Apr. 1—Amid the Obama administration’s celebration of marketplace enrollments that appear to have met expectations, some researchers have raised a warning flag.

The state that provided the model for the recently launched large-scale federal coverage expansion left many of its residents struggling to afford needed care years after it was implemented, researchers wrote in a recent Health Affairs post.

The concerns of the researchers, led by Sharon Long, a senior fellow at the Urban Institute, stemmed from a March survey by the Blue Cross and Blue Shield Foundation Massachusetts, which identified a range of ways residents continue to struggle with healthcare cost.

The 2006 health reform initiative in Massachusetts, which served as the model for the Affordable Care Act (ACA), resulted in the nation’s highest rate of insurance coverage. 

But the survey found that in 2012, more than one-third (38.7 percent) of Massachusetts adults with coverage for the entire past year reported problems with healthcare costs, and higher unaffordability rates (41.6 percent) existed for adults at or below the federal poverty level (FPL).

The result was that insured adults in the state reported going without needed health care, cutting back on other spending, reducing savings, and taking on debt to deal with healthcare costs.

“The challenges faced by low-income and middle-income Massachusetts families are particularly worrisome given that the consumer protections for out-of-pocket health care costs are generally better in Massachusetts than those required under the ACA,” Long and her colleagues wrote.

Comparing Out-of-Pocket Costs

For example, the state healthcare law limited out-of-pocket spending on drugs to $1,000 for people earning from 100 to 200 percent of FPL and enrolled in subsidized coverage health insurance program. The ACA allows more than double the out-of-pocket spending ($2,250) for that income range.

Nearly one-third (31.6 percent) of low-income Massachusetts residents reported problems related to their spending on health care, which included difficulty paying medical bills or medical debt, and 23.6 percent reported going without some type of needed health care because of the cost.

“The experience in Massachusetts demonstrates that while expansions in insurance coverage do lead to improved access to care—as evidenced, for example, by the higher shares of Massachusetts adults with preventive care visits and dental visits after reform—having insurance is not necessarily sufficient to provide protection from the challenge of healthcare costs,” the researchers wrote.

Publication Date: Tuesday, April 01, 2014