Access update

40 Pages·2001·2.9 MB·English

by  Massachusetts. Division of Health Care Finance and Policy

2001
Access Update
0e "s
P°s/tory Copy
Massachusetts Elderly
and Prescription Drug Coverage
Thispublication isthefirstinaseriesofmonographsbasedon the About one-fifth of seniors (19.5%) are low-income
resultsoftheDivisionofHealth CareFinanceandPolicy's2000 (below 150% ofthe federal poverty level orFPL).
HealthInsuranceStatusofMassachusettsResidentsSurvey. This Metro Boston has the highest proportion of elderly
seriesisalsoavailableon ourwebsite: www.state.ma.us/dhcfp. (36%), followedby the Southeast region (19.6%).
(see Figure 1 and Figure 2 below)
The
rising cost of prescription drugs and prescription
drugcoveragehasmadeitincreasinglychallengingfor
many elders to afford necessary medications. Nation- Figure 1
wide, 55% ofadults ages 65 and over take three or more pre- Massachusetts Non-Institutionalized Elderly
scription drugs on a regular basis and 23% report a "serious by Income
problem" paying for needed prescription medicines.1 Massa-
HMO
chusetts has experienced disruptions in the Medicare
HMO
market, such as the capping ofthe Medicare pharmacy
HMO
benefit and the discontinuation of several Medicare
products.2 Access to affordable drug coverage has become a
key political issue atboth the state and national levels.
ThisissueofAccess Updatelooksatprescriptiondrugcov-
erage for non-institutionalized seniors in Massachusetts and
analyzes the burden ofprescription drug expenditures on spe-
cific categories of Massachusetts elderly. The survey of the
health insurance status of Massachusetts residents was con-
ducted between February and July of 2000. Information was
collected on 452 households with an elderly resident and
Figure 2
736 elderly individuals living in these households. Interviews
Massachusetts Non-Institutionalized Elderly
were conducted using computer-assistedtelephone interview-
by Region
ing technology. The survey questionnaire was available in
^eti
bothSpanishandEnglish. Responsestosurveyquestionswere Worcester
12%
weighted in order to reflectpopulation estimates.
MetroBoston
37%
Demographics
i
• Most Massachusetts elderly are female (57%).
• Over halfthe population is married (55%), and another W
34% are widowed; the remainderhave neverbeen mar- Northeast \ /
ried, orare divorced orseparated.
• While most seniors (85%) do not work, about 15% of
Southeast
seniors report that they are employed. 20%
Access Update: Massachusetts Elderly and Prescription Drug Coverage
author: Victoria Nixon • series editor: Cindy Wacks • design: Heather Shannon • distribution: Dorothy Barron
copyright © March 2001 Division of Health Care Finance and Policy
Prescription Drug Coverage setts seniors report that they spend more than $100 monthly
Survey results indicate that just over 28% of non-institu- onprescriptiondrugs. Nearlyhalfoflow-incomeseniorswith-
tionalizedMassachusetts seniorslackprescriptiondrugcover- out prescription drug coverage (46%) had high out-of-pocket
age.Low-incomeseniorsaremuchlesslikelytohavecoverage costs (see Figure 3 and Figure 4below left).
than those residing in households with incomes greater than The very old are also disproportionately represented
150% of the federal poverty level. While 19.5% of seniors among the population of non-institutionalized seniors lack-
reside in low-income households, 44.3% ofthese elderly lack ing prescription drug benefits. While 11.6% ofthe non-insti-
drug coverage. tutionalized elderly are ages 85 and over, more than half of
Seniors without pharmacy coverage are twice as likely to these seniors(56%)reportnopharmacycoverage. Incompari-
face high out-of-pocketcosts (more than $75 per month) than son, less than 32% ofseniors ages 75 to 84 and about 19% of
those with prescription drug coverage. The burden ofout-of- seniors ages 65 to 74 report lacking pharmacy coverage.
