Massachusetts Health Insurance Survey 2014 Key Findings

2014 MASSACHUSETTS HEALTH INSURANCE SURVEY KEY FINDINGS Prepared by: Laura Skopec, Sharon K. Long, and Thomas H. Dimmock, Urban Institute Susan Sherr, David Dutwin, and Kathy Langdale, SSRS MAY 2015

OVERVIEW concentrations of low income residents and oversampled respondents with prepaid cell phones not attached to a permanent account. Both oversampling strategies were designed to increase the number of interviews completed with low income and uninsured respondents. The Massachusetts Health Insurance Survey (MHIS), conducted by the Center for Health Information and Analysis (CHIA), provides information on health insurance coverage, health care access and use and perceived health care affordability for Massachusetts residents. The MHIS is a tool used by CHIA, legislators, policymakers, employers, insurers and other stakeholders to track and monitor the experiences of Massachusetts residents in obtaining timely and affordable health care. Because of the change in methodology, it is not possible to determine whether any changes over time are due to the survey design change or due to underlying changes in health insurance coverage, health care access, and health care affordability in Massachusetts. Therefore, the 2014 MHIS should be considered a new baseline and should not be used to calculate changes from earlier years of the survey. In 2014, the MHIS methodology was modified to provide a better understanding of health insurance coverage in the Commonwealth. Specifically, the 2014 MHIS used a dual-frame random digit dialing (RDD) landline and cell phone sample, with the survey completed entirely over the phone. The 2008-2011 surveys used a dual-frame landline RDD and address- based sample, with surveys completed by phone, via the Internet, and in hard copy. In 2014, the MHIS also oversampled landlines in areas with higher Along with changes in methodology, the 2014 MHIS introduces two new topics: insurance coverage transitions and respondents strategies to lower their health care costs. 2

BACKGROUND ON THE MHIS The survey is conducted in English and Spanish and its average completion time is 21 minutes. The 2014 MHIS was fielded between May 14 and July 30, 2014. Surveys were completed with 4,024 Massachusetts households, collecting data on 4,024 target persons, including 504 children aged 0 to 18, 2,553 non-elderly adults aged 19 to 64, and 967 elderly adults aged 65 and older. The Massachusetts Health Insurance Survey (MHIS) provides information on health insurance coverage, health care access and use and perceived health care affordability for the non-institutionalized population in Massachusetts. Information on health insurance coverage and demographic information is collected for all members of the household, with more detailed information collected for one randomly selected household member (referred to as the target person in the household) and other members of his or her family who are residing in the household. Target adults tend to respond to the survey for themselves, while a proxy, generally a parent, responds for a target child. The data reported here are for the household target person. For simplicity, we refer to the target person as the respondent in discussing survey findings. The overall response rate for the 2014 MHIS was 30.9 percent, combining the response rate of 32.4 percent for the landline telephone sample and the 27.7 percent for the cell phone sample. All estimates based on the survey are prepared using weights that adjust for the complex survey design, for undercoverage, and for survey nonresponse. Additional information about the MHIS is available in the MHIS Methodology Report. . 3

1. HEALTH INSURANCE COVERAGE AND UNINSURANCE

Uninsurance Rate for All Massachusetts Respondents, 2008-2011 and 2014 25% 20% 15% 9.2 10% 6.6 5.9 5.5 3.9 3.7 5% 3.1 2.7 2009 2.6 2008 0% 1.9 2010 2011 2012 2013 2014 Uninsured at the time of the survey (MHIS 2008-2011) Uninsured at the time of the survey (MHIS 2014) Ever uninsured over the past 12 months (MHIS 2008-2011) Ever uninsured over the past 12 months (MHIS 2014) Note: Due to a change in survey design for the MHIS in 2014, estimates for 2014 are not directly comparable to estimates for 2008-2011. Source: 2008-2011, 2014 Massachusetts Health Insurance Survey 5

Health Insurance Coverage for All Massachusetts Respondents in 2014 96.3 97.6 100% 90.7 80% 60% 40% 20% 0% Insured at the time of the survey Insured at any time over the past 12 months Always insured over the past 12 months Source: 2014 Massachusetts Health Insurance Survey 6

Health Insurance Coverage in Massachusetts in 2014, by Age Group 99.0 99.9 98.8 98.2 96.5 95.9 95.3 94.9 100% 87.7 80% 60% 40% 20% 0% Insured at the time of the survey Insured at any time over the past 12 months Always insured over the past 12 months Children (0 to 18) Non-elderly adults (19 to 64) Elderly adults (65 and older) Source: 2014 Massachusetts Health Insurance Survey 7

