Study shows those without health insurance in Mass. are disproportionately people of color, immigrants

Thousands of Massachusetts residents from marginalized backgrounds could gain health insurance coverage should policy makers move to expand eligibility criteria for state-subsidized plans and remove administrative hurdles, a report released Thursday found.

Massachusetts boasts the highest insurance rate in the country, with about 2% to 3% lacking coverage at any point in time. But those roughly 200,000 uninsured individuals are disproportionately people of color or immigrants, and about one-third have limited English language skills that make it difficult to use the state’s insurance marketplace, according to the report from the Blue Cross Blue Shield of the Massachusetts Foundation.

“Massachusetts pioneered a system of near-universal health care coverage that was later adopted nationally in the Affordable Care Act. We have a lot to be proud of, but our work is not finished,” Audrey Shelto, president and CEO of the foundation, said in a statement. “Our research shows there is an opportunity to build on our legacy by tackling the coverage disparities that persist in our system through further action on the policy front.”

The report pointed to another statistic to put the state of the uninsured in perspective. The state’s overall low uninsured rate rose above 7% — encompassing about 503,000 people — in a 2019 state survey that probed how many individuals didn’t have coverage over a 12-month period, the report noted.

The new report comes as hundreds of thousands of people stand to lose Mass Health insurance coverage as program administrators redetermine eligibility for 2.3 million members. Some of those people remain eligible for certain subsidized plans, the foundation said.

Researchers found that Black residents comprise 7% of the state population, but 11% of Bay Staters who are uninsured. Hispanic residents represent 12% of the state population but 23% of the uninsured population. Meanwhile, just over half of the uninsured population is white, although these residents make up 71% of the state’s population, according to the report. A majority of residents without health insurance cited the price tag as a barrier.

Officials can alleviate that concern by raising the income eligibility level for ConnectorCare health insurance plans — which come with $0 or low monthly premiums, according to the state — above 300% of the federal poverty line. The current maximum threshold is $40,770 for one individual and $83,250 for a household of four.

House Democrats in the annual budget bill they are advancing this week propose launching a two-year pilot program expanding eligibility for ConnectorCare to residents earning up to 500% of the federal poverty level.

In another ConnectorCare change, the report urges officials to allow individuals at up to 200% of the federal line to benefit from $0 monthly premiums, rather than pay the $48 amount. Officials could also slash co-pays for certain health treatments, easing current circumstances in which Bay Staters may opt to go to the emergency room as needed to avoid incurring those monthly costs.

The report also recommends that MassHealth and ConnectorCare plans should be available to individuals and families in Massachusetts regardless of their immigration status. But that would also require state dollars to be used to cover Bay Staters who are disqualified under federal rules, the report said.

About half of uninsured adults are eligible for public or government-subsidized programs, according to the report.

Yet Bay Staters could experience coverage gaps as they navigate “complicated processes” like enrollment and eligibility renewals. Those problems are exacerbated when people don’t know where or how to seek help, as well as for people “who do not speak English or Spanish or have low literacy, who have physical and behavioral health conditions, or who have experienced job loss, food insecurity, homelessness, and other forms of instability or crisis situations.”

Officials could lessen MassHealth coverage gaps by conducting multilingual outreach, expanding “automated eligibility practices,” and implementing a policy that would ensure continuous eligibility for 12 months, according to the report.

The Blue Cross Blue Shield of the Massachusetts Foundation said its policy recommendations can serve as “guide posts” for future decision-making.

“Those discussions should view the goal of closing the state’s remaining coverage gaps as achievable and as part of the larger goal of making health care more equitable, affordable, and accessible for everyone who lives in Massachusetts,” the report said.

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