pocket drug costs falls disproportionately on certain groups Most drug spending is forlong-term conditions oracom-
of the elderly. These groups include seniors without supple- bination of long and short-term conditions. Less than 8%
mental coverage orMedicaid, low-income elderly, those with of drug spending for seniors is for short-term conditions
chronic conditions, and the very old (ages 85 and over). The only.3 Nearly all seniors with high out-of-pocketcosts report
majority of elderly who used prescription drugs in the past at least one long-term condition requiring prescription drug
yearspentbetween $11 and $50out-of-pocket monthly. How- medication.
ever, approximately 18% of non-institutionalized Massachu-
Sources of Prescription Drug Coverage
Figure 3 About 29% of the elderly report that a Medigap policy
% HMO
Monthly Out-of-Pocket Drug Costs helps pay for their drugs, 31 stated that a Medicare
provides assistance, 10% credit MassHealth, and 28% report
that they receive assistance from a private insurer. Of those
interviewed, 11% state that the Senior Pharmacy Program
helped pay fortheirprescription drugs4 (see Figure 5 below).
Figure 5
Sources of Prescription Drug Coverage*
11.0% |10.2%
lessthan $11 to$50 $51 to$75 $76to$100 morethan
$10 $100
Figure 4
Non-Institutionalized Elderly Lacking Drug Benefit
by Income
Medigap Medicare MassHealth Private Pharmacy
HMO Insurance Program
"Pleasenotethattheseresponsesarenotmutuallyexclusive.
30.1%
26.1%
The Senior Pharmacy Program
1
In response to decreasing coverage for prescription drugs
and increasing out-of-pocket expenses for the elderly, the
SeniorPharmacyProgramwasimplementedinMassachusetts
151-200% 201-400%
ofFPL ofFPL onJuly 1, 1997.5
Access Update • 2
Survey respondents were asked about sources ofprescrip- The Prescription Advantage Plan
tion coverage for the past 12 months. For some of that time The "PrescriptionAdvantage Plan" is the name ofthe new
period the SeniorPharmacy Programprovided Massachusetts insurance-based prescription drug program signed into Mas-
residents, ages 65 and over, up to $750 in prescription drug sachusetts law this year. TheAdvantage Plan will be available
coverage per year. As of January 1, 2000 new legislation toeldersandtopeoplewithqualifieddisabilities.Whenimple-
amended the Senior Pharmacy Program calling it the Phar- mented in April of 2001, this plan will replace the existing
macy Program. The Pharmacy Program now provides up to Pharmacy and Pharmacy Plus Programs.6 Those enrolled in
$1,250 annually to eligible elders or disabled individuals to these programs will automatically be considered formember-
help pay for prescription drugs. Survey response indicates ship in the new insurance plan. Enrollees contribute monthly
that approximately 63,000 seniors receive assistance through premiums, annual deductibles and co-payments on a gradu-
this program. These survey results are validated by program ated scale based on annual household income.
enrollment figures.
Conclusion
Potentially Eligible Seniors Out-of-pocketcostsfallmostheavilyonspecificcategories
The elderly most likely to be eligible for the Pharmacy of elderly, including low-income seniors, the very old, those
Program are those residing in households with incomes of with chronic health conditions and those lacking supplemen-
185% ofthe FPL or less with no other prescription drug ben- tal coverage or Medicaid. Studies based on national samples
efit. Survey data indicate that about 8% of non-institutional- ofpersons ages 65 and over report that out-of-pocket expen-
ized seniors are potentially eligible. More potentially eligible ditures as a percentage of total health care expenditures are
seniors reside in the Metro Boston region (38.3%) and the highestforthose with no supplemental coverage.
West region (23.4%) than in other regions of the state. The The Division's survey findings were validated by a recent
majority ofeligible seniors report at least one long-term con- study by the Rand Corporation. The Rand study found that
dition requiring prescription drug medication. among elderly persons, insurance coverage for drugs reduces
the fraction ofhousehold income spent on prescription drugs
Awareness of the Pharmacy Program by 50%. The authors concluded that the groups most likely
The proportion of seniors who have heard of the Massa- tobenefitfromsuchcoverage areelderly women, low-income
chusetts Pharmacy Program has increased from 35% in 1998 seniors, and those with chronic conditions.
