Boston Area News

Steve LeBlanc, Associated Press writer
BOSTON (AP) ― Nearly 100,000 Massachusetts taxpayers have been hit with a new fine for failing to obtain health insurance, even as a major survey concludes the effort to create near-universal coverage is meeting key goals.

Five percent of Massachusetts taxpayers failed to obtain health coverage in 2007, and more than half of those, about 97,000, were forced to forfeit their personal exemption, worth $219, after it was determined they could have afforded health care.

Two percent of taxpayers -- about 62,000 filers -- were found not to earn enough for health care and weren't fined. Under the landmark law, taxpayers must show they are insured or face penalties. The numbers were based on a review of 86 percent of expected tax filers for 2007.

Gov. Deval Patrick said the fact that 95 percent of filers were insured shows the 2006 law -- which mandates health care for nearly all residents -- is making progress.

"We continue to put one foot in front of the other," Patrick said Monday.
A total of $9.7 million in fines was deposited into a trust fund to help cover the cost of the law. New monthly penalties for those who can afford health care but refuse will jump in 2008 and could total as much as $912 for individuals by December.

On Tuesday, researchers released the first major survey of the health care law.

The uninsurance rate for Massachusetts adults dropped by more than half and residents were paying less in out-of-pocket health expenses, according to the report, which also found low- income adults were more likely to have regular check-ups and dental visits since the law took effect.

Researchers from the Urban Institute interviewed 3,000 Massachusetts residents in the fall of 2006, just before the law took effect, and conducted a second round of interviews a year later.

The report in the journal Health Affairs includes a series of major findings, according to Sharon Long, an economist and the report's author.

The most important was the drop in the uninsurance rate among working age adults from 13 to 7 percent. The biggest drop was among poorer residents.

Nearly 350,000 residents have been added to the ranks of the insured in Massachusetts under the law, which created a subsidized health care program for those earning less than three times the federal poverty level.

Even among higher-earning residents there was a smaller but significant decline in the uninsured. The law also created the Health Care Connector to help higher wage earners sign up for lower-cost, non-subsidized insurance plans.

"It's a very positive first year," said Long.

The survey also found people are paying less for health care-related expenses.

The share of adults reporting out-of-pocket expenses of more than $500 dropped by four percent. The number of low-income adults reporting out-of-pocket expenses of more than $3,000 fell eight percent.

Low-income adults were more likely to have a place to go when they were sick and were more likely to visit a doctor for preventive care.

Despite the increase in the ranks of the insured, the study found little effect on the use of emergency rooms for non-emergency care. And the fear that employers would begin dropping health coverage as the new law took effect hasn't happened.

Long said the study also included good news for policy makers. She said 71 percent of working age adults expressed support for the law.

That support will come in handy as lawmakers struggle to find ways to cover the soaring costs of the law.

"The continued challenge of health reform requires the continued support of the population and we find support for health care reform among adults in Massachusetts remains high," Long said.

In 2006, a legislative committee estimated the law would cost about $725 million in the fiscal year starting in July. In his budget, Patrick set aside $869 million, but those overseeing the law have already acknowledged costs will rise even higher.

Lawmakers are hoping to close the gap in part with a new dollar-per-pack cigarette tax.

"Our success has created a very big challenge for us," said Senate President Therese Murray.

The report was paid for by Blue Cross and Blue Shield of Massachusetts, the Commonwealth Fund, and the Robert Wood Johnson Foundation.

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