Table Of Content

2001 Access Update 0e "s P°s/tory Copy Massachusetts Elderly and Prescription Drug Coverage Thispublication isthefirstinaseriesofmonographsbasedon the About one-fifth of seniors (19.5%) are low-income resultsoftheDivisionofHealth CareFinanceandPolicy's2000 (below 150% ofthe federal poverty level orFPL). HealthInsuranceStatusofMassachusettsResidentsSurvey. This Metro Boston has the highest proportion of elderly seriesisalsoavailableon ourwebsite: www.state.ma.us/dhcfp. (36%), followedby the Southeast region (19.6%). (see Figure 1 and Figure 2 below) The rising cost of prescription drugs and prescription drugcoveragehasmadeitincreasinglychallengingfor many elders to afford necessary medications. Nation- Figure 1 wide, 55% ofadults ages 65 and over take three or more pre- Massachusetts Non-Institutionalized Elderly scription drugs on a regular basis and 23% report a "serious by Income problem" paying for needed prescription medicines.1 Massa- HMO chusetts has experienced disruptions in the Medicare HMO market, such as the capping ofthe Medicare pharmacy HMO benefit and the discontinuation of several Medicare products.2 Access to affordable drug coverage has become a key political issue atboth the state and national levels. ThisissueofAccess Updatelooksatprescriptiondrugcov- erage for non-institutionalized seniors in Massachusetts and analyzes the burden ofprescription drug expenditures on specific categories of Massachusetts elderly. The survey of the health insurance status of Massachusetts residents was conducted between February and July of 2000. Information was collected on 452 households with an elderly resident and Figure 2 736 elderly individuals living in these households. Interviews Massachusetts Non-Institutionalized Elderly were conducted using computer-assistedtelephone interview- by Region ing technology. The survey questionnaire was available in ^eti bothSpanishandEnglish. Responsestosurveyquestionswere Worcester 12% weighted in order to reflectpopulation estimates. MetroBoston 37% Demographics i • Most Massachusetts elderly are female (57%). • Over halfthe population is married (55%), and another W 34% are widowed; the remainderhave neverbeen mar- Northeast \ / ried, orare divorced orseparated. • While most seniors (85%) do not work, about 15% of Southeast seniors report that they are employed. 20% Access Update: Massachusetts Elderly and Prescription Drug Coverage author: Victoria Nixon • series editor: Cindy Wacks • design: Heather Shannon • distribution: Dorothy Barron copyright © March 2001 Division of Health Care Finance and Policy Prescription Drug Coverage setts seniors report that they spend more than $100 monthly Survey results indicate that just over 28% of non-institu- onprescriptiondrugs. Nearlyhalfoflow-incomeseniorswith- tionalizedMassachusetts seniorslackprescriptiondrugcover- out prescription drug coverage (46%) had high out-of-pocket age.Low-incomeseniorsaremuchlesslikelytohavecoverage costs (see Figure 3 and Figure 4below left). than those residing in households with incomes greater than The very old are also disproportionately represented 150% of the federal poverty level. While 19.5% of seniors among the population of non-institutionalized seniors lack- reside in low-income households, 44.3% ofthese elderly lack ing prescription drug benefits. While 11.6% ofthe non-insti- drug coverage. tutionalized elderly are ages 85 and over, more than half of Seniors without pharmacy coverage are twice as likely to these seniors(56%)reportnopharmacycoverage. Incompari- face high out-of-pocketcosts (more than $75 per month) than son, less than 32% ofseniors ages 75 to 84 and about 19% of those with prescription drug coverage. The burden ofout-ofseniors ages 65 to 74 report lacking pharmacy coverage. pocket drug costs falls disproportionately on certain groups Most drug spending is forlong-term conditions oracom- of the elderly. These groups include seniors without supple- bination of long and short-term conditions. Less than 8% mental coverage orMedicaid, low-income elderly, those with of drug spending for seniors is for short-term conditions chronic conditions, and the very old (ages 85 and over). The only.3 Nearly all seniors with high out-of-pocketcosts