to 55% in 2000. Awareness for seniors within the eligible As policy makers attempt to allocate limited health care
income category is even greater, with approximately 69% resources, understanding the distribution of out-of-pocket
aware of the program. These results indicate that increased pharmacycosts acrosssub-groupsofelderlyis vital.The 2000
outreach efforts were effective. There is a higher awareness Health Insurance Status of Massachusetts Residents Survey
ofthe Pharmacy Program among seniors living in the Metro provides one source of information for policy makers. With
Boston and Southeastregions (see Figure 6 below). the pendingimplementation ofthe new pharmaceuticalcover-
ageplan,itisimportanttocontinuemonitoringtheprogressof
Figure 6 new initiatives in providing access to necessary medications
Awareness of Senior Pharmacy Program forvulnerable Massachusetts residents.
by Region
Worcester
13.0%
1. The NewsHourwithJim Lehrer/ Kaiser Family Foundation / Harvard School of Public
HealthNationalSurveyonPrescriptionDrugs.09/2000(conductedJuly-September2000).
2. "No Giving Thanks to Pilgrim." Boston Globe, 11/22/1998. See also Boston Globe.
08/24/1999."W.Mass.EldersMayGetHealthCoverageAid"byRichardA.Knox.
3. Short-termconditionsaredefinedasconditionslastingfewerthan30days.
—
4. Categoriesoverlap becauserespondentscouldselectmorethanonecategory,thetotal
doesnotequal100%.
5. ThisprogramisfundedthroughtheChildren'sandSenior'sHealthCareAssistanceFund
andtheTobaccoSettlementFund.
6. Pharmacy Plus Program assists seniors and disabled persons with high prescription
drug costs. Qualified applicants must have spent at least 10°o of their gross monthly
incomeonprescriptiondrugsinthreeoftheprevioussixmonthsandhaveannualincome
under$41.200forindividualsand$55,320foracouple.ThePharmacyPlusprogrampro-
videsdrugcoveragewithnodollarlimit.
Access Update • 3
Ml Division of Health Care Finance and Policy
Two Boylston Street
\:,V Boston. MA 02116-4704
Argeo Paul Cellucci, Governor • William D. O'Leary, Secretary, Executive Office of Health and Human Services
Louis I. Freedman, Commissioner • Division of Health Care Finance and Policy • Two Boylston Street • Boston, MA 02116-4704
phone: [phone] • fax: [phone] • publications: 617-988-3125 • www.state.ma.us/dhcfp
What's
New
www.state.ma.us/dhcfp
from
DHCFP?
Access to Health Care in Massachusetts:
A Catalog of Programs for Uninsured and Underinsured Individuals
This catalog includes information about private and public health care programs including
eligibility criteria, benefits and services offered and information on how to apply and how to
contact the program. Get your copy today at www.state.ma.us/dhcfp.
Massachusetts Health CareTrends: 1990-1999
Using charts and graphs, this report summarizes the past decade focusing on how the health
care delivery system has changed since 1990 and how Massachusetts differs from the United
States as a whole. Print this report forfree from our web site: www.state.ma.us/dhcfp
Regulations
DHCFP regulations are available online. Please visit our web site at www.state.ma.us/dhcfp to
obtain copies of the regulations, public hearing notices and the public hearing schedule.
Number 2 • June 2001
Access Update
DOCUMENTS
GOVERMENT
COLLECTION
MAR 0 3 2002
Health Insurance Status
Massachusetts
University of
Depository Copy
of Massachusetts Children
Thispublication isthesecondinaseriesofmonographsbasedon Children are more likely to receive health insurance
theresultsoftheDivisionofHealth Care FinanceandPolicy's2000 coverage through Medicaid than non-elderly adults.
HealthInsuranceStatusofMassachusettsResidentsSun'ey: This 16.3% versus 10.2% (see Figure 1 below).
series isalsoavailableonourwebsite: www.state.ma.us/dhcfp.
