Women’s Health Policy and Advocacy Program
MASSACHUSETTS HEALTH REFORM:
IMPACT ON WOMEN’S HEALTH
Tracey Hyams, JD, MPH, Director
Laura Cohen, Policy Analyst
Women’s Health Policy and Advocacy Program
Connors Center for Women’s Health and Gender Biology
Brigham and Women’s Hospital
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Women’s Health Policy and Advocacy Program
DATA SOURCES
• The Blue Cross Blue Shield of Massachusetts Foundation:
http://bluecrossfoundation.org/
•Ibis Reproductive Health:
http://www.ibisreproductivehealth.org/
•Suffolk University Center for Women’s Health and Human Rights:
http://www.suffolk.edu/college/10649.html
•Brigham and Women’s Center for Community Health and Health
Equity:
www.brighamandwomens.org/communityprograms/
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Women’s Health Policy and Advocacy Program
MASSACHUSETTS
BEFORE HEALTH REFORM
• Strong consumer protections
• No pre-existing condition limitations
• Pro-choice legislature and government
• 26 mandated benefits including:
maternity, mammography, contraceptive services, HRT,
pap smears, infertility treatment, mental health
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Women’s Health Policy and Advocacy Program
HOW DOES REFORM IN MA
COMPARE TO NATIONAL REFORM?
Provision
MA
US
Individual mandate
√
√
Employer penalty 
√
√
Medicaid expansion
√
√
Insurance exchanges
√
√
Sliding scale subsidies for certain individuals and families
√
√
A required set of health benefits for all private plans
√
√
No gender or health-status premium rating allowed
√
√
Caps on out-of-pocket spending
√
√
Direct access to an OB/GYN without referral
√
√
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Women’s Health Policy and Advocacy Program
LANGUAGE OF MASSACHUSETTS
HEALTH REFORM
• Health Insurance Connector
• Minimum Creditable Coverage (MCC)
• Commonwealth Care (subsidized)
• Commonwealth Choice (unsubsidized)
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Women’s Health Policy and Advocacy Program
EVALUATING MASSACHUSETTS
HEALTH REFORM
• Coverage
• Access
• Affordability
• Transitions
• Remaining Opportunities
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Women’s Health Policy and Advocacy Program
Coverage
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Women’s Health Policy and Advocacy Program
IMPROVEMENTS IN COVERAGE
SINCE REFORM
• Most newly-insured have subsidized coverage
– 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
Figure 2
Uninsurance Trends Women 18-64
United States vs. Massachusetts
2003-2009
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
2003
2005
United States
2007
2009
Massachusetts
Source: Current Population Survey 2003 - 2009
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Women’s Health Policy and Advocacy Program
Figure 1
Distribution of the Newly Insured
June 2006-June 2009
CommCare(No
Premium),
123,000, 31%
Non-Group
(Individual),
49,000, 12%
MassHealth,
99,000, 24%
CommCare
(PremiumPaying), 54,000,
13%
Private Group
(ESI), 83,000,
20%
Source: Massachusetts Division of Health Care Finance and Policy
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Women’s Health Policy and Advocacy Program
Insurance Coverage of Women 18-64: United States and
Massachusetts, 2008
80%
70%
60%
70.9%
62.6%
50%
40%
30%
20%
18.1%
16.9%
10%
4.8%
10.2%
3.2%
5.9%
1.8%
5.6%
0%
Employer
Individual
United States
Medicaid
Other Public
Uninsured
Massachusetts
Source: Current Population Survey 2008
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Women’s Health Policy and Advocacy Program
HEALTH COVERAGE OF WOMEN
IN MASSACHUSETTS
Source of Coverage
Any insurance coverage
Fall
Fall
2006 2009
91.4 97.1
Difference
+
5.7
ESI coverage
67.1
68.7
+
1.6
Public or other coverage
24.3
28.4
+
4.1
Source: Sharon Long. The Impacts of Health Reform on Health Insurance Coverage and
Health Care Access, Use, and Affordability for Women in Massachusetts. The BCBS of
MA Foundation.
