Correspondence
Proposals for Payment Reform in Massachusetts
N Engl J Med 2009; 361:2492-2493December 17, 2009
- Article
To the Editor:
Steinbrook (Sept. 10 issue)1 repeats the claim by the Massachusetts government that health care reform has reduced the proportion of residents who are uninsured to 2.6%. This estimate comes from a state-sponsored survey that excluded two groups with low rates of coverage: families without landline telephones and immigrants who speak neither English nor Spanish (i.e., 40% of persons in the state who do not speak English).
In contrast, the Census Bureau2 found that 5.5% of Massachusetts residents were uninsured in 2008, based on face-to-face interviews conducted in virtually all local languages. Moreover, the Census Bureau's figure is the only one that allows valid comparisons to the coverage rates nationally, in other states, and over time in Massachusetts.
Approximately 352,000 people remained uninsured in Massachusetts in 2008, a decrease of 305,000 from the 2006 prereform estimate. The expansion of Medicaid and the Medicaid-like, highly subsidized Commonwealth Care program account for the vast majority of this decrease. The much-ballyhooed mandate to purchase coverage played a minor role.
2 ReferencesDavid U. Himmelstein, M.D.
Steffie Woolhandler, M.D., M.P.H.
Harvard Medical School, Boston, MA
dhimmelstein@challiance.org 1
Steinbrook R . The end of fee-for-service medicine? Proposals for payment reform in Massachusetts. N Engl J Med 2009;361:1036-1038
Full Text | Web of Science | Medline2
Bureau of the Census. Health insurance coverage status and type of coverage by state all people: 1999 to 2008. Washington, DC: Census Bureau. (Accessed November 23, 2009, at http://www.census.gov/hhes/www/hlthins/historic/hihistt4.xls.)
Author/Editor Response
When my Perspective article was published online on July 29, the most recent data were from the 2008 Massachusetts Health Insurance Survey. The survey estimated that 2.6% of state residents (about 165,000 people) lacked health insurance.1 Revised in 2008, the survey was conducted by telephone, Web, and mail and was available in English, Spanish, and Portuguese. By combining a sample selected through random-digit landline telephone dialing with an address-based sample, the survey reached persons without landline telephones who rely on cell phones. The 2009 Massachusetts Health Insurance Survey, which was released in October, estimated that 2.7% of state residents (about 171,000 people) lacked health insurance.1
The Census Bureau's 2008 estimates of health insurance coverage were released in September.2 Unlike the Massachusetts Health Insurance Survey, which asks about insurance coverage at the time of the survey, the Current Population Survey asks about insurance coverage over the previous calendar year. According to the Census Bureau report, “health insurance coverage is likely to be underreported on the Current Population Survey.”2 Thus, estimates of uninsurance rates are generally higher than rates in other national and state-specific surveys.2,3
3 ReferencesRobert Steinbrook, M.D.
1
Long SK, Phadera L, Stockley K, et al. Health insurance coverage in Massachusetts: results from the 2008 and 2009 Massachusetts health insurance surveys. Boston: Office of Health and Human Services, Division of Health Care Finance and Policy, October 2009. (Accessed November 23, 2009, at http://www.mass.gov/dhcfp.)
2
DeNavas-Walt C, Proctor BD, Smith JC. US Census Bureau current population reports, P60-236: income, poverty and health insurance coverage in the United States, 2008. Washington, DC: Government Printing Office, 2009. (Accessed November 23, 2009, at http://www.census.gov/prod/2009pubs/p60-236.pdf.)
3
Long SK, Phadera L. Estimates of health insurance coverage in Massachusetts from the 2009 Massachusetts Health Insurance Survey. Boston: Office of Health and Human Services, Division of Health Care Finance and Policy, October 2009. (Accessed November 23, 2009, at http://mass.gov/dhcfp.)