Access to health care has long been an indicator Figure 1
of one's quality of health. Literature suggests that Source of Insurance
access to health care forchildren improves the like-
lihood that they receive continuous health care and preven-
tative health monitoring that will in turn positively impact
theiremotional andphysical development.1Yet, access tocare
is largely determined by health insurance coverage since it
offers a "regular" source of care, as well as the capacity to
pay for it. Research shows that nationwide, children without
insurance are six times less likely to seek medical care when
needed than those with private insurance and fourtimes more
Children Adults
likely than all insured children (privately insured and those
covered by Medicaid) to delay seeking care due to affordabil- 'Employersprovidinghealthinsurancecoverageincludecoverageprovidedbythemilitary,a
grouppurchaserorpastemployers.
ity concerns of their parents.: This issue of Access Update
presents findings from the 1998 and 2000 health insurance
status surveys by the Division of Health Care Finance and Background
Policy and highlights the significant differences between The latter halfof the 1990s saw a strong economic boom
insured and uninsured children in Massachusetts. in Massachusetts resulting in record low unemployment rates
and an increase injob growth.At the same time, the Medicaid
Key Findings of the 2000 Survey program expanded coverage under a section 1115 Medicaid
• The rate of uninsured children decreased by over 50% research and demonstration waiver. Incorporating funds from
from 6.3% in 1998 to 3% in 2000. the State Children's Health Insurance Program (SCHIP).4 this
• The majority (68%) of uninsured children are between waiver expanded MassHealth coverage to include children
ages 6 and 18. (ages 18 and younger), pregnant women and their newborns,
• The Southeast and Worcester regions have the largest andadultsliving inhouseholdswith incomeupto200r< ofthe
percent ofuninsured children, as apercentoftheir total federal poverty level (FPL).5 Since the waiver's implementa-
child populations, with 4.1% and4% respectively. tion. MassHealth enrollment has increased by 30.9% for low-
• Hispanicchildrenaremorelikelytobeuninsured(5.5%) income children insuring 400.425 Massachusetts children.6
than otherracial orethnic groups. Inaccordancewitha 1997 legislativemandate, theDivision
• Uninsuredchildrenaremorelikelytoliveinlow-income ofHealth Care Finance and Policy conducted two state-spon-
households1 (40.3%) than are insuredchildren (25%). sored surveys to identify the characteristics and health-related
Access Update: Health Insurance Status of Massachusetts Children
author: Susan Kennedy • series editor: Cindy Wacks • design: Heather Shannon • distribution Dorothy Barron
copyright © June 2001 Division of Health Care Finance and Policy
decision-making patterns of the uninsured and underinsured Figure 3
populations. Each survey was conducted between February Percent of Children by Insurance Status
and July of their given year. The 1998 survey collected data and Income c
on 2,107 children ages 18 and younger, and the 2000 survey
gathered data on 1,958 children ofthe same age group. Both
80%r
surveys used a random digit dialing methodology where the Below
200%FPL
sample was drawn from a computer-generated random list of 60% - Above
telephone numbers. The survey questionnaire was available 200%FPL
in Spanish and English. Responses to survey questions were
weighted in orderto reflectcurrent population estimates.
Demographics
Insured Uninsured
Age. The lowest rate of uninsured people in Massachusetts
(3%) is among children ages 18 and younger. Among all chil-
dren, the largest percent of uninsured children are between
ages 6 and 18 (68%). Between 1998 and 2000, the largest Race. Despite having the highest uninsured rate (5.5%), the
decreases (almost 50% each) in the numberofuninsured indi- Hispanic populationexhibitedthe largestdeclineinthe rateof
viduals were found among the infant (ages one and younger) uninsured with a 47% decrease between 1998 and 2000. The
and the 6 to 12 age groups. During this same time period, white and black populations have nearly equivalent rates of
the uninsured rate for those ages two to five changed only uninsured children, with 2.7% and 2.8% respectively. While
slightly, exhibiting the highest rate (3.6%) among all children the uninsured rate among black children has remained rel-
(seeFigure 2 below). atively constant, the uninsured rate for white children has
declined by almost half(see Figure 4 below).
