Massachusetts Health Reform:Good for women?

A model for the U.S.?

Tracey Hyams, JD, MPHDirector, Women’s Health Policy and Advocacy ProgramConnors Center for Women’s Health and Gender Biology

Brigham and Women’s Hospital, BostonAcademy Health Annual Research Meeting

July 27, 2009

• Outline of Massachusetts health reform

• Impact of Massachusetts reform, especially for women

• Compare Massachusetts with efforts

in Washington

Goals for today:

Elements of Health Care Reform in Massachusetts

Universal Coverage (2006)

• Expanded Medicaid• Individual mandate• Employer mandate• Established Commonwealth Connector

→ Commonwealth Care (sliding subsidies for private coverage <300% FPL)

→ Commonwealth Choice (>300% FPL)→ Benefits → Affordability

Elements of Health Care Reform in Massachusetts

Costs, Quality, Delivery (2008)

• Established 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 Massachusetts

• Preventive and primary care• Emergency services• Hospitalization• Ambulatory services• Prescription drugs • Mental Health

• Contraceptives• Pap smears • Infertility treatment • Mammography• Maternity care• Hormone replacement therapy

• Near-universal coverage• 97.4 percent insured• Most uninsured “young invincibles”

• Improved access overall• premiums for individuals and small groups• High public support (74 percent)• Employer support• Robust benefit package, including

Challenges in Massachusetts

• High cost / financing• Rising enrollment → rising costs → new cuts

• Affordability• 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)

• Gaps in coverage → inconsistent access• Erosion of the safety net

• $150 million cut from largest “safety net” hospitals

• Women remain vulnerable:• Age 45 – 64 are increasingly underinsured• Are 3.5 times more likely to forego services

Meet Louise…

• Age 26, earns $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

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.

Louise’s total out of pocket health costs Louise’s total out of pocket health costs for premiums, deductibles, co-pays:for premiums, deductibles, co-pays:

Baseline Conditions in Massachusetts

• Low rate of uninsured (10 – 12%)• Free Care Pool• Robust benefit mandates, including reproductive

health• Non-profit insurers• Trust among stakeholders• Health care as economic driver• Public Support• Employer buy-in

• Legislative and executive approval (but no CBO)

Lessons from Massachusettsfor Women’s Health Policy

• Consolidation, regulation of the individual and small group markets is effective

• Coverage ≠ access• Affordability• Continuity of coverage• Workforce shortages

• Women, poor, and racial/ethnic minorities remain vulnerable

Contact

Tracey Hyams, JD, MPHDirector, Women’s Health Policy and

Advocacy Connors Center for Women’sHealth and Gender Biology

Brigham and Women’s Hospital75 Francis Street, OBC3-34A

Boston, MA 02115617 – 525 – 7516

THYAMS@PARTNERS.ORGwww.brighamandwomens.org/womenspolicy

Thank you!