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May 3, 2023

Report: Affordability, eligibility challenges among main reasons Mass. residents remain uninsured

A cluster of three tall buildings behind an outdoor glass walkway. Photo | Courtesy of Blue Cross Blue Shield The Boston offices of Blue Cross Blue Shield of Massachusetts

Affordability, specific challenges facing immigrant groups, and eligibility transitions are three top reasons why some residents of Massachusetts are uninsured, according to the Closing the Coverage Gaps: Reducing Health Insurance Disparities in Massachusetts report from Blue Cross Blue Shield of Massachusetts Foundation.

The report, released on Thursday, aimed to detail the causes that lead residents to remain uninsured while proposing policies to close that gap.

The state’s uninsurance rate was 3.0% in 2019, representing approximately 204,000 uninsured residents at any given time, giving Massachusetts one of the lowest uninsured rates in the country, according to the report. However, 7.3% of Massachusetts residents, or more than 500,00 people, experienced a gap in coverage at some point in a 12-month period.

This group of uninsured residents disproportionately includes people of color, immigrants, and those who are otherwise economically, ethnically or linguistically marginalized, according to the report. 

Some 29% of uninsured people in Massachusetts are residents who are not citizens, 23% are Hispanic, and 11% are Black. Statewide, 12.8% of the population identifies as Hispanic or Latino, and 9.3% are Black or African American, according to 2022 U.S. Census data. 

Among the uninsured population in Massachusetts, 80% cite the cost of insurance as the reason they do not have it. 

According to the report, the majority of uninsured Massachusetts residents want coverage but are excluded from the employer-based health insurance model, face challenges accessing insurance through the state’s Medicaid program called MassHealth, or are not aware that they qualify for affordable options.

“We have a lot to be proud of, but our work is not finished,” Audrey Shelto, president and CEO of BCBSMA, said in a press release accompanying the report.

The report’s proposed policy solutions include raising income eligibility levels for some affordable coverage options, reducing out-of-pocket spending limits, making MassHealth eligibility continuous for 12 months, and easing eligibility transitions. It includes suggestions to extend the state’s Medicaid eligibility regardless of immigration status and using state funds to cover individuals disqualified from coverage under federal rules.

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