Health Insurance Coverage in Massachusetts in 2014, by Gender 97.8 98.9 96.2 94.6 100% 93.0 88.3 80% 60% 40% 20% 0% Insured at the time of the survey Insured at any time over the past 12 months Always insured over the past 12 months Female Male Source: 2014 Massachusetts Health Insurance Survey 8

Health Insurance Coverage in Massachusetts in 2014, by Race/Ethnicity 96.9 96.9 98.0 97.4 97.9 100% 94.4 93.7 92.9 92.6 88.0 87.7 82.0 80% 60% 40% 20% 0% Insured at the time of the survey Insured at any time over the past 12 months Always insured over the past 12 months White, non-Hispanic Black, non-Hispanic Other or multiple races, non-Hispanic Hispanic Source: 2014 Massachusetts Health Insurance Survey 9

Health Insurance Coverage in Massachusetts in 2014, by Family Income 99.0 96.1 97.7 99.8 97.9 95.2 94.7 94.5 94.1 100% 93.1 84.3 83.3 80% 60% 40% 20% 0% Insured at the time of the survey Insured at any time over the past 12 months Always insured over the past 12 months Income at or below 138% of the Federal Poverty Level (FPL) Income between 138 and 299% of the FPL Income between 300 and 399% of the FPL Income at or above 400% of the FPL Source: 2014 Massachusetts Health Insurance Survey 10

Health Insurance Coverage in Massachusetts in 2014, by Region Insured at the time of the survey (%) Insured at any time over the past 12 months (%) Always insured over the past 12 months (%) Western MA 96.5 96.8 90.5 Central MA 96.2 97.6 89.0 Northeast MA 96.9 98.5 91.3 Metro West 98.6 99.2 94.1 Metro Boston 93.9 96.0 87.6 Metro South 97.0 97.6 92.0 Southcoast 98.2 99.6 94.7 Cape and Islands 96.6 98.1 94.9 Source: 2014 Massachusetts Health Insurance Survey 11

Transitions in Health Insurance Coverage for All Massachusetts Respondents in 2014 100% 90.7 80% 60% 40% 20% 9.2 5.5 2.2 1.6 0% Always insured over past 12 months Ever uninsured over past 12 months Gained coverage over past 12 months Lost coverage over past 12 months Always uninsured over past 12 months Note: The categories listed in this figure are not mutually exclusive. The group Ever uninsured over past 12 months includes those always uninsured over the past 12 months, gaining coverage over the past 12 months, and losing coverage over the past 12 months. Source: 2014 Massachusetts Health Insurance Survey 12

Transitions in Health Insurance Coverage in Massachusetts in 2014, by Age Group 95.9 95.3 100% 87.7 80% 60% 40% 20% 12.3 7.2 4.7 4.0 3.7 2.7 2.4 2.2 1.8 0.6 0.4 0.0 0% Always insured over past 12 months Ever uninsured over past 12 months Gained coverage over past 12 months Lost coverage over past 12 months Always uninsured over past 12 months Children (0 to 18) Non-elderly adults (19 to 64) Elderly adults (65 and older) Note: The categories listed in this figure are not mutually exclusive. The group Ever uninsured over past 12 months includes those always uninsured over the past 12 months, gaining coverage over the past 12 months, and losing coverage over the past 12 months. Source: 2014 Massachusetts Health Insurance Survey 13

Transitions in Health Insurance Coverage in Massachusetts in 2014, by Gender 100% 93.0 88.3 80% 60% 40% 20% 11.7 7.0 6.3 4.8 2.8 2.6 1.6 0.6 0% Always insured over past 12 months Ever uninsured over past 12 months Gained coverage over past 12 months Lost coverage over past 12 months Always uninsured over past 12 months Female Male Note: The categories listed in this figure are not mutually exclusive. The group Ever uninsured over past 12 months includes those always uninsured over the past 12 months, gaining coverage over the past 12 months, and losing coverage over the past 12 months. Source: 2014 Massachusetts Health Insurance Survey 14