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Women’s Health Policy and Advocacy Program
IMMIGRANT WOMEN
• Until June 2009, legal permanent residents
eligible for subsidized coverage through
CommCare.
– Cut due to budget constraints
• “CommBridge” created to cover nearly
30,000 LPRs who lost coverage
– Capped enrolment
– Limited benefits
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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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Women’s Health Policy and Advocacy Program
Access to Care
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Women’s Health Policy and Advocacy Program
IMPROVEMENTS IN ACCESS
AMONG WOMEN IN MA
Fall 2006 Fall 2009 Difference
Had usual source of care
90.3
92.8
+ 2.5
Any doctor visit past 12 months
84.8
90.7
+ 5.8
Visit for preventive care
77.4
82.0
+ 4.6
Any dental visit past 12 months
72.7
79.1
+ 6.4
Did not get needed care for any reason
in past 12 months
26.9
21.2
- 5.7
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Source: Sharon Long. The Impacts of Health Reform on Health Insurance Coverage and Health Care Access, Use, and Affordability
for Women in Massachusetts. The BCBS of MA Foundation.
Women’s Health Policy and Advocacy Program
ACCESS AMONG WOMEN IN MA
• Essential Women’s Health Benefits
– Reproductive Health
– Primary Care (Ob/Gyn)
– Mental Health, Dental Care, Preventive Screenings
• Vulnerable Populations
– Younger Women
– Racial and Ethnic Minorities
– Immigrants
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Women’s Health Policy and Advocacy Program
REPRODUCTIVE HEALTH
• Generally, health reform expanded access to contraceptives
• Cost does not appear to be a barrier to contraceptive use after
health reform
• Remaining barriers
- Women receive Rx instead of contraceptives
- No Rx coverage in some young adult-target plans
- Difficulty understand what plans cover
- Frequent changes in insurance status impact cost and continuity of contraceptive use
• Insurers continue to cover abortions
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Women’s Health Policy and Advocacy Program
ACCESS TO PRIMARY CARE
• In 2009, one in five women reported difficult
finding a provider
• “Several labor market conditions”- internal
medicine, family medicine and Ob/Gyn
• Wait times for internal medicine, family
medicine and Ob/Gyn unacceptably long
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Women’s Health Policy and Advocacy Program
ACCESS TO PRIMARY CARE
PROVIDERS
Percent of Massachusetts Primary Care Providers
Accepting New Patients
Service
2008
2009
Family Medicine
65%
60%
Internal Medicine
52%
44%
Obstetrics and Gynecology
92%
81%
Source: Massachusetts Physician Workforce Study. 2009.
Massachusetts Medical Society.
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Women’s Health Policy and Advocacy Program
Affordability
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Women’s Health Policy and Advocacy Program
WHO IS MOST AT RISK?
•Moderate-income women
•Women choosing low-premium, high
deductible health plans
•Women enrolled in young adult-target plans
•Women transitioning from the safety net to
cost-sharing plans
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Women’s Health Policy and Advocacy Program
MEET MALIKA
Malika is a student who became pregnant while covered through her
college’s student health plan (SHP). Although her SHP covers
pregnancy, coverage is capped at $25,000 per injury or illness. Malika
had a complicated delivery, which required ambulance transportation
to a hospital better able to handle her high-risk care. Unfortunately,
her plan has an individual service cap on ambulance transportation,
leaving her responsible for $1,500 in out-of-pocket costs. The hospital
charged $24,000 for Malika’s care and $32,000 for her baby’s care. Her
health plan decided to count Malika and her baby’s care as a single
episode of illness, leaving her with $31,000 in additional out-of-pock
costs. Her massive medical bills qualify her for the Health Safety
Net; however, she is still responsible for paying a significant portion
of the costs herself - $16,000.
“If the insurance barely helped me then what am I paying them
for?”