report majority of elderly who used prescription drugs in the past at least one long-term condition requiring prescription drug yearspentbetween $11 and $50out-of-pocket monthly. How- medication. ever, approximately 18% of non-institutionalized Massachu- Sources of Prescription Drug Coverage Figure 3 About 29% of the elderly report that a Medigap policy % HMO Monthly Out-of-Pocket Drug Costs helps pay for their drugs, 31 stated that a Medicare provides assistance, 10% credit MassHealth, and 28% report that they receive assistance from a private insurer. Of those interviewed, 11% state that the Senior Pharmacy Program helped pay fortheirprescription drugs4 (see Figure 5 below). Figure 5 Sources of Prescription Drug Coverage* 11.0% |10.2% lessthan $11 to$50 $51 to$75 $76to$100 morethan $10 $100 Figure 4 Non-Institutionalized Elderly Lacking Drug Benefit by Income Medigap Medicare MassHealth Private Pharmacy HMO Insurance Program "Pleasenotethattheseresponsesarenotmutuallyexclusive. 30.1% 26.1% The Senior Pharmacy Program 1 In response to decreasing coverage for prescription drugs and increasing out-of-pocket expenses for the elderly, the SeniorPharmacyProgramwasimplementedinMassachusetts 151-200% 201-400% ofFPL ofFPL onJuly 1, 1997.5 Access Update • 2 Survey respondents were asked about sources ofprescrip- The Prescription Advantage Plan tion coverage for the past 12 months. For some of that time The "PrescriptionAdvantage Plan" is the name ofthe new period the SeniorPharmacy Programprovided Massachusetts insurance-based prescription drug program signed into Mas- residents, ages 65 and over, up to $750 in prescription drug sachusetts law this year. TheAdvantage Plan will be available coverage per year. As of January 1, 2000 new legislation toeldersandtopeoplewithqualifieddisabilities.Whenimple- amended the Senior Pharmacy Program calling it the Phar- mented in April of 2001, this plan will replace the existing macy Program. The Pharmacy Program now provides up to Pharmacy and Pharmacy Plus Programs.6 Those enrolled in $1,250 annually to eligible elders or disabled individuals to these programs will automatically be considered formember- help pay for prescription drugs. Survey response indicates ship in the new insurance plan. Enrollees contribute monthly that approximately 63,000 seniors receive assistance through premiums, annual deductibles and co-payments on a gradu- this program. These survey results are validated by program ated scale based on annual household income. enrollment figures. Conclusion Potentially Eligible Seniors Out-of-pocketcostsfallmostheavilyonspecificcategories The elderly most likely to be eligible for the Pharmacy of elderly, including low-income seniors, the very old, those Program are those residing in households with incomes of with chronic health conditions and those lacking supplemen- 185% ofthe FPL or less with no other prescription drug ben- tal coverage or Medicaid. Studies based on national samples efit. Survey data indicate that about 8% of non-institutional- ofpersons ages 65 and over report that out-of-pocket expen- ized seniors are potentially eligible. More potentially eligible ditures as a percentage of total health care expenditures are seniors reside in the Metro Boston region (38.3%) and the highestforthose with no supplemental coverage. West region (23.4%) than in other regions of the state. The The Division's survey findings were validated by a recent majority ofeligible seniors report at least one long-term con- study by the Rand Corporation. The Rand study found that dition requiring prescription drug medication. among elderly persons, insurance coverage for drugs reduces the fraction ofhousehold income spent on prescription drugs Awareness of the Pharmacy Program by 50%. The authors concluded that the groups most likely The proportion of seniors who have heard of the Massa- tobenefitfromsuchcoverage areelderly women, low-income chusetts Pharmacy Program has increased from 35% in 1998 seniors, and those with chronic conditions. to 55% in 2000. Awareness for seniors within the eligible As policy makers attempt to allocate limited health care income category is even greater, with approximately 69% resources, understanding the distribution