Massachusetts
M
h
tt Health
H lth Reform:
R f
Good for women?
A model for the U.S.?
Tracey Hyams, JD, MPH
Director, Women’s Health Policy and Advocacy Program
Connors Center for Women’s Health and Gender Biology
Brigham
g
and Women’s Hospital,
p
, Boston
Academy Health Annual Research Meeting
July 27, 2009
Goals for today:
• Outline of Massachusetts health reform
• Impact of Massachusetts reforms, especially
for women
• Understand lessons for national health reform
Elements of Health Care Reform
i Massachusetts
in
M
h
tt
Universal Coverage (2006)
•
•
•
•
Expanded Medicaid
Individual mandate
Employer mandate
Established Commonwealth Connector
→ Commonwealth
Care (sliding subsidies for
private coverage <300% FPL)
→ Commonwealth
C
lth Choice
Ch i (>300%
( 300% FPL)
→ Benefits
→ Affordability
Elements of Health Care Reform
i Massachusetts
in
M
h
tt
C
Costs,
Quality,
Q li
Delivery
D li
(2008)
•
Established Mass.
Mass Health Care Quality and
Cost Council
•
•
•
•
FFS  P4P  Global payments
Expands primary care
Statewide health IT
Medicaid Medical home demonstration
What’s Working in
M
Massachusetts
h
tt
•
Near-universal coverage


•
•
•
•
•
97.4 percent insured
Most uninsured “young invincibles”
Improved access overall
 premiums for individuals and small
groups
High
g p
public support
pp
((74 p
percent))
Employer support
Robust benefit package, including…
Benefit Mandates in Massachusetts
(partial list)
•
•
•
•
•
•
•
Preventive
P
i
and
d primary
i
care
Emergency services
Hospitalization
Ambulatory
y services
Prescription drugs
Mental health
Bone marrow treatments
for breast cancer
•
•
•
•
•
•
•
•
Contraceptives
C
i
Pap smears
Infertility treatment
Mammography
Maternity care
Hormone replacement
therapy
Cardiac rehab
Home health care
Challenges in Massachusetts
•
High cost / financing
•
•
Affordability
•
•
•
•
Rising enrollment → rising costs → new cuts
Increasing premiums, deductibles, co-pays
Medical debt
Racial, ethnic, and (likely) gender disparities
Access to primary care
•
•
•
Geographic, racial, ethnic disparities
24% subsidized coverage vs. 7% privately insured
report challenges
Continued reliance on emergency room
(continued…)
Challenges in Massachusetts
(
(continued)
ti
d)
•
•
•
Gaps in coverage → inconsistent access
Erosion of the safety net
• $150 million cut from largest “safety net”
hospitals
p
Women remain vulnerable:
• Age 45 – 64 are increasingly underinsured
• Are 3.5 times more likely to forego services
Meet Louise…
Louise
•
•
•
•
•
Age 26,
26 earns $35,000/year
$35 000/year
Overall good health
Suffers from anxiety; began seeing a
psychotherapist and taking Effexor
Received HPV vaccinations
Birth control failed, had an abortion
Louise’ss total out of pocket health costs
Louise
for premiums, deductibles, coco-pays:

Plan (with Rx)
Total Annual
Cost*
Young Adult
$6,713
Bronze
$4,844
Silver
$4,554
*For health plans with prescription coverage.
Source: Sered, Susan et al. “Women and Health Care Reform in Massachusetts.” Policy Brief, Spring 2008. Center for Women’s Health and
Human Rights, Suffolk University. Accessed at http://www.suffolk.edu/files/cwhhr/Health_Policy_Brief.pdf.
Baseline Conditions
i Massachusetts
in
M
h
tt
•
•
•
•
•
•
•
•
•
Low rate
L
t off uninsured
i
d (10 – 12%)
Free Care Pool
Robust benefit mandates, including
reproductive health
Non-profit insurers
Trust among stakeholders
Health care as economic driver
Public support
pp
Employer buy-in
Legislative and executive approval
(b no CBO)
(but
Lessons from Massachusetts
for Women’s Health Policy
•
Consolidation, regulation of the individual and
small group markets does lower costs
•
Coverage ≠ access
• Affordability
• Continuity of coverage
• Workforce shortages
•
Women, poor, and
W
d racial/ethnic
i l/ th i minorities
i
iti
remain vulnerable
Contact
Tracey Hyams, JD, MPH
Director, Women’s Health Policy and
Advocacy Connors Center for Women’s
H lth and
Health
dG
Gender
d Bi
Biology
l
Brigham and Women’s Hospital
75 Francis Street, OBC3-34A
Boston, MA 02115
617 – 525 – 7516
THYAMS@PARTNERS.ORG
www.brighamandwomens.org/womenspolicy
Thank you!