Transitions in Health Insurance Coverage in Massachusetts in 2014, by Race and Ethnicity 100% 92.6 88.0 87.7 82.0 80% 60% 40% 17.6 20% 12.3 12.0 10.3 8.9 7.5 6.0 5.3 4.4 3.8 3.4 1.8 1.8 1.3 1.3 1.0 0% Always insured over past 12 months Ever uninsured over past 12 months Gained coverage over past 12 months Lost coverage over past 12 months Always uninsured over past 12 months White, non-Hispanic Black, non-Hispanic Other or multiple races, non-Hispanic Hispanic Note: The categories listed in this figure are not mutually exclusive. The group Ever uninsured over past 12 months includes those always uninsured over the past 12 months, gaining coverage over the past 12 months, and losing coverage over the past 12 months. Source: 2014 Massachusetts Health Insurance Survey 15

Transitions in Health Insurance Coverage in Massachusetts in 2014, by Family Income 97.9 100% 93.1 84.3 83.3 80% 60% 40% 16.6 15.6 20% 10.7 10.0 6.9 4.1 3.4 3.0 2.3 2.2 2.2 1.8 1.6 1.2 0.8 0.2 0% Always insured over past 12 months Ever uninsured over past 12 months Gained coverage over past 12 months Lost coverage over past 12 months Always uninsured over past 12 months Income at or below 138% of Federal Poverty Level (FPL) Income between 138 and 299% FPL Income between 300 and 399% FPL Income at or above 400% FPL Note: The categories listed in this figure are not mutually exclusive. The group Ever uninsured over past 12 months includes those always uninsured over the past 12 months, gaining coverage over the past 12 months, and losing coverage over the past 12 months. Source: 2014 Massachusetts Health Insurance Survey 16

Transitions in Health Insurance Coverage in Massachusetts in 2014, by Region Always insured over the past 12 months (%) Ever uninsured over the past 12 months (%) Gained coverage over the past 12 months (%) Lost coverage over the past 12 months (%) Always uninsured over the past 12 months (%) Western MA 90.5 9.5 6.0 1.9 1.6 Central MA 89.0 11.0 7.1 1.9 2.0 Northeast MA 91.3 8.5 5.5 1.9 1.2 Metro West 94.1 5.9 4.3 1.1 0.4 Metro Boston 87.6 12.3 6.2 4.0 2.2 Metro South 92.0 8.1 5.1 1.0 2.0 Southcoast 94.7 5.3 3.5 1.5 0.3 Cape and Islands 94.9 5.5 2.1 1.5 1.9 Note: The categories listed in this figure are not mutually exclusive. The group Ever uninsured over past 12 months includes those always uninsured over the past 12 months, gaining coverage over the past 12 months, and losing coverage over the past 12 months. Source: 2014 Massachusetts Health Insurance Survey 17

Health Insurance Coverage among Insured Respondents in Massachusetts in 2014 100% 80% 58.8 60% 40% 16.4 15.6 20% 7.9 1.3 0% Employer-sponsored insurance Medicare Private non-group coverage, including Commonwealth Choice MassHealth or Commonwealth Care Other coverage or coverage type not reported Notes: Respondents were assigned a single coverage type based on the following hierarchy: employer-sponsored insurance; Medicare; private non-group coverage including Commonwealth Choice; MassHealth or Commonwealth Care; and other coverage. Medicare coverage estimates include Railroad Retirement board coverage. MassHealth or Commonwealth Care includes temporary coverage while the respondent's application for coverage from the Health Connector or MassHealth is being processed. Estimates may not sum to 100% due to rounding. It is important to remember that survey respondents often have difficulty reporting type of insurance coverage correctly. Source: 2014 Massachusetts Health Insurance Survey 18

Health Insurance Coverage among Insured Respondents in Massachusetts in 2014, by Age Group 100% 80% 67.0 65.1 63.6 60% 40% 29.5 24.1 15.7 20% 9.5 9.4 7.6 2.5 2.0 1.8 1.2 0.8 0.3 0% Employer-sponsored insurance Medicare Private non-group coverage, including Commonwealth Choice MassHealth or Commonwealth Care Other coverage or coverage type not reported Children (0 to 18) Non-elderly adults (19 to 64) Elderly adults (65 and older) Notes: Respondents were assigned a single coverage type based on the following hierarchy: employer-sponsored insurance; Medicare; private non-group coverage including Commonwealth Choice; MassHealth or Commonwealth Care; and other coverage. Medicare coverage estimates include Railroad Retirement board coverage. MassHealth or Commonwealth Care includes temporary coverage while the respondent's application for coverage from the Health Connector or MassHealth is being processed. Estimates may not sum to 100% due to rounding. It is important to remember that survey respondents often have difficulty reporting type of insurance coverage correctly. Source: 2014 Massachusetts Health Insurance Survey 19