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Women’s Health Policy and Advocacy Program
MEET ANN
Ann is 56 years old, divorced with two adult
children. She makes $62,000 a year and a realtor
for a small firm not required to offer health
insurance. This year, Ann had an annual
mammogram which detected an abnormal mass in
her right breast. She was diagnosed with breast
cancer and had a mastectomy. Ann’s income
qualifies her for a Commonwealth Choice plan.
This chart highlights her out-of-pocket costs
(premiums, deductibles and co pays) for one year
under different Commonwealth Choice Plans.
Plan (with Rx)
Total Annual Cost
Bronze
$7,128
Silver
$4,004
Gold
$5,234
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Women’s Health Policy and Advocacy Program
MEET JENNIFER
Jennifer is 31 years-old and self-employed. She
makes $32,600 a year and does not qualify for
subsidized Commonwealth Care. It is
important to note that Jennifer make $100
dollars more than the income cut off for
Commonwealth Care program ($32,500) yet
she pays between $83 and $108 more per month
on premiums.
Jennifer will pay between $996-$1,296 more
per-year just on premiums because she makes
$100 dollars more than the income cap for
Commonwealth Care.
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Women’s Health Policy and Advocacy Program
MEET DIANA
Diana is a 28-year old single adult working at a
small firm that does not provide health
insurance. She makes 32,400 dollars a year,
making her eligible for Commonwealth Care.
Diana pays $116 a month on premiums, far less
than her sister Jennifer, despite the fact that
Diana only makes $200 dollars more than
Jennifer.
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Women’s Health Policy and Advocacy Program
AGE RATING
Lowest-cost Commonwealth Choice Plans for
a 31 year-old vs. 59-year old woman in Boston
Plan
Bronze
31 year-old
Jennifer
$224
59 year-old
Lily
$444
Silver
Gold
$272
$392
$544
$799
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Women’s Health Policy and Advocacy Program
Transitions in
Eligibility and Coverage
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Women’s Health Policy and Advocacy Program
• Women are more likely to experience life changes
and variable income, which impact eligibility
• Income eligibility for Medicaid and subsidized
coverage are only dollars apart
• In 2009, an average of 9,800 people transitioned into
MassHealth from Commonwealth Care and the
Health Safety Net (HSN)
• 9,400 transitioned from MassHealth and HSN to
Commonwealth Care
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Women’s Health Policy and Advocacy Program
MEET CHRISTINA
below 200% FPL. Christina must apply for Medicaid Christina
is a 27 year old single woman earning 150% of the Federal
Poverty Level ($16,245 a year) working as a waitress and is
eligible for Commonwealth Care. Christina become pregnant
and is now categorically eligible for Medicaid because her
income is because eligibility for public insurance negates
Commonwealth Care eligibility. While she waits for
MassHealth eligibility, she in insured by MassHealth Prenatal,
a short-term program designed to cover pregnant women while
they wait for MassHealth approval. After birth, she must reapply to Commonwealth Care because her income makes her
MassHealth ineligible (mothers with Medicaid eligible children
can remain beneficiaries if they make 133% or less of the FPL).
In one year, Christina has applied to three insurance plans and
transitioned between plans four times.
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Women’s Health Policy and Advocacy Program
OPPORTUNITIES FOR MA
AND NATIONAL HEALTH REFORM
• Collect and Stratify Data by Sex
• Reduce Costs / Monitor Affordability
• Administrative Simplicity / Patient Navigation
• Primary Care Shortage
• Vulnerable Populations
- Young Women
- Immigrant Women
- Racial and Ethnic Minorities
- Caregivers
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Women’s Health Policy and Advocacy Program
To read the Women’s Health Policy and Advocacy
Program’s Issue Brief, please click this link:
http://www.brighamandwomens.org/ConnorsCent
er/images/ConnorsCenter.pdf
Contact Information
Tracey Hyams, JD, MPH
Director, Women’s Health Policy and Advocacy Program
Connors Center for Women’s Health and Gender Biology
Brigham and Women’s Hospital
Boston, MA
thyams@partners.org
www.brighamandwomens.org/womenspolicy
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