SEPT. 19, 2011

Cost still a barrier for the uninsured, study says

A new study of Cambridge Health Alliance patients shows that many of the people who remain uninsured have jobs and don’t qualify for a state subsidy, but they cannot afford an insurance plan on their own or through their employers. For others, job loss and glitches in the enrollment process have caused them to lose coverage.

Dr. Rachel Nardin, a neurologist at Cambridge Health Alliance, said the study offers a reminder of the pitfalls of the Massachusetts system that could be inherited by the rest of the country as provisions of the federal Affordable Care Act, modeled after Massachusetts’s 2006 health law, take effect.

“When you have a system that tries to insure people through a patchwork of different mechanisms, it’s inherently unstable,’’ said Nardin, chairwoman of the Massachusetts chapter of Physicians for a National Health Program, which supports a single-payer health system. “You’re going to leave some people out.’’


The study, published online last week by the Journal of General Internal Medicine, surveyed 431 patients, ages 18 to 64, who visited a Cambridge Health Alliance emergency department from July 2009 to March 2010, and found 189 people who were uninsured.

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About two-thirds of the uninsured were employed, and 49 percent said they were motivated by the 2006 law to buy insurance but could not find an affordable plan. One quarter of the uninsured who had jobs worked for a company that offered an insurance plan, which disqualified them from being eligible for state-subsidized coverage.

Though the majority of the uninsured had incomes low enough that they should have qualified for state-sponsored plans, about 30 percent reported not being able to afford coverage.

“For some working poor, even heavily subsidized insurance premiums may be unaffordable,’’ the authors said.

About 35 percent of the uninsured reported losing their insurance coverage, most because they lost a job or had their plans canceled because of lapsed paperwork or other reasons.


The state reports that 98 percent of Massachusetts residents are now enrolled in a plan, though some estimates put that figure closer to 95 percent or slightly lower.

“We have achieved the near-universal goals of the landmark 2006 legislation,’’ said Dick Powers, spokesman for the Massachusetts Health Connector, the agency that manages the marketplace for state-subsidized plans. “The majority of the few remaining uninsured are low-income people whom we’ll strive to help as we implement national reform and perfect the Massachusetts model.’’

Nardin said her group’s study points to how hard it is to reach the uninsured.

“Even with incredible hard work, in a state that started out with enormous resources, this is the best we have been able to do,’’ she said.

Short of implementing a national single-payer plan, Nardin said the state could look at making more people eligible for state-sponsored plans or reducing the paperwork that people must complete to remain enrolled in a plan once they qualify.


Powers said controls on eligibility are critical to the program’s integrity and taxpayer confidence.

Chelsea Conaboy can be reached at Follow her on Twitter @cconaboy.