%
44%
81%
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MA Med Society 2009 Physician Workforce Study
BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
IMMIGRANT WOMEN
• Prior to JJune 2009,
2 9, Massachusetts insured
Legal Permanent Residents (LPRs) under
subsidized Commonwealth Care but cut
coverage due to budget constraints.
• The state created a separate insurance plan to
cover the nearly
y 330,000
,
LPRs that lost
coverage.
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BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
Affordability
y
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BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
WHO IS MOST AT RISK?
•Moderate-income women
•Women on low-premium, subsidized
insurance plans
•Young
Y
women enrolled
ll d in
i Y
Young Ad
Adult
l
Plans (YAPs)
•Women transitioning from no cost-sharing
to cost-sharing
h i plans
l
12
BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
MODERATE INCOME WOMEN
• Women earningg slightly
g y above the income limit for
Commonwealth Care are economically vulnerable
Commonwealth Care vs. Choice Premiums
Income
$32 400
$32,400
$32 600
$32,600
Monthly Premium
$116
$223
•Higher salary pays $107 more per month on premiums, $1284
more per year
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BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
COMMONWEALTH CHOICE
• 56
year old, divorced women with no dependents
•Below
B l
are th
the estimated
ti t d out-of-pocket
t f
k t costs
t for
f
her if she were diagnosed with breast cancer
(mastectomy)
Plan Type
yp
Bronze
Sil
Silver
Gold
Annual Out-of-Pocket Costs
$7,128
$
$4,004
$5,234
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BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
AGE RAT
RATING
NG
Lowest-cost C
L
Commonwealth
l h Ch
Choice
i Plans
Pl
ffor
a 31 year-old vs. 59-year old woman in Boston
Plan
31 year-old
59 year-old
Bronze
$224
$444
Silver
Gold
$272
$392
$544
$799
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BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
Transitions in Eligibility
and Coverage
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BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
• Women are more likely to experience life changes like
pregnancy or marriage and
d variable
bl income, which
h h impact
income eligibility
• Income eligibility for Medicaid and subsidized coverage are
only dollars apart
• In 2009,
2009 an average of 99,800
800 people transitioned into
MassHealth from Commonwealth Care and the Health
y Net ((HSN))
Safety
• 9,400 transitioned from MassHealth and Health Safety Net
to Commonwealth Care
17
Women’s Health Policy and Advocacy Program
Multiple
p Transitions
•27 year old single woman earning 150% of the Federal Poverty
Level (($16,245
, 45 a y
year)) is eligible
g
for Commonwealth Care.
•She becomes pregnant and is now categorically eligible for
Medicaid because her eligibility for public insurance negates
Commonwealth Care eligibility.
•While she waits for MassHealth eligibility,
eligibility she in insured by
MassHealth Prenatal, a short-term program designed to cover
pregnant
p
g
women while they
y wait for MassHealth approval.
pp
•After birth, she must re-apply to Commonwealth Care because
her income makes her MassHealth ineligible (mothers with
Medicaid eligible children can remain beneficiaries if they make
18
133% or less of the FPL).
BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
RESEARCH
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BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
ONGOING RESEARCH
• ASIST 2010: Public Health Approach to Screening and
Lifestyle Intervention
Inter enti n in Uninsured W
Women
men
1. Purpose is to gain insight into impact of models of care pre- and postMA HC Reform
R f
2. Measure the utilization of breast and cervical cancer and cardiovascular
w
uninsured
d women
w
ggain access to w
widely
d y available health
screeningg when
insurance
1. Some moving from Women’s Health Network (navigation
model) to other products;
3. Investigate the effectiveness of a program, Healthy Heart, to reduce
risk of heart disease in a vulnerable population pre- and post- MA HC
reform.
f
• Women’s Health Data Matrix
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BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
Current Projects related to the Impact on Massachusetts Health Reform on Women’s Health (March
2010)-Massachusetts Data- DRAFT
Name of
Project
Principal
Investi
gator
Key Research
Questions
Key Data
Sources
Goals and Measures
Studied
Timeline
- Percentage of Commonwealth
Care enrollees that are
women.
- Percentage of Commonwealth
Choice enrollees that are
women.
- How high deductible plans are
more burdensome for
women.
- Annual out of pock expenses
for women.
- Number/percentage rates of
women who are
uninsured.