Health Insurance Coverage among Insured Respondents in Massachusetts in 2014, by Gender 100% 80% 61.1 56.8 60% 40% 17.6 16.5 15.1 14.5 20% 8.2 7.4 1.9 0.9 0% Employer-sponsored insurance Medicare Private non-group coverage, including Commonwealth Choice MassHealth or Commonwealth Care Other coverage or coverage type not reported Female Male Notes: Respondents were assigned a single coverage type based on the following hierarchy: employer-sponsored insurance; Medicare; private non-group coverage including Commonwealth Choice; MassHealth or Commonwealth Care; and other coverage. Medicare coverage estimates include Railroad Retirement board coverage. MassHealth or Commonwealth Care includes temporary coverage while the respondent's application for coverage from the Health Connector or MassHealth is being processed. Estimates may not sum to 100% due to rounding. It is important to remember that survey respondents often have difficulty reporting type of insurance coverage correctly. Source: 2014 Massachusetts Health Insurance Survey 20

Health Insurance Coverage among Insured Respondents in Massachusetts in 2014, by Race and Ethnicity 100% 80% 64.3 54.1 60% 46.7 42.4 40% 31.4 29.8 23.5 17.7 17.6 20% 12.9 11.5 9.8 9.1 7.5 7.4 4.6 4.4 3.6 1.0 0.9 0% Employer-sponsored insurance Medicare Private non-group coverage, including Commonwealth Choice MassHealth or Commonwealth Care Other coverage or coverage type not reported White, non-Hispanic Black, non-Hispanic Other or multiple races, non-Hispanic Hispanic Notes: Respondents were assigned a single coverage type based on the following hierarchy: employer-sponsored insurance; Medicare; private non-group coverage including Commonwealth Choice; MassHealth or Commonwealth Care; and other coverage. Medicare coverage estimates include Railroad Retirement board coverage. MassHealth or Commonwealth Care includes temporary coverage while the respondent's application for coverage from the Health Connector or MassHealth is being processed. Estimates may not sum to 100% due to rounding. It is important to remember that survey respondents often have difficulty reporting type of insurance coverage correctly. Source: 2014 Massachusetts Health Insurance Survey 21

Health Insurance Coverage among Insured Respondents in Massachusetts in 2014, by Family Income 100% 85.4 80% 70.3 60% 46.4 41.0 40% 32.4 20.7 19.2 16.5 14.2 12.5 20% 8.4 7.7 6.2 6.0 5.1 2.3 1.7 1.6 1.2 1.1 0% Employer-sponsored insurance Medicare Private non-group coverage, including Commonwealth Choice MassHealth or Commonwealth Care Other coverage or coverage type not reported Income at or below 138% of Federal Poverty Level (FPL) Income between 138 and 299% FPL Income between 300 and 399% FPL Income at or above 400% FPL Notes: Respondents were assigned a single coverage type based on the following hierarchy: employer-sponsored insurance; Medicare; private non-group coverage including Commonwealth Choice; MassHealth or Commonwealth Care; and other coverage. Medicare coverage estimates include Railroad Retirement board coverage. MassHealth or Commonwealth Care includes temporary coverage while the respondent's application for coverage from the Health Connector or MassHealth is being processed. Estimates may not sum to 100% due to rounding. It is important to remember that survey respondents often have difficulty reporting type of insurance coverage correctly. Source: 2014 Massachusetts Health Insurance Survey 22

Health Insurance Coverage among Insured Respondents in Massachusetts in 2014, by Region Employer- sponsored insurance (%) Medicare (%) Private non-group coverage, including Commonwealth Choice (%) MassHealth or Commonwealth Care (%) Other coverage or coverage type not reported (%) Western MA 50.9 20.4 18.3 0.5 9.8 Central MA 58.2 19.5 13.2 2.8 6.3 Northeast MA 63.7 11.7 16.5 0.4 7.8 Metro West 69.4 15.8 6.9 1.5 6.4 Metro Boston 60.4 12.8 17.5 1.9 7.5 Metro South 57.4 21.1 13.6 2.0 6.0 Southcoast 42.6 23.7 23.4 0.7 9.7 Cape and Islands 47.8 19.7 15.4 0.2 17.0 Notes: Respondents were assigned a single coverage type based on the following hierarchy: employer-sponsored insurance; Medicare; private non-group coverage including Commonwealth Choice; MassHealth or Commonwealth Care; and other coverage. Medicare coverage estimates include Railroad Retirement board coverage. MassHealth or Commonwealth Care includes temporary coverage while the respondent's application for coverage from the Health Connector or MassHealth is being processed. Estimates may not sum to 100% due to rounding. It is important to remember that survey respondents often have difficulty reporting type of insurance coverage correctly. Source: 2014 Massachusetts Health Insurance Survey 23

