Massachusetts Health Reform: Good for women? A model for the U.S.?

1. Massachusetts Health Reform:Good for women? A model for the U.S.? Tracey Hyams, JD, MPH Director, Women’s Health Policy and Advocacy Program Connors Center for Women’s Health and Gender Biology Brigham and Women’s Hospital, Boston Academy Health Annual Research Meeting July 27, 2009

2. Goals for today: • Outline of Massachusetts health reform • Impact of Massachusetts reform, especially for women • Compare Massachusetts with efforts in Washington

3. Elements of Health Care Reform in Massachusetts Universal Coverage (2006) • Expanded Medicaid • Individual mandate • Employer mandate • Established Commonwealth Connector • Commonwealth Care (sliding subsidies for private coverage <300% FPL) • Commonwealth Choice (>300% FPL) • Benefits • Affordability

4. Elements of Health Care Reform in Massachusetts Costs, Quality, Delivery (2008) • Established Mass. Health Care Quality and Cost Council • FFS  P4P  Global payments • Expands primary care • Statewide health IT • Medicaid Medical home demonstration

5. Preventive and primary care Emergency services Hospitalization Ambulatory services Prescription drugs Mental Health Contraceptives Pap smears Infertility treatment Mammography Maternity care Hormone replacement therapy What’s Working in Massachusetts • Near-universal coverage • 97.4 percent insured • Most uninsured “young invincibles” • Improved access overall •  premiums for individuals and small groups • High public support (74 percent) • Employer support • Robust benefit package, including

6. Challenges in Massachusetts • High cost / financing • Rising enrollment → rising costs → new cuts • Affordability • Increasing premiums, deductibles, co-pays • Medical debt • Racial, ethnic, and (likely) gender disparities • Access to primary care • Geographic, racial, ethnic disparities • 24% subsidized coverage vs. 7% privately insured report challenges • Continued reliance on emergency room (continued…)

7. Challenges in Massachusetts(continued) • Gaps in coverage → inconsistent access • Erosion of the safety net • $150 million cut from largest “safety net” hospitals • Women remain vulnerable: • Age 45 – 64 are increasingly underinsured • Are 3.5 times more likely to forego services

8. Age 26, earns $35,000/year Overall good health Suffers from anxiety; began seeing a psychotherapist and taking Effexor Received HPV vaccinations Birth control failed, had an abortion Meet Louise… • Louise’s total out of pocket health costs for premiums, deductibles, co-pays: *For health plans with prescription coverage. Source: Sered, Susan et al. “Women and Health Care Reform in Massachusetts.” Policy Brief, Spring 2008. Center for Women’s Health and Human Rights, Suffolk University. Accessed at http://www.suffolk.edu/files/cwhhr/Health_Policy_Brief.pdf.

9. Baseline Conditionsin Massachusetts • Low rate of uninsured (10 – 12%) • Free Care Pool • Robust benefit mandates, including reproductive health • Non-profit insurers • Trust among stakeholders • Health care as economic driver • Public Support • Employer buy-in • Legislative and executive approval (but no CBO)

10. Lessons from Massachusettsfor Women’s Health Policy • Consolidation, regulation of the individual and small group markets is effective • Coverage ≠ access • Affordability • Continuity of coverage • Workforce shortages • Women, poor, and racial/ethnic minorities remain vulnerable

11. Contact Tracey Hyams, JD, MPH Director, Women’s Health Policy and Advocacy Connors Center for Women’s Health and Gender Biology Brigham and Women’s Hospital 75 Francis Street, OBC3-34A Boston, MA 02115 617 – 525 – 7516 THYAMS@PARTNERS.ORG www.brighamandwomens.org/womenspolicy Thank you!