Figure 2
Percent of Uninsured Children within Age Group Figure 4 (
Percent of Uninsured Children within Race
and Ethnic Group
12%
1998
10% 10.5% 2000
8%
6%
4% 5.1%
Ages0-1 Ages2-5 Ages6-12 Ages 13-18
2%
0%
White Black Hispanic
Income. Most uninsured children (59.7%) live in households
with incomes at or above 200% ofthe FPL. While this illus-
trates the successful expansion efforts to insure low-income Region. The majority ofuninsured children in Massachusetts
children, adisproportionatenumberofuninsuredchildren still live in the Metro Boston (29.7%) and Southeast (27.8%)
reside in low-income households. In fact, 40.3% of all unin- regions. Within specific regions, the Southeast andWorcester
suredchildrenlive in low-income households while only 25% areas have the highest percentages ofuninsured children with
ofinsuredchildrenliveinhouseholdswith incomeatorabove 4.1% and 4% respectively. The largest strides in decreasing
200% ofthe FPL (see Figure 3 top right). the uninsured rate among Massachusetts children are found
Access Update • 2
in the West and Northeast regions, showing 67% and 33% office visits. These findings suggest that the uninsured lack
declines respectively between 1998 and 2000 (see Figure 5). access or opt not to obtain routine care from a primary care
physician on a regularbasis (see Figures 6 and 7 below).
Figure 5
Percent of Uninsured Children within Region Figure 6
Percent of Children by Insurance Status
and Emergency Room Utilization
8% r
1998
6% - 2000
6.3% 80%
5.6% 0Visits
4% - 4.6% 60% 73.0% 70.8% 1-4Visits
3.5% 3.6% 5+Visits
2% 40% -
0% 20% -
Metro Northeast Southeast West Worcester 7.4%
Boston 1.7%
0%
Insured Uninsured
Access and Utilization
Having a regular source ofcare, such as a clinic or physi- Figure 7
cian'soffice,ismorelikelytoensureappropriatepediatriccare Percent of Children by Insurance Status
and monitoring. Without health insurance coverage, access to and Physician Office Utilization
care can be more difficult. As the 1998 and 2000 survey data
indicate, uninsuredchildrenare lesslikely toutilizehealthcare
services than are insured children. While about the same per-
centofuninsuredchildren(73.8%)asinsuredchildren(76.1%)
reported needing medical care in the past 12 months, unin-
sured children were twice as likely not to seek this care than
were the insured children. For the most recent medical care
sought, 27.3% ofuninsuredchildren received services paid for
by the Massachusetts Uncompensated Care Pool,7 suggesting
that cost is likely abarrier to seeking appropriate health care.
Insured Uninsured
Despite physician recommendations that children visit a
pediatrician eight times in the first year oflife, three times in
the second year and once ayearuntil age six,8uninsuredchil-
dren are less likely to visit a doctor than are insured children Consistent with national findings, uninsured children ages
(34.2% versus 11.7%). In addition, 81.8% ofinsuredchildren three and older are also less likely to visit the dentist than are
made between one and ten visits to the doctorin the last year, insured children according to survey responses. Almost 20%
compared to only 59.9% ofuninsured children. ofuninsured children, compared with 11.5% ofinsured chil-
While only a small percent of children visited the emer- dren, did not visit the dentist in the past year. One possible
gency room in the last year, the percent ofuninsured children explanation for this sizable disparity is the high cost ofcom-
(29.2%) whomadeone ormore visits was slightlyhigherthan prehensive or even routine dental care. However, less access
thatofinsuredchildren (27.8%).Although uninsuredchildren topreventiveroutine dental carecould result in more complex
are more likely to utilize emergency room services, it is strik- and costly treatment when care is finally sought (see Figure 8
ingthatinsuredchildren are farmore likely tomakephysician on page 4).
Access Update • 3
.
Figure 8 such as asthma (87.6%) or attention deficit disorder (12.5%),
Percent of Children by Insurance Status compared with only 7% of insured children. About 16% of
and Dental Office Utilization uninsured children have a chronic medical condition lasting
three months or longer that requires monitoring, compared
with 14% ofinsuredchildren. Uninsuredchildren are still less
likely to receive treatment for their chronic condition than
are insured children, with 15% of uninsured chronically ill
children versus only 1.3% of their insured counterparts not
seeking visits to the doctor in the past three months for their
condition. Similarly, 44.4% ofthese uninsured children com-
pared with 32.1% ofthe insured children eitherdid not fill the
prescriptionortakethemedicineprescribedfortheircondition
Insured Uninsured in the past three months (see Figure 9 left).
