A new report from the Robert Wood Johnson Foundation of the uninsured in Massachusetts holds important lessons for federal regulators and lawmakers as they plot ways to implement the individual health insurance mandate in 2014. Massachusetts, which implemented an individual requirement to purchase health care coverage in 2006, now has the lowest uninsurance rate in the country — 4.1% in 2008 — but has yet to achieve true universal coverage. The RWJ report examines who makes up that 4% and why:
Consistent with earlier work on the characteristics of uninsured adults in Massachusetts and in the nation as a whole, we find that the adults who remained uninsured under health reform in Massachusetts in 2008 were more likely than those with insurance coverage to be:
- Male, young, and single
- Racial/ethnic minorities and non-citizens
- Unable to speak English well or very well
- Living in a household in which there was no adult able to speak English well or very well
Compared with insured respondents, uninsured adults also reported substantially lower educational attainment and less employment and had lower family income and greater financial stress.
In other words, despite the state’s far-reaching enrollment campaign, “broad-based policy initiatives and outreach under federal reform may be less effective at stimulating take-up among certain demographic groups than among the population as a whole,” the study finds. “These hard-to-reach groups will require targeted policy and outreach efforts that address their particular barriers to health insurance take-up.”
Other than the ‘Enroll America’ campaign between the health insurance industry and consumer group Families USA, health care reform regulators and lawmakers have said little publicly about the importance of enrolling everyone in health insurance once the individual mandate becomes operational in 2014. These results and Massachusetts’ experience suggest that the government should pay particular attention to lower-income communities, many of whom will become Medicaid eligible.