2. HEALTH CARE ACCESS AND USE

Health Care Access and Use for All Massachusetts Respondents, 2008-2011 and 2014 100% 92.9 91.9 91.0 90.9 87.7 90% 88.1 88.0 88.3 87.9 86.8 80% 79.3 78.5 78.5 78.4 78.3 70% 60% 50% 2008 2009 2010 2011 2012 2013 2014 Had a usual source of care (excluding the emergency department) (MHIS 2008-2011) Had a usual source of care (excluding the emergency department) (MHIS 2014) Had a visit to a general doctor or specialist in the past 12 months (MHIS 2008-2011) Had a visit to a general doctor or specialist in the past 12 months (MHIS 2014 Had a visit to a general doctor for preventive care in the past 12 months (MHIS 2008-2011) Had a visit to a general doctor for preventive care in the past 12 months (MHIS 2014) Note: Due to a change in survey design for the MHIS in 2014, Massachusetts estimates for 2014 are not directly comparable to estimates for 2008-2011. Source: 2008-2011, 2014 Massachusetts Health Insurance Survey 25

Health Care Access and Use for All Massachusetts Respondents in 2014 100% 87.7 86.8 78.5 80% 70.1 60% 40% 20% 0% Had a usual source of care (excluding the emergency department) Had a visit to a general doctor or specialist in the past 12 months Had a visit to a general doctor for preventive care in the past 12 months Had a dental care visit in the past 12 months Source: 2014 Massachusetts Health Insurance Survey 26

Health Care Access and Use in Massachusetts in 2014, by Age Group 94.5 100% 92.9 91.8 89.9 88.5 84.6 83.4 81.9 81.3 80% 73.9 67.8 62.2 60% 40% 20% 0% Had a usual source of care (excluding the emergency department) Had a visit to a general doctor or specialist in the past 12 months Had a visit to a general doctor for preventive care in the past 12 months Had a dental care visit in the past 12 months Children (0 to 18) Non-elderly adults (19 to 64) Elderly adults (65 and older) Source: 2014 Massachusetts Health Insurance Survey 27

Health Care Access and Use in Massachusetts in 2014, by Gender 100% 90.9 90.6 84.3 82.8 81.7 75.0 80% 72.2 67.9 60% 40% 20% 0% Had a usual source of care (excluding the emergency department) Had a visit to a general doctor or specialist in the past 12 months Had a visit to a general doctor for preventive care in the past 12 months Had a dental care visit in the past 12 months Female Male Source: 2014 Massachusetts Health Insurance Survey 28

Health Care Access and Use in Massachusetts in 2014, by Race and Ethnicity 100% 90.3 88.8 81.6 81.5 80.7 80.6 80.4 80.2 78.9 75.3 80% 72.5 72.3 70.3 69.4 66.6 54.2 60% 40% 20% 0% Had a usual source of care (excluding the emergency department) Had a visit to a general doctor or specialist in the past 12 months Had a visit to a general doctor for preventive care in the past 12 months Had a dental care visit in the past 12 months White, non-Hispanic Black, non-Hispanic Other or multiple races, non-Hispanic Hispanic Source: 2014 Massachusetts Health Insurance Survey 29

Health Care Access and Use in Massachusetts in 2014, by Family Income 100% 93.2 90.8 85.2 84.8 84.1 84.0 83.7 83.4 82.7 82.5 75.8 75.4 80% 73.0 71.5 59.8 55.3 60% 40% 20% 0% Had a usual source of care (excluding the emergency department) Had a visit to a general doctor or specialist in the past 12 months Had a visit to a general doctor for preventive care in the past 12 months Had a dental care visit in the past 12 months Income at or below 138% of Federal Poverty Level (FPL) Income between 138 and 299% FPL Income between 300 and 399% FPL Income at or above 400% FPL Source: 2014 Massachusetts Health Insurance Survey 30

