Health Reform Challenges: Understanding Low-Income Massachusetts Residents Whom Remain Uninsured

In April 2006, the Commonwealth of Massachusetts passed one of the most significant pieces of health care reform legislation of any state, Chapter 58 of the Acts of 2006, creating sweeping changes to public health insurance programs and health insurance regulations. Massachusetts expanded Medicaid benefits, created new subsidized health insurance programs, and established a new quasi-public authority to manage health care reform. In addition, the state mandated employers to make health insurance available to their employees or pay a penalty and implemented the first in the nation individual mandate requiring the purchase of health insurance. This robust health reform has been very successful in getting Massachusetts's residents health insurance, pushing the state's uninsured rate down to 2.7%; creating the lowest uninsurance rate in the nation. Despite the goal of universal health coverage, robust support for low-income persons to obtain health insurance, and strong financial incentives on both individuals and employers, some 171,000 Massachusetts residents remain uninsured. Although health reform has significantly benefited individuals making less than 300% of the federal poverty level (FPL), these individuals still have uninsured rates significantly higher than the state average, even though Massachusetts offers subsidized public health insurance programs for those earning below 300% FPL. What are the perceptions, attitudes, and understanding of health insurance options of low-income adults, those earning below 300% FPL, which causes them to remain uninsured despite the state's comprehensive health reform efforts? This study interviews Massachusetts residents who earn less than 300% FPL who are uninsured, with a recently insured matched sample, to determine their decisions on obtaining health insurance or not.