of out-of-pocket aware of the program. These results indicate that increased pharmacycosts acrosssub-groupsofelderlyis vital.The 2000 outreach efforts were effective. There is a higher awareness Health Insurance Status of Massachusetts Residents Survey ofthe Pharmacy Program among seniors living in the Metro provides one source of information for policy makers. With Boston and Southeastregions (see Figure 6 below). the pendingimplementation ofthe new pharmaceuticalcover- ageplan,itisimportanttocontinuemonitoringtheprogressof Figure 6 new initiatives in providing access to necessary medications Awareness of Senior Pharmacy Program forvulnerable Massachusetts residents. by Region Worcester 13.0% 1. The NewsHourwithJim Lehrer/ Kaiser Family Foundation / Harvard School of Public HealthNationalSurveyonPrescriptionDrugs.09/2000(conductedJuly-September2000). 2. "No Giving Thanks to Pilgrim." Boston Globe, 11/22/1998. See also Boston Globe. 08/24/1999."W.Mass.EldersMayGetHealthCoverageAid"byRichardA.Knox. 3. Short-termconditionsaredefinedasconditionslastingfewerthan30days. — 4. Categoriesoverlap becauserespondentscouldselectmorethanonecategory,thetotal doesnotequal100%. 5. ThisprogramisfundedthroughtheChildren'sandSenior'sHealthCareAssistanceFund andtheTobaccoSettlementFund. 6. Pharmacy Plus Program assists seniors and disabled persons with high prescription drug costs. Qualified applicants must have spent at least 10°o of their gross monthly incomeonprescriptiondrugsinthreeoftheprevioussixmonthsandhaveannualincome under$41.200forindividualsand$55,320foracouple.ThePharmacyPlusprogrampro- videsdrugcoveragewithnodollarlimit. Access Update • 3 Ml Division of Health Care Finance and Policy Two Boylston Street \:,V Boston. MA 02116-4704 Argeo Paul Cellucci, Governor • William D. O'Leary, Secretary, Executive Office of Health and Human Services Louis I. Freedman, Commissioner • Division of Health Care Finance and Policy • Two Boylston Street • Boston, MA 02116-4704 phone: 617-988-3100 • fax: 617-727-7662 • publications: 617-988-3125 • www.state.ma.us/dhcfp What's New www.state.ma.us/dhcfp from DHCFP? Access to Health Care in Massachusetts: A Catalog of Programs for Uninsured and Underinsured Individuals This catalog includes information about private and public health care programs including eligibility criteria, benefits and services offered and information on how to apply and how to contact the program. Get your copy today at www.state.ma.us/dhcfp. Massachusetts Health CareTrends: 1990-1999 Using charts and graphs, this report summarizes the past decade focusing on how the health care delivery system has changed since 1990 and how Massachusetts differs from the United States as a whole. Print this report forfree from our web site: www.state.ma.us/dhcfp Regulations DHCFP regulations are available online. Please visit our web site at www.state.ma.us/dhcfp to obtain copies of the regulations, public hearing notices and the public hearing schedule. Number 2 • June 2001 Access Update DOCUMENTS GOVERMENT COLLECTION MAR 0 3 2002 Health Insurance Status Massachusetts University of Depository Copy of Massachusetts Children Thispublication isthesecondinaseriesofmonographsbasedon Children are more likely to receive health insurance theresultsoftheDivisionofHealth Care FinanceandPolicy's2000 coverage through Medicaid than non-elderly adults. HealthInsuranceStatusofMassachusettsResidentsSun'ey: This 16.3% versus 10.2% (see Figure 1 below). series isalsoavailableonourwebsite: www.state.ma.us/dhcfp. Access to health care has long been an indicator Figure 1 of one's quality of health. Literature suggests that Source of Insurance access to health care forchildren improves the like- lihood that they receive continuous health care and preven- tative health monitoring that will in turn positively impact theiremotional andphysical development.1Yet, access tocare is largely determined by health insurance coverage since it offers a "regular" source of care, as well as the capacity to pay for it. Research shows that nationwide, children without insurance are six times less likely to seek medical care when needed than those with private insurance and fourtimes more Children Adults likely than all insured children (privately