Health Care Access and Use in Massachusetts in 2014, by Region Had a usual source of care (excluding the emergency department) (%) Had a visit to a general doctor or specialist in the past 12 months (%) Had a visit to a general doctor for preventive care in the past 12 months (%) Had a dental care visit in the past 12 months (%) Western MA 85.8 86.3 78.5 65.8 Central MA 85.5 86.9 80.0 65.6 Northeast MA 91.3 88.7 81.2 71.7 Metro West 90.0 92.8 83.0 81.2 Metro Boston 82.9 80.6 70.6 68.6 Metro South 90.2 88.0 80.4 70.9 Southcoast 89.3 93.6 84.9 61.6 Cape and Islands 94.1 87.4 80.8 78.7 Source: 2014 Massachusetts Health Insurance Survey 31

Difficulties Getting Health Care for All Massachusetts Respondents in 2014 50% 40% 30% 19.2 20% 13.5 12.4 10% 0% Told doctor's office or clinic did not accept insurance type over the past 12 months Told doctor's office or clinic was not accepting new patients over the past 12 months Unable to get an appointment with a health provider as soon as needed over the past 12 months Source: 2014 Massachusetts Health Insurance Survey 32

Difficulties Getting Health Care in Massachusetts in 2014, by Age Group 50% 40% 30% 23.6 17.6 20% 15.6 13.2 10.2 8.8 10% 6.8 6.6 5.0 0% Told doctor's office or clinic did not accept insurance type over the past 12 months Told doctor's office or clinic was not accepting new patients over the past 12 months Unable to get an appointment with a health provider as soon as needed over the past 12 months Children (0 to 18) Non-elderly adults (19 to 64) Elderly adults (65 and older) Source: 2014 Massachusetts Health Insurance Survey 33

Difficulties Getting Health Care in Massachusetts in 2014, by Gender 50% 40% 30% 22.1 20% 16.1 15.7 13.8 11.1 11.0 10% 0% Told doctor's office or clinic did not accept insurance type over the past 12 months Told doctor's office or clinic was not accepting new patients over the past 12 months Unable to get an appointment with a health provider as soon as needed over the past 12 months Female Male Source: 2014 Massachusetts Health Insurance Survey 34

Difficulties Getting Health Care in Massachusetts in 2014, by Race and Ethnicity 50% 40% 27.7 30% 24.0 20.3 19.8 18.9 17.4 20% 14.1 12.9 12.7 11.8 11.7 11.5 10% 0% Told doctor's office or clinic did not accept insurance type over the past 12 months Told doctor's office or clinic was not accepting new patients over the past 12 months Unable to get an appointment with a health provider as soon as needed over the past 12 months White, non-Hispanic Black, non-Hispanic Other or multiple races, non-Hispanic Hispanic Source: 2014 Massachusetts Health Insurance Survey 35

Difficulties Getting Health Care in Massachusetts in 2014, by Family Income 50% 40% 30% 23.8 19.9 18.6 18.4 18.2 17.3 20% 15.9 15.4 11.5 10.5 10.1 10% 6.7 0% Told doctor's office or clinic did not accept insurance type over the past 12 months Told doctor's office or clinic was not accepting new patients over the past 12 months Unable to get an appointment with a health provider as soon as needed over the past 12 months Income at or below 138% of Federal Poverty Level (FPL) Income between 138 and 299% FPL Income between 300 and 399% FPL Income at or above 400% FPL Source: 2014 Massachusetts Health Insurance Survey 36

Difficulties Getting Health Care in Massachusetts in 2014, by Region Told doctor's office or clinic did not accept insurance type over the past 12 months Told doctor's office or clinic was not accepting new patients over the past 12 months Unable to get an appointment with a health provider as soon as needed over the past 12 months Western MA 15.9 18.3 18.6 Central MA 13.2 12.9 20.5 Northeast MA 9.5 8.4 16.5 Metro West 13.1 18.1 20.3 Metro Boston 11.2 12.5 20.0 Metro South 13.6 14.0 20.1 Southcoast 14.8 15.2 22.8 Cape and Islands 14.3 18.0 17.2 Source: 2014 Massachusetts Health Insurance Survey 37

Emergency Department Use by All Massachusetts Respondents in 2014 50% 38.7 40% 31.2 30% 20% 14.7 10% 0% Any emergency department (ED) visit over the past 12 months More than one ED visit over the past 12 months Among those with an ED visit over the past 12 months, most recent ED visit was for a non-emergency condition Note: A non-emergency condition is one that the respondent thought could have been treated by a regular doctor if one had been available. Source: 2014 Massachusetts Health Insurance Survey 38

