Universal health insurance is not a panacea
In a recent study published by the Massachusetts Budget and Policy Center (MBPC), it was reported that 94 percent of state residents had health insurance in the years spanning 2007–2008, more than any other state in the nation.
The report utilized the most recent census data and suggested that the beneficial impact of the 2006 health reform law is clear because only 5.4 percent of state residents remain uninsured. Unfortunately, the report gives an overly rosy picture of the impact of health care reform in Massachusetts; moreover, aggregate data at the state level can discourage an informed discussion of some very important and fundamental questions about the nature and form of universal health care.
It may be true, for example, that 94 percent of all residents have some form of health insurance, but this figure most certainly varies by location, race and ethnicity.
As important as is the issue of health insurance and whether or not we have achieved 100 percent coverage, problems and challenges associated with glaring health care disparities in places like Boston remain salient. This issue of racial disparity and inequity has tended not to receive much attention in media reports. Instead, news accounts focus almost exclusively on the need to achieve universal health insurance for all people in Massachusetts.
Data derived from the Massachusetts Department of Public Health’s Behavioral Risk Factor Surveillance System Survey (2007), disaggregated by zip code, paints a more detailed portrait of the existing state of health care in Massachusetts, and raises issues not being addressed in discussions and reports about universal health insurance.
In Boston, for example, this data shows very large discrepancies in access to health insurance and to the type of coverage. Among Bostonians, 8.3 percent of whites, 28.3 percent of African Americans, and a whopping 41 percent of all Latinos have coverage via a program issued by the state (Medicaid or MassCHIP). According to these data, among Roxbury residents, 10 percent of non-Latino whites, 15 percent of non-Latino blacks and nine percent of all Latinos have no health insurance.
Importantly, even if they are now covered by some insurance plan, questions about access, quality and affordability can and should be raised. In Mattapan, nine percent of non-Hispanic blacks and 52.4 percent of Latinos self-reported that they do not have any health insurance, a scenario very much at odds with what has been reported by the census.
Very similar percentages of people reported that they could not see a physician regularly because of inadequate health care coverage and most probably unaffordable co-payments. Approximately 15 percent of blacks and Latinos said they could not afford to see a doctor regularly because of the cost. It is not clear that Massachusetts health care reform responds adequately to these kinds of problems.
There seems to be a presumption in the MBPC report that all health insurance is the same for everyone. But, universal health insurance does not necessarily mean that everyone will have the same access to quality and affordable healthcare. There are important racial/ethnic differences when it comes to the percentage of persons reporting fair/poor health, with whites significantly less likely to do so. Dorchester has the largest proportion of Latinos reporting fair/poor health and Roxbury/Mattapan has the largest proportion of blacks reporting fair or poor health. Massachusetts health care reform and the complete insurance requirement does not fully address issues related to these kinds of health care disparities by location and race and ethnicity.
The call for and implementation of universal health insurance coverage should be applauded. We need to document the number of people who are not insured, and therefore do not have access to health services. At the same time, let us not assume that universal health insurance is a panacea for the enormous health challenges facing the people of Massachusetts, where regardless of universal insurance coverage, issues of inadequate access, affordable access, and equitable access have yet to be addressed — and, where locational, racial and ethnic differences continue to point to health inequalities.
Gia Barboza, PhD is the Director of Research and Evaluation for the Dudley Street Neighborhood Initiative (DSNI) and teaches in the Sociology and Criminology Department at Curry College in Milton, Mass.