insured and those covered by Medicaid) to delay seeking care due to affordabil- 'Employersprovidinghealthinsurancecoverageincludecoverageprovidedbythemilitary,a grouppurchaserorpastemployers. ity concerns of their parents.: This issue of Access Update presents findings from the 1998 and 2000 health insurance status surveys by the Division of Health Care Finance and Background Policy and highlights the significant differences between The latter halfof the 1990s saw a strong economic boom insured and uninsured children in Massachusetts. in Massachusetts resulting in record low unemployment rates and an increase injob growth.At the same time, the Medicaid Key Findings of the 2000 Survey program expanded coverage under a section 1115 Medicaid • The rate of uninsured children decreased by over 50% research and demonstration waiver. Incorporating funds from from 6.3% in 1998 to 3% in 2000. the State Children's Health Insurance Program (SCHIP).4 this • The majority (68%) of uninsured children are between waiver expanded MassHealth coverage to include children ages 6 and 18. (ages 18 and younger), pregnant women and their newborns, • The Southeast and Worcester regions have the largest andadultsliving inhouseholdswith incomeupto200r< ofthe percent ofuninsured children, as apercentoftheir total federal poverty level (FPL).5 Since the waiver's implementa- child populations, with 4.1% and4% respectively. tion. MassHealth enrollment has increased by 30.9% for low- • Hispanicchildrenaremorelikelytobeuninsured(5.5%) income children insuring 400.425 Massachusetts children.6 than otherracial orethnic groups. Inaccordancewitha 1997 legislativemandate, theDivision • Uninsuredchildrenaremorelikelytoliveinlow-income ofHealth Care Finance and Policy conducted two state-spon- households1 (40.3%) than are insuredchildren (25%). sored surveys to identify the characteristics and health-related Access Update: Health Insurance Status of Massachusetts Children author: Susan Kennedy • series editor: Cindy Wacks • design: Heather Shannon • distribution Dorothy Barron copyright © June 2001 Division of Health Care Finance and Policy decision-making patterns of the uninsured and underinsured Figure 3 populations. Each survey was conducted between February Percent of Children by Insurance Status and July of their given year. The 1998 survey collected data and Income c on 2,107 children ages 18 and younger, and the 2000 survey gathered data on 1,958 children ofthe same age group. Both 80%r surveys used a random digit dialing methodology where the Below 200%FPL sample was drawn from a computer-generated random list of 60% - Above telephone numbers. The survey questionnaire was available 200%FPL in Spanish and English. Responses to survey questions were weighted in orderto reflectcurrent population estimates. Demographics Insured Uninsured Age. The lowest rate of uninsured people in Massachusetts (3%) is among children ages 18 and younger. Among all children, the largest percent of uninsured children are between ages 6 and 18 (68%). Between 1998 and 2000, the largest Race. Despite having the highest uninsured rate (5.5%), the decreases (almost 50% each) in the numberofuninsured indi- Hispanic populationexhibitedthe largestdeclineinthe rateof viduals were found among the infant (ages one and younger) uninsured with a 47% decrease between 1998 and 2000. The and the 6 to 12 age groups. During this same time period, white and black populations have nearly equivalent rates of the uninsured rate for those ages two to five changed only uninsured children, with 2.7% and 2.8% respectively. While slightly, exhibiting the highest rate (3.6%) among all children the uninsured rate among black children has remained rel- (seeFigure 2 below). atively constant, the uninsured rate for white children has declined by almost half(see Figure 4 below). Figure 2 Percent of Uninsured Children within Age Group Figure 4 ( Percent of Uninsured Children within Race and Ethnic Group 12% 1998 10% 10.5% 2000 8% 6% 4% 5.1% Ages0-1 Ages2-5 Ages6-12 Ages 13-18 2% 0% White Black Hispanic Income. Most uninsured children (59.7%) live in households with incomes at or above 200% ofthe FPL. While this illus- trates the successful expansion efforts to insure