Massachusetts is held up as a model for healthcare coverage, with about 98% of residents covered by insurance. And new polling from a GBH News partnership with Commonwealth Beacon exploring access to healthcare in Massachusetts shows most residents say they’re satisfied with their health insurance.
But digging a little deeper into the numbers reveals a paradox: Nearly one-third of Massachusetts residents are still delaying care — or skipping it altogether — because of the high costs. So, high satisfaction with insurance on one hand, but unaffordable care on the other.
Richard Parr, research director at the MassInc polling group, which conducted the survey, joined GBH’s All Things Considered host Arun Rath to help make sense of the numbers. What follows is a lightly edited transcript of the conversation.
Arun Rath: I usually want to go in with the bad news and then get to the good, but let’s go backwards on this and start off with what sounds really good with this. The poll finds a majority of residents say they’re satisfied with their health insurance. What’s driving the satisfaction?
Richard Parr: Yeah, this is an interesting one. As you mentioned in the beginning, there are some problems here, but if you ask people right off the top, just, “What do you think? Do you like the care you’re getting? Do you like the insurance you’re getting?” We’re seeing about three-quarters of people saying at least that they’re very, or somewhat, satisfied.
So, I think it raises some interesting questions. Where is this bar for folks? How much are they willing to put up with, but still feel like they have a pretty good experience from their healthcare system here?
Rath: I don’t know if this is a question you can answer, but it feels like we have a high bar here in Massachusetts. Do you think we do?
Parr: Yes, and I think the residents think that too. One of the questions we asked in the survey was, “How would you rank Massachusetts compared to other states in terms of the quality of healthcare, and also, in terms of the affordability of the healthcare?”
We are rated very highly in terms of quality; 42% say we’re one of the top states, and another 27% say we are above average. We’re a little bit more mixed, I would say, when it comes to the affordability question. More people there are saying we’re kind of middle of the pack, and they’re kind of equally distributed between being above average or below average.
But in terms of quality, people think they’re in one of the best states, and I wonder if that is coloring some of the opinions about their satisfaction level. If they think that we’re one of the best, maybe they’re willing to put up with some things, thinking that the grass is not greener anywhere else.
Rath: Interesting. Well, let’s dig a bit deeper into that. It seems kind of alarming … When we see that we’re generally satisfied with our healthcare, it sounds alarming to hear about people skipping or delaying care because of costs. Can you break that down a little bit? What’s going on there?
Parr: This was one of the interesting findings. About one-third, I think 33%, of folks were telling us that they had skipped OR delayed — so we don’t quite know if people are outright skipping or if they’re just putting off medical care because of costs.
There are some variations in this. We’re seeing that younger people are much more likely to skip care. That might be sort of a sense of feeling invincible. And older people, folks who are 65 or older in this survey, were much less likely to skip care. Again, that might just be their stage of life and they feel like they need to be taking care of things.
Another interesting factor, though, is that a lot of those people are on Medicare, of course. We found that folks who are on Medicare are much less likely to skip care than folks who have private insurance. So even though we’re seeing an overall satisfaction with insurance that’s quite high, there are some variations between whether you have private insurance or whether you have public insurance — meaning either Medicare or Medicaid/MassHealth.
Rath: When people are delaying or denying coverage because of cost — you know, we’re talking about being satisfied with their insurance coverage — are there people who are getting denied claims?
Parr: Yeah, so this is an interesting question as well. This relates specifically to people who have insurance. We asked people if they’d ever had a claim for medical care for themselves or someone whose care they manage — so, this could be a child that they take care of or an older adult that they’re taking care of — have they ever had a claim denied by a health insurance company? And 28% of folks said yes, so it’s a minority. Most people have not had this experience, but it’s still a pretty good chunk of people. Over a quarter, right?
Then, we did a follow-up question to ask folks, “Well, were you able to resolve that issue to your satisfaction or not?” And only about half — 48% — said yes, they had, and 51% said no. That means that, roughly speaking, about 14% of people have had a claim denied and have not been able to solve that in a way that was to their satisfaction.
Rath: As we zoom in again and try to reconcile if this really is a contradiction that people are generally satisfied with health insurance — say, like these younger people that you were talking about — are they really outliers, or is there something more complex going on here, if that makes sense?
Parr: I think that some of this has to do with our perception of health care in Massachusetts and how we’re kind of trying to reconcile that with the care that we’re getting. It’s sort of the opposite of the grass being greener on the other side.
People think they’re in one of the best health care states in America here, and so they don’t really think that they’re likely to get much better anywhere else. As a result, they may be overstating, perhaps, how good they think it is and are willing to put up with a little bit in terms of these denied claims and in terms of putting off care.
In some parts of the state, we found that people are waiting a longer period of time to get to see a doctor, depending on the availability of doctors in their region. Some people are driving longer distances to get to their doctors. This is particularly an issue when you get outside of the Greater Boston area, so there is a little bit of unevenness, I would say, in terms of the geography here.
If you’re close to Boston, where our excellent university-based hospitals are, people are saying that they’re able to get to a doctor’s appointment, they’re able to get to it quickly, and they don’t have to drive very far to get there. As you get further out into the western part of the state, or the more southeastern part of this state, people are telling us that they are driving longer distances in order to get to appointments, and that they’re having to wait longer to get an appointment in the first place.
Rath: Finally, do these findings suggest lessons for policymakers for health policy, when it comes to making things better for people who aren’t in those areas, for people across the state?
Parr: One of the things that’s really interesting in this survey is we asked about telehealth, which was obviously a very big thing during the pandemic a few years ago. The rate of people who are using telehealth has really dropped off now, and it’s not being utilized nearly as much as it was before.
But if you think about some of these other regions of the state where there are longer distances, or perhaps a [smaller] number of doctors that people can see in an appointment, you could see that maybe telehealth could help to start to fill that gap a little bit more, if we were to try to push that a little more for folks.
Maybe there are some appointments that could be scheduled more easily or gotten to more easily if we’re using all of the different ways that we can communicate with our doctors. Right now, it seems like we’ve kind of reverted back to just the traditional “go to the doctor when you have a problem,” as opposed to using some of these different technologies.