Conclusion
Massachusetts has made exceptional strides in decreasing
the number ofuninsured children, particularly those who are
Figure 9 low-income. However, many Massachusetts children remain
Percent of Children Not Seeking Care for Chronic uninsured. As supportedby the survey results, uninsured chil-
Condition byType of Care* and Insurance Status drencontinue toexperiencebarriers toregularcare. Since itis
likely that these families are harder to reach, it is critical that
we continue to look for ways to enroll these children in pro-
50% r grams for which they are eligible. With the existing data, as
Insured
40% - Uninsured well as future research efforts, it is hopeful thatthese children
and families will benefit from direct public policy initiatives
30% " 32.1% aimed at serving theirhealth needs.
20% "
10% -
1.3%
0%
Prescriptions DoctorVisits
1 Edmunds,M.andM.J.Coye,eds.AmericasChildren HealthInsuranceandAccessto
Care.NationalAcademyPress:Washington.D.C.,1998.
'Typesofcarearenotnecessarilyindependentofeachother. 2 IbidandAmerica'sChildren:KeyIndicatorsofWeil-Being.2000www.childstats.gov.
3. Inthismonographlow-incomehouseholdsarehouseholdswithincomebelow200%ofthe
federalpovertylevel.
4. TheChildren'sHealthInsuranceProgram(CHIP)isa1997federal/statehealthinsurance
initiativethatprovideshealthinsurancecoveragetolow-incomechildren.
The overall trends in health care utilization by uninsured 5. CenterforMassHealthEvaluationandResearch.MassachusettsTitleXXIChildren's
HealthInsuranceProgramAnnualReport,April5.1999.
childrenareparticularlydisconcertingconsideringtheslightly 6. DivisionofMedicalAssistance.CaseloadSnapshotReport,February28,2001
higher number ofuninsured children with chronic or specific 7. TheUncompensatedCarePoolpaysformedicallynecessaryservicesforlow-income
uninsuredandunderinsuredpeopleprovidedbyacutehospitalsandcommunityhealth
medical conditions or disabilities. About 13% of uninsured centersinMassachusetts.
8. MaternalandChildHealthBureau.ChildHealthUSA2000.U.S.DepartmentofHealthand
children reported having a medical condition or disability HumanServices.HealthResourcesandServicesAdministration.2000.
Jane Swift, Governor • William D. O'Leary, Secretary, Executive Office of Health and Human Services
Louis I. Freedman, Commissioner • Division of Health Care Finance and Policy •Two Boylston Street • Boston, MA 02116-4704
phone: [phone] • fax: [phone] • publications: 617-988-3125 • www.state.ma.us/dhcfp
55. HS Ac ^Ubot/j
ill.-?-:
Number 3 • June 2001
Access Update
GOVERMENT DOCUMENTS
COLLECTION
MAR
0 3 2002
Health InSUranCe StatUS
University of Massachusetts
Depository Copy
of Massachusetts Adults
77ii'spublication isthethirdinaseriesofmonographsbasedon the • Most non-elderly adults receive health insurance cover-
resultsoftheDivisionofHealth CareFinanceandPolicy's2000 age through their employer (78.8%), with Medicaid
HealthInsuranceStatusofMassachusettsResidentsSurvey. This 10.2%) being the second largest source ofhealth care
(
series isalsoavailableon ourwebsite: www.state.ma.us/dhcfp. coverage (see Figure 1 below).
Access to health care has long been an indicator
ofone's quality ofhealth. Literature suggests that Figure 1
health insurance coverage can affect adults' access Source of Insurance for Non-Elderly Adults
to health care and in turn, impact their health status. Health
insurance coverage is a common indicator of access. With-
100%
Other
out health insurance, adults are less likely to have a primary 10.2% I
Medicaid
care physician, forexample.
Research shows that non-elderly adults are 40% more I Employer*
likely to be uninsured and much less likely to have public 83.3%
insurance such as Medicaid1 than children. This issue of
Access Update presents findings from the 1998 and 2000
health insurance status surveys by the Division of Health 0% *
Care Finance and Policy and highlights the significantdiffer-
ences in health status and health service utilization between
'Employersprovidinghealthinsurancecoverageincludecoverageprovidedbythemilitary,a
insured and uninsured adults in Massachusetts.2 grouppurchaserorpastemployers.