low-income Region. The majority ofuninsured children in Massachusetts children, adisproportionatenumberofuninsuredchildren still live in the Metro Boston (29.7%) and Southeast (27.8%) reside in low-income households. In fact, 40.3% of all unin- regions. Within specific regions, the Southeast andWorcester suredchildrenlive in low-income households while only 25% areas have the highest percentages ofuninsured children with ofinsuredchildrenliveinhouseholdswith incomeatorabove 4.1% and 4% respectively. The largest strides in decreasing 200% ofthe FPL (see Figure 3 top right). the uninsured rate among Massachusetts children are found Access Update • 2 in the West and Northeast regions, showing 67% and 33% office visits. These findings suggest that the uninsured lack declines respectively between 1998 and 2000 (see Figure 5). access or opt not to obtain routine care from a primary care physician on a regularbasis (see Figures 6 and 7 below). Figure 5 Percent of Uninsured Children within Region Figure 6 Percent of Children by Insurance Status and Emergency Room Utilization 8% r 1998 6% - 2000 6.3% 80% 5.6% 0Visits 4% - 4.6% 60% 73.0% 70.8% 1-4Visits 3.5% 3.6% 5+Visits 2% 40% - 0% 20% - Metro Northeast Southeast West Worcester 7.4% Boston 1.7% 0% Insured Uninsured Access and Utilization Having a regular source ofcare, such as a clinic or physi- Figure 7 cian'soffice,ismorelikelytoensureappropriatepediatriccare Percent of Children by Insurance Status and monitoring. Without health insurance coverage, access to and Physician Office Utilization care can be more difficult. As the 1998 and 2000 survey data indicate, uninsuredchildrenare lesslikely toutilizehealthcare services than are insured children. While about the same per- centofuninsuredchildren(73.8%)asinsuredchildren(76.1%) reported needing medical care in the past 12 months, uninsured children were twice as likely not to seek this care than were the insured children. For the most recent medical care sought, 27.3% ofuninsuredchildren received services paid for by the Massachusetts Uncompensated Care Pool,7 suggesting that cost is likely abarrier to seeking appropriate health care. Insured Uninsured Despite physician recommendations that children visit a pediatrician eight times in the first year oflife, three times in the second year and once ayearuntil age six,8uninsuredchil- dren are less likely to visit a doctor than are insured children Consistent with national findings, uninsured children ages (34.2% versus 11.7%). In addition, 81.8% ofinsuredchildren three and older are also less likely to visit the dentist than are made between one and ten visits to the doctorin the last year, insured children according to survey responses. Almost 20% compared to only 59.9% ofuninsured children. ofuninsured children, compared with 11.5% ofinsured chil- While only a small percent of children visited the emer- dren, did not visit the dentist in the past year. One possible gency room in the last year, the percent ofuninsured children explanation for this sizable disparity is the high cost ofcom- (29.2%) whomadeone ormore visits was slightlyhigherthan prehensive or even routine dental care. However, less access thatofinsuredchildren (27.8%).Although uninsuredchildren topreventiveroutine dental carecould result in more complex are more likely to utilize emergency room services, it is strik- and costly treatment when care is finally sought (see Figure 8 ingthatinsuredchildren are farmore likely tomakephysician on page 4). Access Update • 3 . Figure 8 such as asthma (87.6%) or attention deficit disorder (12.5%), Percent of Children by Insurance Status compared with only 7% of insured children. About 16% of and Dental Office Utilization uninsured children have a chronic medical condition lasting three months or longer that requires monitoring, compared with 14% ofinsuredchildren. Uninsuredchildren are still less likely to receive treatment for their chronic condition than are insured children, with 15% of uninsured chronically ill children versus only 1.3% of their insured counterparts not seeking visits to the doctor in the past three months for their condition. Similarly, 44.4% ofthese uninsured children compared with 32.1% ofthe insured children eitherdid