Emergency Department Use in Massachusetts in 2014, by Age Group 50% 42.4 40.2 40% 31.8 31.5 29.2 30% 26.6 20% 16.8 15.5 11.4 10% 0% Any emergency department (ED) visit over the past 12 months More than one ED visit over the past 12 months Among those with an ED visit over the past 12 months, most recent ED visit was for a non-emergency condition Children (0 to 18) Non-elderly adults (19 to 64) Elderly adults (65 and older) Note: A non-emergency condition is one that the respondent thought could have been treated by a regular doctor if one had been available. Source: 2014 Massachusetts Health Insurance Survey 39

Emergency Department Use in Massachusetts in 2014, by Gender 50% 38.9 38.5 40% 33.0 29.2 30% 20% 15.9 13.5 10% 0% Any emergency department (ED) visit over the past 12 months More than one ED visit over the past 12 months Among those with an ED visit over the past 12 months, most recent ED visit was for a non-emergency condition Female Male Note: A non-emergency condition is one that the respondent thought could have been treated by a regular doctor if one had been available. Source: 2014 Massachusetts Health Insurance Survey 40

Emergency Department Use in Massachusetts in 2014, by Race and Ethnicity 60% 55.2 48.4 50% 43.5 40% 30.0 28.8 28.1 28.1 30% 21.9 20% 12.9 12.4 10% * * 0% Any emergency department (ED) visit over the past 12 months More than one ED visit over the past 12 months Among those with an ED visit over the past 12 months, most recent ED visit was for a non-emergency condition White, non-Hispanic Black, non-Hispanic Other or multiple races, non-Hispanic Hispanic * The value has been suppressed due to small sample size. Note: A non-emergency condition is one that the respondent thought could have been treated by a regular doctor if one had been available. Source: 2014 Massachusetts Health Insurance Survey 41

Emergency Department Use in Massachusetts in 2014, by Family Income 50% 45.8 42.3 38.5 40% 34.6 33.1 29.2 27.5 30% 22.3 18.0 20% 10.0 7.0 10% * 0% Any emergency department (ED) visit over the past 12 months More than one ED visit over the past 12 months Among those with an ED visit over the past 12 months, most recent ED visit was for a non-emergency condition Income at or below 138% of Federal Poverty Level (FPL) Income between 138 and 299% FPL Income between 300 and 399% FPL Income at or above 400% FPL * The value has been suppressed due to small sample size. Note: A non-emergency condition is one that the respondent thought could have been treated by a regular doctor if one had been available. Source: 2014 Massachusetts Health Insurance Survey 42

Emergency Department Use in Massachusetts in 2014, by Region Any emergency department (ED) visit over the past 12 months (%) More than one ED visit over the past 12 months (%) Among those with an ED visit over the past 12 months, most recent ED visit was for a non- emergency condition (%) Western MA 32.3 16.6 37.8 Central MA 34.5 20.2 43.4 Northeast MA 27.4 12.0 38.9 Metro West 28.7 12.0 * Metro Boston 33.2 16.0 39.4 Metro South 29.7 11.8 * Southcoast 35.8 17.3 * Cape and Islands 31.3 13.7 * * The value has been suppressed due to small sample size. Note: A non-emergency condition is one that the respondent thought could have been treated by a regular doctor if one had been available. Source: 2014 Massachusetts Health Insurance Survey 43

3. HEALTH CARE AFFORDABILITY

Unmet Health Care Needs and Difficulty Paying Family Medical Bills for All Massachusetts Respondents, 2008-2011 and 2014 50% 40% 27.9 30% 23.9 22.7 20.7 20.7 20% 19.6 18.0 17.5 15.7 15.2 10% 0% 2008 2009 2010 2011 2012 2013 2014 Any unmet need for health care because of costs (MHIS 2008-2011) Any unmet need for health care because of costs (MHIS 2014) Had difficulty paying medical bills in the past 12 months (MHIS 2008-2011) Had difficulty paying medical bills in the past 12 months (MHIS 2014) Note: Due to a change in survey design for the MHIS in 2014, estimates for 2014 are not directly comparable to estimates from 2008-2011. Estimates for unmet need for health care due to costs include unmet needs for dental as well as medical care. Medical care includes doctor care, specialist care, and prescription drugs. Source: 2008-2011, 2014 Massachusetts Health Insurance Survey 45