Key Findings ofthe 2000 Survey
• The rate of uninsured adults decreased by over 25% Background
from 10.8% in 1998 to 8% in 2000. The latter half of the 1990s saw a strong economic boom
• The majority (56%) of uninsured adults are between in Massachusetts resulting in record low unemployment rates
ages 19 and 34. and an increase in job growth. At the same time, the Medic-
• More males than females are uninsured. aid program expandedcoverage undera Section 1115 Medic-
• The Southeast region has the largest percent of unin- aid research and demonstration waiver. This waiverexpanded
sured adults (10.1%). The Worcester and Western coverage to children (ages 18 and younger), pregnant women
regions have the second largest percent of uninsured and their newborns, and adults living in households with
adults, with 7.8% and 7.6% respectively. income up to 200% ofthe federal poverty level (FPL)/ Since
• Hispanic adults are morelikely tobeuninsured(24.2%) the waiver's implementation, MassHealth enrollment has
than otherracial orethnic groups. Black adults have the increased by 65.5% for low-income adults insuring 416.281
second highest uninsured rate (16.2%). Massachusetts adults.5
• Uninsured adults are more likely to live in low-income Inaccordancewitha 1997legislativemandate,theDivision
households3 (42%) than are insured adults (14.4%). ofHealth Care Finance and Policy conducted two state-spon-
Access Update: Health Insurance Status of Massachusetts Adults
author: Susan Kennedy • series editor: Cindy Wacks • design: Heather Shannon • distribution: Dorothy Barron
copyright © June 2001 Division of Health Care Finance and Policy
sored surveys to identify thecharacteristics andhealth-related are insured adults. Nearly 86% ofinsured adults report resid-
decision making patterns of the uninsured and underinsured ing in households with income above 200% of the FPL (see
populations. Each survey was conducted between February Figure 3 below).
and July of their given year. The 1998 survey collected data
on 4,419 adults ages 19 to 64 and the 2000 survey gathered
dataon4,375 adultsofthe same age group. Both surveysused Figure 3
a random digit dialing methodology where the sample was Percent of Non-Elderly Adults by Insurance Status
drawn from a computer-generated random list of telephone and Income
numbers. The survey questionnaire was available in Spanish
and English. Responses to survey questions were weighted in
order toreflect current population estimates. Below
200%FPL
Above
Demographics
200%FPL
Age. The highest rate of uninsured people in Massachu-
setts (8%) is among non-elderly adults ages 19 to 64. Among
all adults, the largest percent of uninsured individuals are
between ages 19 and 34 (56%). Within each age group, those
ages 19 to 24 have the highest uninsured rate (17%). The 25 Insured Uninsured
to34agegrouphas the secondhighest uninsured rate (10.5%)
and the second largest decline (32%) in the rate of uninsured
between 1998 and 2000. The 55 to 64 age group exhibited
the largest decrease (almost 50%) in their uninsured rate (see Race. The Hispanic population has the highest uninsured
Figure 2 below). rate (24.2%) which increasedbyalmost2%between 1998 and
2000. The white and Asian populations have the lowest rates
of uninsured adults, with 6% and 3.2% respectively. While
Figure 2 the uninsured rate among black adults has declined slightly,
Percent of Uninsured Non-Elderly Adults the uninsured rate for white adults has declined by almost
within Age Group one-third. Although the Asian population exhibited the larg-
est decline in the uninsured rate (71.1%) between 1998 and
2000. this may be attributable to the small number ofAsians
20%r 1998 captured in the survey (see Figure 4below).
19.5%
2000
15%
10% Figure 4
Percent of Uninsured Non-Elderly Adults
within Race and Ethnic Group
Ages
19-24
25% r
1998
20% ~ 2000
Income. More uninsured adults (58%) live in households 15% -
with incomes above 200% ofthe federal poverty level (FPL).
10% -
While this is consistent with successful state sponsored
expansion efforts to insure low-income adults, uninsured
adults are more than twice as likely to reside in low-income
households with income at or below 200% of the FPL than White Black Asian Hispanic
Access Update • 2