not fill the prescriptionortakethemedicineprescribedfortheircondition Insured Uninsured in the past three months (see Figure 9 left). Conclusion Massachusetts has made exceptional strides in decreasing the number ofuninsured children, particularly those who are Figure 9 low-income. However, many Massachusetts children remain Percent of Children Not Seeking Care for Chronic uninsured. As supportedby the survey results, uninsured chil- Condition byType of Care* and Insurance Status drencontinue toexperiencebarriers toregularcare. Since itis likely that these families are harder to reach, it is critical that we continue to look for ways to enroll these children in pro- 50% r grams for which they are eligible. With the existing data, as Insured 40% - Uninsured well as future research efforts, it is hopeful thatthese children and families will benefit from direct public policy initiatives 30% " 32.1% aimed at serving theirhealth needs. 20% " 10% - 1.3% 0% Prescriptions DoctorVisits 1 Edmunds,M.andM.J.Coye,eds.AmericasChildren HealthInsuranceandAccessto Care.NationalAcademyPress:Washington.D.C.,1998. 'Typesofcarearenotnecessarilyindependentofeachother. 2 IbidandAmerica'sChildren:KeyIndicatorsofWeil-Being.2000www.childstats.gov. 3. Inthismonographlow-incomehouseholdsarehouseholdswithincomebelow200%ofthe federalpovertylevel. 4. TheChildren'sHealthInsuranceProgram(CHIP)isa1997federal/statehealthinsurance initiativethatprovideshealthinsurancecoveragetolow-incomechildren. The overall trends in health care utilization by uninsured 5. CenterforMassHealthEvaluationandResearch.MassachusettsTitleXXIChildren's HealthInsuranceProgramAnnualReport,April5.1999. childrenareparticularlydisconcertingconsideringtheslightly 6. DivisionofMedicalAssistance.CaseloadSnapshotReport,February28,2001 higher number ofuninsured children with chronic or specific 7. TheUncompensatedCarePoolpaysformedicallynecessaryservicesforlow-income uninsuredandunderinsuredpeopleprovidedbyacutehospitalsandcommunityhealth medical conditions or disabilities. About 13% of uninsured centersinMassachusetts. 8. MaternalandChildHealthBureau.ChildHealthUSA2000.U.S.DepartmentofHealthand children reported having a medical condition or disability HumanServices.HealthResourcesandServicesAdministration.2000. Jane Swift, Governor • William D. O'Leary, Secretary, Executive Office of Health and Human Services Louis I. Freedman, Commissioner • Division of Health Care Finance and Policy •Two Boylston Street • Boston, MA 02116-4704 phone: 617-988-3100 • fax: 617-727-7662 • publications: 617-988-3125 • www.state.ma.us/dhcfp 55. HS Ac ^Ubot/j ill.-?-: Number 3 • June 2001 Access Update GOVERMENT DOCUMENTS COLLECTION MAR 0 3 2002 Health InSUranCe StatUS University of Massachusetts Depository Copy of Massachusetts Adults 77ii'spublication isthethirdinaseriesofmonographsbasedon the • Most non-elderly adults receive health insurance cover- resultsoftheDivisionofHealth CareFinanceandPolicy's2000 age through their employer (78.8%), with Medicaid HealthInsuranceStatusofMassachusettsResidentsSurvey. This 10.2%) being the second largest source ofhealth care ( series isalsoavailableon ourwebsite: www.state.ma.us/dhcfp. coverage (see Figure 1 below). Access to health care has long been an indicator ofone's quality ofhealth. Literature suggests that Figure 1 health insurance coverage can affect adults' access Source of Insurance for Non-Elderly Adults to health care and in turn, impact their health status. Health insurance coverage is a common indicator of access. With- 100% Other out health insurance, adults are less likely to have a primary 10.2% I Medicaid care physician, forexample. Research shows that non-elderly adults are 40% more I Employer* likely to be uninsured and much less likely to have public 83.3% insurance such as Medicaid1 than children. This issue of Access Update presents findings from the 1998 and 2000 health insurance status surveys by the Division of Health 0% * Care Finance and Policy and highlights the significantdiffer- ences in health status and health service utilization between 'Employersprovidinghealthinsurancecoverageincludecoverageprovidedbythemilitary,a insured and uninsured adults in Massachusetts.2 grouppurchaserorpastemployers. Key