MASSACHUSETTS HEALTH REFORM: IMPACT ON WOMEN’S HEALTH

1. Women’s Health Policy and Advocacy Program MASSACHUSETTS HEALTH REFORM: IMPACT ON WOMEN’S HEALTH Tracey Hyams, JD, MPH, Director Laura Cohen, Policy Analyst Women’s Health Policy and Advocacy Program Connors Center for Women’s Health and Gender Biology Brigham and Women’s Hospital

2. Women’s Health Policy and Advocacy Program DATA SOURCES • The Blue Cross Blue Shield of Massachusetts Foundation:http://bluecrossfoundation.org/ • Ibis Reproductive Health: • http://www.ibisreproductivehealth.org/ • Suffolk University Center for Women’s Health and Human Rights: • http://www.suffolk.edu/college/10649.html • Brigham and Women’s Center for Community Health and Health Equity: • www.brighamandwomens.org/communityprograms/

3. Women’s Health Policy and Advocacy Program MASSACHUSETTSBEFORE HEALTH REFORM • Strong consumer protections • No pre-existing condition limitations • Pro-choice legislature and government • 26 mandated benefits including: maternity, mammography, contraceptive services, HRT, pap smears, infertility treatment, mental health

4. Women’s Health Policy and Advocacy Program HOW DOES REFORM IN MA COMPARE TO NATIONAL REFORM?

5. Women’s Health Policy and Advocacy Program LANGUAGE OF MASSACHUSETTS HEALTH REFORM • Health Insurance Connector • Minimum Creditable Coverage (MCC) • Commonwealth Care (subsidized) • Commonwealth Choice (unsubsidized)

6. Women’s Health Policy and Advocacy Program EVALUATING MASSACHUSETTS HEALTH REFORM • Coverage • Access • Affordability • Transitions • Remaining Opportunities

7. Women’s Health Policy and Advocacy Program Coverage

8. Women’s Health Policy and Advocacy Program IMPROVEMENTS IN COVERAGE SINCE REFORM • Most newly-insured have subsidized coverage • 68 percent covered through MassHealth or CommCare • 12 percent non-group individual, 20 percent ESI • All populations of women experienced significant coverage gains since reform • Lower income • Racial and ethnic minorities • Women 50 – 64 • Women without dependent children • Total enrollment in subsidized coverage remains higher among women than men

9. Women’s Health Policy and Advocacy Program Source: Current Population Survey 2003 - 2009

10. Women’s Health Policy and Advocacy Program Source: Massachusetts Division of Health Care Finance and Policy

11. Women’s Health Policy and Advocacy Program Source: Current Population Survey 2008

12. Women’s Health Policy and Advocacy Program HEALTH COVERAGE OF WOMEN IN MASSACHUSETTS Source: Sharon Long. The Impacts of Health Reform on Health Insurance Coverage and Health Care Access, Use, and Affordability for Women in Massachusetts. The BCBS of MA Foundation.

13. Women’s Health Policy and Advocacy Program IMMIGRANT WOMEN • Until June 2009, legal permanent residents eligible for subsidized coverage through CommCare. • Cut due to budget constraints • “CommBridge” created to cover nearly 30,000 LPRs who lost coverage • Capped enrolment • Limited benefits

14. Women’s Health Policy and Advocacy Program WHO ARE THE UNINSURED WOMEN IN MA? • Nearly 60,000 women remain uninsured • Uninsured women are disproportionately • Young • Single • Hispanic • Over half are employed (often in smaller firms) • Over 75 percent of have incomes under 300 percent FPL and may qualify for subsidized coverage

15. Women’s Health Policy and Advocacy Program Access to Care

16. Women’s Health Policy and Advocacy Program IMPROVEMENTS IN ACCESS AMONG WOMEN IN MA Source: Sharon Long. The Impacts of Health Reform on Health Insurance Coverage and Health Care Access, Use, and Affordability for Women in Massachusetts. The BCBS of MA Foundation.

17. Women’s Health Policy and Advocacy Program ACCESS AMONG WOMEN IN MA • Essential Women’s Health Benefits • Reproductive Health • Primary Care (Ob/Gyn) • Mental Health, Dental Care, Preventive Screenings • Vulnerable Populations • Younger Women • Racial and Ethnic Minorities • Immigrants

18. Women’s Health Policy and Advocacy Program REPRODUCTIVEHEALTH • Generally, health reform expanded access to contraceptives • Cost does not appear to be a barrier to contraceptive use after health reform • Remaining barriers • - Women receive Rx instead of contraceptives • - No Rx coverage in some young adult-target plans • - Difficulty understand what plans cover • - Frequent changes in insurance status impact cost and continuity of contraceptive use • Insurers continue to cover abortions

19. Women’s Health Policy and Advocacy Program ACCESS TO PRIMARY CARE • In 2009, one in five women reported difficult finding a provider • “Several labor market conditions”- internal medicine, family medicine and Ob/Gyn • Wait times for internal medicine, family medicine and Ob/Gyn unacceptably long

20. Women’s Health Policy and Advocacy Program ACCESS TO PRIMARY CARE PROVIDERS Source: Massachusetts Physician Workforce Study. 2009. Massachusetts Medical Society.

