I and others write frequently about Massachusetts because of the state’s bold experiment in health reform. Back in 2006, when Mitt Romney signed the state’s health reform legislation into law, there was great anticipation about what would be achieved by requiring residents to purchase health insurance or pay a penalty. After five years, the results are in, and while the news is generally favorable, it’s not all good news.
Yes, Massachusetts has the lowest uninsured rate in the nation. No, health care costs there have not fallen. Yes, access to care has improved. Unfortunately, disparities in coverage and access persist. The latter is the finding of a new study by James Maxwell and colleagues that appears in the September issue of Health Affairs. The authors report that, while insurance coverage has increased among all groups, it has lagged behind for Hispanics–with a particularly troubling lack of progress seen among the Spanish-speaking population.
Non-Hispanic whites were doing well to begin with. Approximately 91 percent of them were insured before the law took effect, and by 2009, that number had reached 96 percent. There’s not much more room for improvement. During the same time period, Hispanics went from an insured rate of 68 percent to nearly 79 percent. Yes, that’s a bigger gain, but there’s a lot of ground to be made up before things are equitable.
The aggregate Hispanic numbers are misleading, though, because language is an important obstacle to navigating the system. Breaking Hispanics into English-speaking and Spanish-speaking groups shows that not speaking English has really made it difficult for people to obtain health insurance. In 2005, 78 percent of English-speaking Hispanics had coverage, compared to just 51 percent of Spanish-speaking Hispanics. Three years after health reform was enacted, those numbers improved to 88 percent for English-speaking Hispanics and 67 percent for Spanish-speaking Hispanics. That’s right. The Spanish-speaking Hispanics are doing worse after health reform than their English-speaking counterparts were doing before reform. Suffice it to say, if Massachusetts still has this much work to do, the rest of the country faces a monumental task.