Findings ofthe 2000 Survey • The rate of uninsured adults decreased by over 25% Background from 10.8% in 1998 to 8% in 2000. The latter half of the 1990s saw a strong economic boom • The majority (56%) of uninsured adults are between in Massachusetts resulting in record low unemployment rates ages 19 and 34. and an increase in job growth. At the same time, the Medic- • More males than females are uninsured. aid program expandedcoverage undera Section 1115 Medic- • The Southeast region has the largest percent of unin- aid research and demonstration waiver. This waiverexpanded sured adults (10.1%). The Worcester and Western coverage to children (ages 18 and younger), pregnant women regions have the second largest percent of uninsured and their newborns, and adults living in households with adults, with 7.8% and 7.6% respectively. income up to 200% ofthe federal poverty level (FPL)/ Since • Hispanic adults are morelikely tobeuninsured(24.2%) the waiver's implementation, MassHealth enrollment has than otherracial orethnic groups. Black adults have the increased by 65.5% for low-income adults insuring 416.281 second highest uninsured rate (16.2%). Massachusetts adults.5 • Uninsured adults are more likely to live in low-income Inaccordancewitha 1997legislativemandate,theDivision households3 (42%) than are insured adults (14.4%). ofHealth Care Finance and Policy conducted two state-spon- Access Update: Health Insurance Status of Massachusetts Adults author: Susan Kennedy • series editor: Cindy Wacks • design: Heather Shannon • distribution: Dorothy Barron copyright © June 2001 Division of Health Care Finance and Policy sored surveys to identify thecharacteristics andhealth-related are insured adults. Nearly 86% ofinsured adults report resid- decision making patterns of the uninsured and underinsured ing in households with income above 200% of the FPL (see populations. Each survey was conducted between February Figure 3 below). and July of their given year. The 1998 survey collected data on 4,419 adults ages 19 to 64 and the 2000 survey gathered dataon4,375 adultsofthe same age group. Both surveysused Figure 3 a random digit dialing methodology where the sample was Percent of Non-Elderly Adults by Insurance Status drawn from a computer-generated random list of telephone and Income numbers. The survey questionnaire was available in Spanish and English. Responses to survey questions were weighted in order toreflect current population estimates. Below 200%FPL Above Demographics 200%FPL Age. The highest rate of uninsured people in Massachu- setts (8%) is among non-elderly adults ages 19 to 64. Among all adults, the largest percent of uninsured individuals are between ages 19 and 34 (56%). Within each age group, those ages 19 to 24 have the highest uninsured rate (17%). The 25 Insured Uninsured to34agegrouphas the secondhighest uninsured rate (10.5%) and the second largest decline (32%) in the rate of uninsured between 1998 and 2000. The 55 to 64 age group exhibited the largest decrease (almost 50%) in their uninsured rate (see Race. The Hispanic population has the highest uninsured Figure 2 below). rate (24.2%) which increasedbyalmost2%between 1998 and 2000. The white and Asian populations have the lowest rates of uninsured adults, with 6% and 3.2% respectively. While Figure 2 the uninsured rate among black adults has declined slightly, Percent of Uninsured Non-Elderly Adults the uninsured rate for white adults has declined by almost within Age Group one-third. Although the Asian population exhibited the largest decline in the uninsured rate (71.1%) between 1998 and 2000. this may be attributable to the small number ofAsians 20%r 1998 captured in the survey (see Figure 4below). 19.5% 2000 15% 10% Figure 4 Percent of Uninsured Non-Elderly Adults within Race and Ethnic Group Ages 19-24 25% r 1998 20% ~ 2000 Income. More uninsured adults (58%) live in households 15% - with incomes above 200% ofthe federal poverty level (FPL). 10% - While this is consistent with successful state sponsored expansion efforts to insure low-income adults, uninsured adults are more than twice as likely to reside in low-income households with income at or below 200% of the FPL than White Black Asian Hispanic Access Update • 2