Health insurance venture propels Commonwealth to top of the list

Massachusetts has the highest rate of residents with health insurance in the nation, according to a federal report released yesterday that provides fresh evidence of success in the state's bold experiment to insure nearly everyone.

The US Census Bureau study found that when data from 2006 and 2007 were averaged, 92.1 percent of Bay Staters had health insurance. That is significantly higher than during the previous two-year period, when the figure stood at 89.7 percent.

By comparison, barely three-quarters of residents had health coverage in Texas, the state that fared worst. Nationally, nearly 86 percent of Americans were insured in the 2006-07 period.

The report emerges two years after Massachusetts became the first state to adopt a law requiring virtually all residents to have insurance and as national leaders closely track developments here during a presidential election year when health issues have taken center stage.

"At a time when policymakers nationwide are wrestling with how you can make health reform work at the national level, there could very well be important lessons in the Massachusetts experience," said Jarrett Barrios, president of Blue Cross Blue Shield of Massachusetts Foundation.

Last week, a state report concluded that nearly three-quarters of previously uninsured residents had gained coverage under the state's landmark campaign. Since the program began in June 2006, 439,000 more people have enrolled in health insurance, and nearly half of them signed up for private insurance not underwritten by taxpayers, the study found.

Census officials consider the two-year average to be the most reliable figure when comparing states because it tends to smooth out one-year statistical blips. But there is reason to believe the two-year average may be understating the progress in enrollment.

Rates for 2007, which are useful for suggesting trends, show that 94.6 percent of Massachusetts residents were covered last year.

An analysis by Brian Rosman, research director for the advocacy group Health Care for All, found that Massachusetts is responsible for 23 percent of a national decline in the number of uninsured. Last year, about 45.7 million lacked health insurance, down from 47 million in 2006.

"The fact that we really stick out and that we made such a big jump in insured residents compared to our neighbors and national figures points out that the health reform program is the key variable making the difference," Rosman said.

That program, the state's secretary of health and human services said, targeted the uninsured on multiple fronts. One pivotal component, said Dr. JudyAnn Bigby, was the mandate all residents carry insurance or face a cash penalty.

Similarly, certain employers must offer insurance to employees or face sanctions. At the same time, the state expanded its subsidies for poor adults and children.

"While we've had some bumps in the road with healthcare reform," Bigby said, "it's well worth the effort and the resources we're putting into it."

The economics of universal coverage, though, remain among the most vexing aspects of the initiative. The state is negotiating with federal officials to determine if Massachusetts will continue getting special assistance to help make the experiment work.

But a leading specialist in healthcare economics yesterday questioned whether the law can succeed long-term without significant efforts to rein in rising costs.

"The law's been a blessing to hundreds of thousands of uninsured people, but it's not terribly affordable," said Alan Sager, a professor at the Boston University School of Public Health. "Unfortunately, the political discussion in Massachusetts about cost control has not yet remotely become real."

Premiums for insurance provided through the state's initiative vary substantially, depending on the type of insurance and where the person lives. For example, in July 2007, the least expensive coverage available to a 37-year-old in Boston was $184 through the insurer Neighborhood Health Plan.

Jon Kingsdale, executive director of the state agency responsible for implementing the insurance law, acknowledged that extending coverage to every resident is a daunting proposition.

It's one thing, said Kingsdale of the Commonwealth Health Insurance Connector Authority, to help provide insurance to those who want it but cannot afford it.

"But some people can afford it and aren't as motivated to get it," Kingsdale said. "My sense is that as we get toward the goal line, we need to keep pushing. I'm not sure we can get to 100 percent, but that needs to continue to be our goal."

Stephen Smith can be reached at stsmith@globe.com.