Reported Unmet Need for Health Care Because of Costs for All Massachusetts Respondents in 2014 50% 40% 27.9 30% 20.1 20% 11.2 8.8 10% 0% Any unmet need for health care over the past 12 months because of cost of care Any unmet met need for doctor care over the past 12 months because of cost of care Ever went without prescription drugs over the past 12 months because of costs Any unmet need for dental care over the past 12 months because of cost of care Note: Any unmet need for care is defined as reporting one or more of the following unmet needs for care due to cost: unmet need for doctor care, unmet need for specialist care, unmet need for dental care, or ever went without a prescription drug because of costs. Medical care includes doctor care, specialist care, and prescription drugs. Source: 2014 Massachusetts Health Insurance Survey 46

Reported Unmet Need for Health Care Because of Costs in Massachusetts in 2014, by Age Group 50% 40% 35.2 30% 25.9 22.0 20% 15.4 14.5 12.3 12.1 8.3 7.5 10% 4.6 3.9 3.4 0% Any unmet need for health care over the past 12 months because of cost of care Any unmet met need for doctor care over the past 12 months because of cost of care Ever went without prescription drugs over the past 12 months because of costs Any unmet need for dental care over the past 12 months because of cost of care Children (0 to 18) Non-elderly adults (19 to 64) Elderly adults (65 and older) Note: Any unmet need for care is defined as reporting one or more of the following unmet needs for care due to cost: unmet need for doctor care, unmet need for specialist care, unmet need for dental care, or ever went without a prescription drug because of costs. Medical care includes doctor care, specialist care, and prescription drugs. Source: 2014 Massachusetts Health Insurance Survey 47

Reported Unmet Need for Health Care Because of Costs in Massachusetts in 2014, by Gender 50% 40% 31.1 30% 24.4 21.4 18.6 20% 13.1 9.3 8.9 8.7 10% 0% Any unmet need for health care over the past 12 months because of cost of care Any unmet met need for doctor care over the past 12 months because of cost of care Ever went without prescription drugs over the past 12 months because of costs Any unmet need for dental care over the past 12 months because of cost of care Female Male Note: Any unmet need for care is defined as reporting one or more of the following unmet needs for care due to cost: unmet need for doctor care, unmet need for specialist care, unmet need for dental care, or ever went without a prescription drug because of costs. Medical care includes doctor care, specialist care, and prescription drugs. Source: 2014 Massachusetts Health Insurance Survey 48

Reported Unmet Need for Health Care Because of Costs in Massachusetts in 2014, by Race and Ethnicity 50% 36.9 40% 30.3 27.5 30% 26.6 26.4 21.2 21.0 18.8 18.0 20% 15.8 14.1 10.4 10.1 9.1 7.9 10% 6.3 0% Any unmet need for health care over the past 12 months because of cost of care Any unmet met need for doctor care over the past 12 months because of cost of care Ever went without prescription drugs over the past 12 months because of costs Any unmet need for dental care in the past 12 months because of cost of care White, non-Hispanic Black, non-Hispanic Other or multiple races, non-Hispanic Hispanic Note: Any unmet need for care is defined as reporting one or more of the following unmet needs for care due to cost: unmet need for doctor care, unmet need for specialist care, unmet need for dental care, or ever went without a prescription drug because of costs. Medical care includes doctor care, specialist care, and prescription drugs. Source: 2014 Massachusetts Health Insurance Survey 49

Reported Unmet Need for Health Care Because of Costs in Massachusetts in 2014, By Family Income 50% 40.7 39.1 40% 30.1 29.3 30% 24.0 19.3 20% 16.7 16.0 15.5 13.9 12.9 10.4 8.2 8.0 10% 4.5 3.9 0% Any unmet need for health care over the past 12 months because of cost of care Any unmet met need for doctor care over the past 12 months because of cost of care Ever went without prescription drugs over the past 12 months because of costs Any unmet need for dental care over the past 12 months because of cost of care Income at or below 138% of Federal Poverty Level (FPL) Income between 138 and 299% FPL Income between 300 and 399% FPL Note: Any unmet need for care is defined as reporting one or more of the following unmet needs for care due to cost: unmet need for doctor care, unmet need for specialist care, unmet need for dental care, or ever went without a prescription drug because of costs. Medical care includes doctor care, specialist care, and prescription drugs. Source: 2014 Massachusetts Health Insurance Survey Income at or above 400% FPL 50