The managers of the model for the new Patient Protection and Affordable Care Act (PPACA) health insurance exchange system -- the Massachusetts exchange program -- say low-income and moderate-income users seem to be happy with the program.
But officials at the Commonwealth Health Insurance Connector Authority have found an increase in the percentage of users who have been uninsured, at least temporarily, since they signed up for the exchange.
In related news, a team of outside researchers led by Alison Galbraith of Harvard found that about 60 percent of Massachusetts exchange users with two or more children and incomes under 400 percent of the federal poverty level reported that they found that paying for health care was a serious financial burden.
"We conclude that those with lower incomes, increased health care needs, and more children will be at particular risk after they obtain coverage through exchanges in 2014," Galbraith and her colleagues wrote in a paper published in Health Affairs, a health finance and health policy journal. "Policy makers should develop strategies to further mitigate the financial burden for enrollees who are most susceptible to encountering higher-than-expected out-of-pocket costs, such as providing cost calculators or price transparency tools."
The Connector Authority survey
Health Connector managers came up with the data for their analysis by conducting a telephone and mail survey of exchange users who qualify to enroll in subsidized Commonwealth Care plans.
About 84 percent of the 857 survey participants said they are satisfied or extremely satisfied with the Commonwealth Care program, up from 77 percent in 2012. The percentage who said they were extremely dissatisfied held steady at 2 percent.
The percentage of said the choice of providers was good, very good or excellent increased to 83 percent, from 80 percent, and the percentage who said the premiums were reasonable jumped to 83 percent, from 66 percent.
But the percentage who suffered a gap in coverage while using the exchange also increased, to 29 percent, from 22 percent.
The percentage of users who had lost access to coverage either permanently or temporarily because of an increase in income fell to 14 percent, from 26 percent.
The percentage who went without coverage because they failed to complete the renewal form rose to 17 percent, from 12 percent, and the percentage who said they had forgotten to pay the monthly premium climbed to 14 percent, from 5 percent.
The Galbraith analysis
The Galbraith team based its analysis -- of exchange users at all income levels -- on results from a survey of 393 Connector enrollees.
The sample included high-income exchange users who had bought unsubsidized coverage through the exchange as well as users who had qualified for subsidies.
The Galbraith team classified survey participants as suffering from a financial burden if the participants said they or family members had, within the previous 12 months, run into trouble with paying medical bills, made special arrangements with health care providers to pay bills over time, or run into trouble with covering the cost of basic living expenses because of the need to pay medical bills.
The percentage of participants who said they suffered from a health care-related financial burden was about the same for users of high-deductible plan options and low-deductible plan options.
Participants who had signed up for mid-level, "silver" level coverage, rather than bare-bones bronze plans or rich gold plans, were the most likely to report facing health-care-related financial burdens.
About 47 percent of the enrollees in silver plans said paying for health care was a burden, compared with 34 percent of the gold plan enrollees and 31 percent of the bronze plan enrollees.