September 29, 2009 – Though many women and family planning providers in Massachusetts express overall satisfaction with health care reform, they identify family planning providers as an integral part of the public health safety net in Massachusetts, providing specific outreach to and services for hard-to-reach and underserved populations and mitigating some of the challenges with implementing health care reform. Ibis Reproductive Health and the Massachusetts Department of Public Health (MDPH) Family Planning Program collaborated on an assessment of the effects of health care reform in Massachusetts on low-income women’s access to contraception.
The research project included a systematic review of the government-subsidized insurance plans available to low-income Massachusetts residents, surveys and in-depth interviews with family planning providers around the Commonwealth, and English- and Spanish-language focus group discussions with low-income women. Women and providers agree that reform has increased access to both health insurance and services. Women in the study identified other positive effects, such as the ability to seek preventive care and reduced stigma from having insurance. However, some new challenges have resulted; both women and providers have difficulties finding information about insurance coverage of services, women struggle to maintain and prove eligibility for subsidized insurance plans, and family planning providers have taken on increased administrative and fiscal responsibilities. “
Women talk about the emotional benefits of knowing they have insurance, and how that might encourage use of health services,” says Kelly Blanchard, president of Ibis Reproductive Health. “At the same time health care reform has spread some of the challenges inherent in the private insurance model, which appears to have created barriers to access to contraception for some women.” New barriers to contraception access have arisen from reform, even though most women who participated in the study reported that they continue to have relatively easy access. Limits to the amount of contraception dispensed at once, high copays, inconvenient pharmacy locations, pharmacists’ lack of knowledge about what prescriptions are covered by the new subsidized plans, and even women’s unfamiliarity with how to use prescriptions were named as new challenges to contraceptive access for previously uninsured women accustomed to accessing services from clinics and community health centers. In addition, health care reform has left out some populations of women, including immigrants, young women, those with unstable employment or income, and those experiencing common life changes such as moving or pregnancy. “Family planning providers continue to provide essential services and play a role as advocates,” says Karen Edlund, Director of the MDPH Family Planning Program. “They are the voice for women in Massachusetts who continue to be forgotten and excluded from improvements to health care.” Contraception is an essential preventive health service. It is critical that women have access to the complete range of methods and that women and health care providers have accurate information about contraception and insurance coverage of reproductive health services in the wake of reform in the Commonwealth.
Read the executive summary and the full report for more detailed information about the findings and the recommendations of the project team. This study was supported by the National Institute for Reproductive Health and the Title X Regional Office for New England. Learn more about Ibis's other work related to Massachusetts health care reform.