As Congress and the Administration debate health care reform, it is instructive to look at the Massachusetts model, now in its third year. Health Affairs today released a study of workers in the Bay State who were interviewed in fall 2008 about their employer-sponsored health care coverage, following up on similar surveys in 2006 and 2007. Despite predictions that employers could reduce coverage or benefits under health reform, the results suggest the opposite, although premiums and out-of-pocket costs have increased for some employees in smaller companies.
These findings are the latest in a series of updates on implementation of the Massachusetts reforms funded by the Blue Cross Blue Shield of Massachusetts Foundation, The Commonwealth Fund, and the Robert Wood Johnson Foundation.
The researchers, from the Urban Institute in Washington, compared the results of three rounds of interviews with several thousand adult workers ages 18-64. The surveys gathered information on insurance status and, for those with insurance, the kind of insurance respondents had, as well as their out-of pocket health care costs and other financial information. The study found that the percentage of workers whose employers made health care available to any workers remained high, at about 90% under health reform, while more workers reported that their employer had made coverage available to them. With the higher offer rate, more workers reported having coverage from employers under health reform, up from 80% to 84%.
To evaluate whether employee contributions toward premiums had significantly increased, the study looked at workers facing higher levels of premiums. While the authors did not find much change overall, there was an 8.6 percentage point increase in the share of workers at twice the average premium for workers in small firms. Nonetheless, the data show a high degree of worker satisfaction with their employer-sponsored health plans, with levels of satisfaction significantly higher in 2008 than in 2006 for the rating of services and quality of care, and no change over time with the share of workers reporting problems with their health plan. Additionally, unmet need due to cost did not increase for workers in small firms, which indicates that higher premiums are not affecting workers’ ability to access needed care.
“Despite the economic downturn in 2008, our findings show a continued commitment by Massachusetts employers to providing workers access to quality health care, even those in smaller firms where some employees have had to shoulder a higher financial burden for premiums,” said Sharon Long, a senior fellow at the Washington-based Urban Institute. “Washington policymakers should look closely at the Massachusetts example as they work to enact national health care reform.”