- Accessibility of insurance for
i
immigrant
i
t women.
Spring
200
8
Funding or
Sponsor
ing
Agency
[Studies Directly Focused on Gender]
Women and
Health Care
Reform in
Massachus
etts
(Policy Brief)
Susan Sered,
PhD
How did/does reform
affect women of
diverse ages
and income
statuses?
How has health
reform
impacted the
most vulnerable
groups of
women?
Published
reports,
surveys,
fact sheets
Center for
Women’s
Health and
Human
Rights
Suffolk
University
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BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
RESEARCH INFRASTRUCTURE
• Data needs
– Women’s Health Data Matrix
– Quantitative and qualitative data
• IRB challenges
– State-based health insurance exchanges
– Insurers and multiple clinical entities
• Anticipating research needed to understand impact
of National HC Reform on Women
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BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
FUTURE RESEARCH
OPPORTUNITIES
• Affordability/Cost
•Cost will be a major focus on next phase of MA HC
reform--?Impact on women
•Coverage
•Medicaid expansion
•Reproductive Health/Abortion
•Transitions in Eligibility and Coverage
•Gender rating
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BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
•Access
FUTURE RESEARCH
OPPORTUNITIES
•Provider Shortages/ED Utilization
•Vulnerable
Vulnerable Populations
•Young women, racial and ethnic minority women,
immigrant women
women, incarcerated women
•Caregivers
•Health Issues of Particular Importance to
Women
•Mental Health
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BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
FUTURE RESEARCH
OPPORTUNITIES
•Quality/Outcomes
Q lit /O t
•Utilization/Screening
•Models of Care across the lifespan (Medical homes)
•Women s health as essential component to “Patient
•Women’s
PatientCentered Outcomes Research”
•Health
H l h outcomes
•Are we achieving improved health?
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BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
OPPORTUNITIES FOR MA
AND NATIONAL HEALTH REFORM
• Collect and Stratify Data by Sex– opportunity to
collaborate with Federal and State institutions (AHRQ)
• Reduce Costs / Monitor Affordability
• Administrative Simplicity / Patient Navigation
• Primary
P
C
Care Sh
Shortage
• Vulnerable Populations
- Young Women
- Immigrant Women
- Racial and Ethnic Minorities
- Caregivers
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BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
DATA SOURCES
• The Blue Cross Blue Shield of Massachusetts Foundation:
http://bluecrossfoundation org/
http://bluecrossfoundation.org/
•Ibis Reproductive Health:
http://www.ibisreproductivehealth.org/
•Public Health Approaches to Screening and Lifestyle Intervention in
Uninsured Women Study (ASIST 2010)
www brighamandwomens org/communityprograms/
www.brighamandwomens.org/communityprograms/
•Suffolk University Center for Women’s Health and Human Rights
http://www.suffolk.edu/college/10649.html
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BRIGHAM AND WOMEN’S HOSPITAL
Mary Horrigan Connors Center for Women’s Health
To read the Women’s Health Policy
y and Advocacy
y
Program’s Issue Brief, please click this link:
http://www.brighamandwomens.org/ConnorsCent
er/images/ConnorsCenter.pdf
Contact Information
Paula A. Johnson, MD, MPH
Chief, Division of Women’s Health
Executive Director, Connors Center for
f Women’s Health
l h and
d
Gender Biology
Brigham and Women’s Hospital
617-732-8985
pajohnson@partners.org
www.brighamandwomens.org/womenspolicy
bi h
d
/
li
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Women’s Health Policy and Advocacy Program
IMPROVEMENTS IN COVERAGE
SINCE REFORM
• Most newly-insured
y
have subsidized coverage
g
– 68 percent covered through MassHealth or CommCare
– 12 percent non-group individual, 20 percent ESI
• All populations of women experienced significant coverage gains
since reform
–
–
–
–
Lower income
Racial and ethnic minorities
Women 50 – 64
Women without dependent children
• Total enrollment in subsidized coverage remains higher among
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women than men
Women’s Health Policy and Advocacy Program
WHO ARE THE UNINSURED
WOMEN IN MA?
• Nearly 60,000 women remain uninsured
• Uninsured women are disproportionately
– Young
– Single
– Hispanic
• Over half are employed (often in smaller firms)
• Over 75 percent of have incomes under 300 percent
FPL and may qualify for subsidized coverage
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