21. Women’s Health Policy and Advocacy Program Affordability

22. Women’s Health Policy and Advocacy Program WHO IS MOST AT RISK? • Moderate-income women • Women choosing low-premium, high deductible health plans • Women enrolled in young adult-target plans • Women transitioning from the safety net to cost-sharing plans

23. Women’s Health Policy and Advocacy Program MEET MALIKA Malika is a student who became pregnant while covered through her college’s student health plan (SHP). Although her SHP covers pregnancy, coverage is capped at $25,000 per injury or illness. Malika had a complicated delivery, which required ambulance transportation to a hospital better able to handle her high-risk care. Unfortunately, her plan has an individual service cap on ambulance transportation, leaving her responsible for $1,500 in out-of-pocket costs. The hospital charged $24,000 for Malika’s care and $32,000 for her baby’s care. Her health plan decided to count Malika and her baby’s care as a single episode of illness, leaving her with $31,000 in additional out-of-pock costs. Her massive medical bills qualify her for the Health Safety Net; however, she is still responsible for paying a significant portion of the costs herself - $16,000. “If the insurance barely helped me then what am I paying them for?”

24. Women’s Health Policy and Advocacy Program MEET ANN Ann is 56 years old, divorced with two adult children. She makes $62,000 a year and a realtor for a small firm not required to offer health insurance. This year, Ann had an annual mammogram which detected an abnormal mass in her right breast. She was diagnosed with breast cancer and had a mastectomy. Ann’s income qualifies her for a Commonwealth Choice plan. This chart highlights her out-of-pocket costs (premiums, deductibles and co pays) for one year under different Commonwealth Choice Plans.

25. Women’s Health Policy and Advocacy Program MEET JENNIFER Jennifer is 31 years-old and self-employed. She makes $32,600 a year and does not qualify for subsidized Commonwealth Care. It is important to note that Jennifer make $100 dollars more than the income cut off for Commonwealth Care program ($32,500) yet she pays between $83 and $108 more per month on premiums. Jennifer will pay between $996-$1,296 more per-year just on premiums because she makes $100 dollars more than the income cap for Commonwealth Care.

26. Women’s Health Policy and Advocacy Program MEET DIANA Diana is a 28-year old single adult working at a small firm that does not provide health insurance. She makes 32,400 dollars a year, making her eligible for Commonwealth Care. Diana pays $116 a month on premiums, far less than her sister Jennifer, despite the fact that Diana only makes $200 dollars more than Jennifer.

27. Women’s Health Policy and Advocacy Program AGE RATING

28. Women’s Health Policy and Advocacy Program Transitions in Eligibility and Coverage

29. Women’s Health Policy and Advocacy Program • Women are more likely to experience life changes and variable income, which impact eligibility • Income eligibility for Medicaid and subsidized coverage are only dollars apart • In 2009, an average of 9,800 people transitioned into MassHealth from Commonwealth Care and the Health Safety Net (HSN) • 9,400 transitioned from MassHealth and HSN to Commonwealth Care

30. Women’s Health Policy and Advocacy Program MEET CHRISTINA below 200% FPL. Christina must apply for Medicaid Christina is a 27 year old single woman earning 150% of the Federal Poverty Level ($16,245 a year) working as a waitress and is eligible for Commonwealth Care. Christina become pregnant and is now categorically eligible for Medicaid because her income is because eligibility for public insurance negates Commonwealth Care eligibility. While she waits for MassHealth eligibility, she in insured by MassHealth Prenatal, a short-term program designed to cover pregnant women while they wait for MassHealth approval. After birth, she must re-apply to Commonwealth Care because her income makes her MassHealth ineligible (mothers with Medicaid eligible children can remain beneficiaries if they make 133% or less of the FPL). In one year, Christina has applied to three insurance plans and transitioned between plans four times.

31. Women’s Health Policy and Advocacy Program OPPORTUNITIES FOR MA AND NATIONAL HEALTH REFORM • Collect and Stratify Data by Sex • Reduce Costs / Monitor Affordability • Administrative Simplicity / Patient Navigation • Primary Care Shortage • Vulnerable Populations • Young Women • Immigrant Women • Racial and Ethnic Minorities • - Caregivers

32. Women’s Health Policy and Advocacy Program To read the Women’s Health Policy and Advocacy Program’s Issue Brief, please click this link: http://www.brighamandwomens.org/ConnorsCenter/images/ConnorsCenter.pdf Contact Information Tracey Hyams, JD, MPHDirector, Women’s Health Policy and Advocacy ProgramConnors Center for Women’s Health and Gender BiologyBrigham and Women’s HospitalBoston, MA thyams@partners.org www.brighamandwomens.org/womenspolicy