Health law task may ease as more get insurance

The number of Massachusetts residents without health insurance has plummeted 19 percent over the past two years, according to state survey results released yesterday.

Governor Mitt Romney attributed the improvement to growth in jobs and to the state's aggressive efforts to enroll more poor residents in the state-federal Medicaid program. Most of the gains appeared to have preceded the launching in July of a state law intended to cover most of the state's uninsured by next summer.

The survey, conducted from February through August, found that 6 percent of adults and children lack coverage, or 372,000 people. That compares with 7.4 percent of the population, or 460,000 people, during the last survey in 2004. The number of uninsured is now almost the lowest since the state began the survey in 1998.

If the decline in uninsured residents is confirmed by US Census Bureau figures that are due out today, it could make the task of insuring all residents easier.

Legislators passed, and Romney signed, a law this spring that requires all residents to have coverage by July 2007.

The state will subsidize insurance premiums for the poorest residents, but healthcare analysts have questioned whether the state will have enough money to provide adequate subsidies as enrollment grows. A significant and sustained drop in uninsured residents would take financial pressure off the state and make it easier to cover everyone.

``If there are fewer people who require subsidies, that can only be good news," said Amy Lischko, commissioner of the state division of Health Care Finance and Policy, which oversees the survey.

But some advocates for the uninsured and health policy specialists said they were surprised by the magnitude of the drop shown by the survey, particularly since national data have shown that employers have scaled back coverage for their employees amid soaring premiums. The Massachusetts survey showed the opposite, that 83 percent of insured residents now get coverage through their employer, compared with 79 percent in 2002.

``The economy has improved, but not that much," said John Holahan, a health policy analyst at the Urban Institute, a nonpartisan policy research organization in Washington, Holahan and others said they are waiting to see if the federal census data confirm the decline.

The state survey and the census always show vastly different numbers of uninsured residents in Massachusetts -- the census reported that 748,000 people were uninsured in the state in 2004. The census numbers are higher because the federal government misses some people enrolled in Medicaid.

In addition, the federal survey asks whether people had been uninsured in the previous 12 months. The state asks residents if they are currently uninsured.

But the two surveys usually agree on whether the numbers are headed up or down. The state's numbers also can fluctuate widely from survey to survey; officials attribute this to changes in the economy.

The new survey found that the number of uninsured children had fallen to 2.5 percent, from 3.2 percent, while the number of uninsured adults under age 65 had dropped to 8.7 percent, from 10.6 percent. The number of uninsured residents dropped in every region in the state, officials said.

The officials credited employers for adding 58,000 new jobs in the past 2 1/2 years, and the state's expansion of Medicaid, some of which was required by the new health insurance law.

About 50,000 poor residents have been enrolled in Medicaid in the past year alone.

``Early phases of healthcare reform are bearing fruit," Romney said in written comments released to the media.

But other results from the survey seemed puzzling. The number of black non-Hispanic residents without insurance, for example, rose to 13.4 percent, from 7.5 percent; they were the only racial group to experience a jump in the numbers of uninsured.

``That makes no sense at all," said John McDonough, who is the executive director of Health Care for All, an advocacy group in Boston. ``When you're increasing Medicaid rolls, that should help African-Americans."

Lischko said state officials still are trying to understand the results, and are conducting more analysis. She said employers may have increased coverage as it became clear that the state was going to pass a law that requires people to have insurance, and that charges employers fees for providing inadequate or no insurance.

Officials will look further into whether specific groups of black residents, such as those living in Boston or recent immigrants, are increasingly uninsured.

Nancy Turnbull, president of the Blue Cross Blue Shield of Massachusetts Foundation, said another question is whether the state under-counted people without insurance, because they are less likely to have telephones. The Center for Survey Research at UMass Boston, which conducts the survey for the state, asks residents questions about their insurance status over the phone, while the federal government does many of its census interviews in person. ``As we have more undocumented immigrants living in Massachusetts, it is becoming more difficult to survey people," she said.