A Tale of Two Surveys. Mass. Uninsured Down, But by How Much?

August 30, 2006

Two surveys released this week show that the number of uninsured residents in Massachusetts is shrinking. According to the U.S. Census Bureau report released yesterday, the number of uninsured people in the Commonwealth fell to 618,000 in 2005 from 748,000 in 2004, a 17% decline. The federal figures come on the heels of the local Division of Health Care Finance and Policy biennial report, released Monday, which indicated the number of uninsured in the state dropped 19% in the past two years. The state report uses a different methodology from the bureau’s approach and found that 372,000 residents only, or 6% of the population, lack health coverage. The federal data indicates 9.8% of state residents do not have health insurance.

Health and Human Service Secretary Timothy Murphy said, "According to federal census figures released today, the number of uninsured people in Massachusetts has dropped from 748,000 to 618,000. While we believe the federal estimates are higher than the actual numbers, the 17% decline trends with our survey released yesterday and is very encouraging as we move deeper into the important implementation phase of healthcare reform." Governor Mitt Romney attributed the improvement to growth in jobs and to the state's aggressive efforts to enroll more poor residents in the state-federal Medicaid program. Most of the gains appeared to have preceded the July launching of a state law intended to cover most of the state's uninsured by next summer.

But some advocates for the uninsured and health policy specialists said they were surprised by the magnitude of the drop shown by the survey, particularly since national data have shown that employers have scaled back coverage for their employees amid soaring premiums. The Massachusetts survey showed the opposite, that 83% of insured residents now get coverage through their employer, compared with 79% in 2002. "The economy has improved, but not that much," said John Holahan, a health policy analyst at the Urban Institute, a nonpartisan policy research organization in Washington. Other results from the state survey seemed puzzling. The number of black non-Hispanic residents without insurance, for example, rose to 13.4%, from 7.5%; they were the only racial group to experience a jump in the numbers of uninsured. "That makes no sense at all," said John McDonough, who is the executive director of Health Care for All, an advocacy group in Boston, "When you´re increasing Medicaid rolls, that should help African-Americans."

Nancy Turnbull, president of the Blue Cross Blue Shield of Massachusetts Foundation, said another question is whether the state under-counted people without insurance because they are less likely to have telephones. The Center for Survey Research at UMass Boston, which conducts the survey for the state, asks residents questions about their insurance status over the phone, while the federal government does many of its census interviews in person. "As we have more undocumented immigrants living in Massachusetts, it is becoming more difficult to survey people," she said.

Members of the new Massachusetts Health Insurance Connector Authority face a critical decision this Friday, to decide how much low-income uninsured individuals can afford to pay toward their health insurance. The authority is in a hurry to reach an agreement because it needs to outline the parameters of so-called Commonwealth Care policies to four managed care organizations that plan to insure members of this group. The group features individuals and families who do not qualify for Medicaid but who don´t earn enough to afford insurance on their own or can´t access insurance through their employers. The state will subsidize insurance premiums for the poorest residents but healthcare analysts have questioned whether the state will have enough money to provide adequate subsidies as enrollment grows. A significant and sustained drop in uninsured residents would take financial pressure off the state and make it easier to cover everyone. "If there are fewer people who require subsidies, that can only be good news," said Amy Lischko, commissioner of the state division of Health Care Finance and Policy, which oversees the survey.

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