Massachusetts Report Provides Insights into Barriers that Remain After Health Reform

A new report released by the Massachusetts Department of Public Health Family Planning Program and Ibis Reproductive Health examines the barriers low-income Massachusetts women face in accessing contraception services since Massachusetts implemented a universal health care bill.

The bill, enacted in 2006, allows low-income residents who are not eligible for Medicaid or Medicare and don’t have insurance through an employer to join one of four government-subsidized private insurance plans. In addition to these government plan options, low-income women without health insurance can also access contraceptive and reproductive health services at sliding-scale fees through family planning clinics and community health centers.

To document the perspectives of low-income women about these services and identify barriers to services (comparing access before and after reform), the researchers reviewed the four public plans to determine how readily a user could understand them and get needed coverage information, surveyed family planning agency staff and conducted in-depth interviews with family planning and clinic staff, and held focus group discussions with low-income women.

Among their findings:

• There was no central source of information on contraceptive coverage that would allow a woman to compare whether her method would be covered by each of the four government plans. Although each plan provided information on all drugs covered, it was difficult to search and use.
• Providers and women both generally reported easy access to contraception before and after reform, but some women reported experiencing barriers to accessing contraception using a prescription at pharmacies. In some cases, this was because of the pharmacists’ lack of information about the plans’ coverage, and in others there were barriers for the women of time, information, location, and cost. For example, the plans apparently only allow one month of oral contraceptive pills to be filled at a time, creating time/access barriers for some women.
• Women and providers felt that some populations – especially immigrants, young women, those with unstable employment or income, and those experiencing life changes – had been “left out” of the benefits for reform, citing problems of  ineligibility, changing eligibility, and confidentiality.
• In general, women needed more information about contraceptive coverage, how to enroll, and how to document their eligibility for the government plans.

The authors made a series of recommendations, such as better educating providers and pharmacists about coverage under the government plans, developing more user-friendly information about coverage (especially of contraceptives), better supporting family planning clinics, and improving contraception coverage and access (such as allowing receipt of multiple months of hormonal contraception at one time, like 90-day or mail-order options provided by many insurers). Because Massachusetts is currently a unique model for health care reform, these findings may provide points of consideration if a public option is part of the national health care reform.

For more health reform-related discussion, see Christine’s posts on the Healthcare System.