By Brian Rosman, Health Care for All Massachusetts
This week Massachusetts officials released the latest
data from their 2010 state insurance survey. The survey provided continued good
news: overall, 98.1 percent of all Massachusetts residents have health
coverage. This compares to a national insurance rate of around 83 percent.
Remarkably, insurance coverage increased from 2009, despite the deep recession.
But even more extraordinary was the finding on coverage
for children. For kids, the 2010 insurance rate is an astonishing 99.8 percent
— essentially universal coverage. Children’s health advocates in Massachusetts,
who have been steadily working on step-by-step improvements to kids coverage
programs, cheered the unprecedented results. We also reflected on how we
achieved such success, and how our lessons can apply nationally.
We would identify three critical factors to the growth in
children’s coverage:
- A strong
base of public programs: Massachusetts has long been among the leaders in state
public programs for children. Our 1996 legislation that expanded Medicaid
eligibility for children up to 200 percent of the federal poverty level (FPL)
inspired Senator Kennedy to introduce the federal CHIP law. Then in 2006, the
state went further and expanded MassHealth, the state’s combined Medicaid and
CHIP program, to all children in families earning up to 300 percent FPL. As a
result, children’s enrollment grew from 435,000 in June 2006, to 529,000 today.
In addition to MassHealth, the state also operates the Children’s Medical
Security Plan, which provides basic pediatric primary care to all uninsured
children ineligible for MassHealth due to immigration status or income. As a
result, all children in Massachusetts are eligible for a public health care
program. - Extensive
Community-based Outreach: Massachusetts put significant resources into outreach
and enrollment assistance, using both a top-down and bottom-up approach. The
top-down effort included mass media ads and partnerships with local icons such
as the Boston Red Sox. These were somewhat targeted to the low-income and
minority community; for example, bus and subway ads were placed on urban lines.
The ads were augmented by grants to dozens of community organizations, focusing
in areas of high uninsurance, particularly minority and non-English speaking
communities. Urban Institute researcher Stan Dorn evaluated the program and
found that “these ‘mini-grants’ helped develop a cadre of agencies and
individuals who were knowledgeable about the state’s health coverage programs,
trained in using the Virtual Gateway [online enrollment system] to complete
applications on behalf of consumers, and skilled in culturally and
linguistically competent strategies for working with diverse, low-income
families.” We learned that having a trusted advisor from one’s own community is
critical to build the confidence required to enter the enrollment process. - Spill-Over
from the Individual Mandate: While children are not included under the
Massachusetts mandate, the extensive attention paid to the need for insurance
coverage led many parents to enroll their children. The mandate sets up a
social expectation that everyone in the Commonwealth should have health
insurance coverage — kids, too. While much of the growth in coverage in
Massachusetts was among groups exempt from the mandate — low-income adults and
children, the cultural force of the mandate provided the backdrop to encourage
enrollment.
We still have more to do to improve children’s health in
Massachusetts. The enrollment system could be made more accessible, notices could be
simpler, and gaps in coverage filled. But this week, kids advocates basked in
the knowledge that universal coverage for children is not a dream. If we can do
it, the rest of the nation can too. Let’s get to work.
The views expressed by Guest Bloggers do not necessarily reflect the views of the Center for Children and Families. This blog was originally posted on Community Catalyst’s Health Policy Hub.