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Even with insurance, Mass. residents often can’t afford care

Nearly all Massachusetts adults have health insurance, but being insured is no guarantee patients can afford health care or even find someone to provide it, according to a survey released Wednesday.

Despite the state’s landmark health care overhaul, the report found, cost and access remain problems for a significant share of residents.

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The 2006 law, which became the model for the federal Affordable Care Act, quickly succeeded at its main goal: ensuring coverage for nearly all residents. But the survey by the Blue Cross Blue Shield of Massachusetts Foundation shows access remains a concern, especially for those with low incomes or health problems.

More than one-third of adults younger than 65 reported going without needed health care despite having insurance. Nearly half had trouble getting access to a health-care professional. One-fifth struggled to pay family medical bills or medical debts from previous years.

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The foundation, which has conducted the survey almost every year since 2006, has repeatedly identified these problems. Their persistence echoes difficulties seen nationwide, as medical costs continue to rise and insurance policies require consumers to pay a greater share in deductibles and copays.

Those out-of-pocket costs represent “a new health care agenda,” said Drew Altman, president and chief executive officer of the Henry J. Kaiser Family Foundation, a nonprofit focusing on national health issues. “It’s not just accessing care, but assuring that people can afford the care they now have access to.

“What we see in survey after survey we do — a significant percentage of people that have coverage also have medical bills that are a real burden for them,” he said. “Those medical bills ripple through the family budget.”

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Audrey Shelto, Blue Cross foundation president, emphasized that people with insurance have better access to care than those who don’t.

“But,” she said, “the affordability issues are clearly still haunting us both in terms of how it impacts individuals and in terms of the overall system.”

The architects of the law deliberately focused on coverage rather than costs, in order to get it passed, she said. In 2012, the state adopted a sweeping law intended to control costs, but Shelto said the law hasn’t yet had much effect.

“It’s going to take more time,” she said. “The issues around affordability are much more complex than access and coverage.”

Amy Whitcomb Slemmer, executive director of the advocacy group Health Care for All, praised the foundation for shining a light on these shortcomings. “The report points to barriers to care that we need to pay attention to,” she said.

The telephone survey, conducted Sept. 8 to Nov. 8 by the Urban Institute, questioned a random sample of 2,014 people ages 19 to 64. Nearly 96 percent said they had health insurance at that time, up from 86 percent in 2006 and better than the 2015 national rate of 87 percent.

Just over 37 percent of adults who were insured the full year reported going without needed health care — including doctor’s visits, tests, screenings, medications, and dental care. Among people with low incomes, more than 50 percent reported unmet health care needs. In a question asked for the first time, the survey found that a quarter of adults do not have dental insurance.

The proportion of people who had problems paying medical bills has declined slightly since 2006. Still, 43 percent said that in 2015, health care costs had caused problems for them and their families, including 19 percent who went without needed care as a result. The problem was more severe among low- and moderate-income adults and people with health problems.

“If you have low income, it’s harder to find providers who accept your type of coverage,” Shelto said. “If you have a chronic condition, the array of services you need are much more complex and numerous.” Additionally, low-income people are more likely to have difficulties finding child care and transportation.

Low-income people are often eligible for MassHealth, which in most cases does not have copays and deductibles. But many low-income people receive insurance through an employer, said Brian Rosman, research director at Health Care for All, and may not be aware they’re eligible for premium subsidies through MassHealth, the state Medicaid program. But help with premiums still doesn’t solve the problem of high deductibles and copays.

The survey also pointed to problems accessing care. Among adults who had insurance for the entire previous year, 47 percent said they’d had trouble getting in to see a health care professional, because they could not find a provider who accepted their insurance or was accepting new patients, or because they couldn’t get an appointment as soon as needed. This problem has worsened over time.

Nearly 86 percent said they had a place where they usually go for care. Even so, one-third of respondents reported visiting a hospital emergency department at least once in the previous year — half for a condition that was not an emergency.

Why are people having trouble getting medical appointments in a state teeming with physicians?

Dr. Dennis M. Dimitri, president of the Massachusetts Medical Society, said many doctors don’t work full time at patient care, instead pursuing research and teaching. Additionally, the problem varies by region, with doctor shortages in Western and Southeastern Massachusetts and on Cape Cod.

Another issue is the shortage, nationally and locally, of primary care doctors, who are the entry point to health care. Doctors with huge medical school debts often prefer higher-paying specialties, and general practice is sometimes regarded as “thankless and unglamorous,” said Dimitri, who is a family practice doctor.

Massachusetts also loses out because the state’s five family practice residency programs have slots for only about 50 new doctors-in-training each year.

Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer.
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