What happens to the women who fall through the cracks of health care reform? Lessons from Massachusetts.

We investigated the impact of Massachusetts health care reform on low-income women's experiences accessing insurance and health services, specifically reproductive health services such as contraception. Our findings suggest that concentrated efforts are needed to make sure that health services are available and accessible to populations who fall through the cracks of health care reform, including immigrants, minors and young adults, and women living outside urban areas. In addition, systems changes are needed to ensure that women going through common life transitions, such as pregnancy, marriage, moving, or graduating from school, have continuous access to insurance, and therefore health services, as their lives change. These groups face barriers enrolling in and maintaining their insurance coverage as well as obtaining timely health care benefits they are eligible for through their insurance benefits or public health programs. Without intervention, many in these groups may delay or avoid seeking health care altogether, which may increase health care disparities in the long term. Family planning providers in Massachusetts have played a critical role in mitigating barriers to insurance and health care. However, recent threats to defund family planning providers call into question the ability of these providers to continue providing much-needed services.

Low-income women's access to contraception after health care reform in Massachusetts.

OBJECTIVES: To determine the experiences of low-income women who were eligible for government-subsidized health insurance and seeking contraception in community pharmacies following health care reform (HCR) in Massachusetts, to investigate the transitions experienced by family planning providers following HCR, and to evaluate the availability and ease of navigation of information on the Commonwealth Care plans websites regarding prescription benefits, including contraceptive formularies and copays. DESIGN: Descriptive, exploratory, nonexperimental study. SETTING: Massachusetts between August 2008 and March 2009. PARTICIPANTS: Family planning agency and site staff (n = 16) at 15 sites and low-income (<300% federal poverty level) English- and Spanish-speaking women (n = 23 and 29, respectively). INTERVENTION: Commonwealth Care (i.e., government-subsidized insurance plans for low-income residents) websites were reviewed, family planning agency administrators were surveyed, family planning staff were interviewed, and focus groups were conducted among low-income women. MAIN OUTCOME MEASURES: Experiences of low-income women and family planning providers. RESULTS: Findings from all study components were highly consistent. After reform, family planning staff reported providing more prescriptions for contraception versus providing contraception on site. Many focus group participants and family planning providers felt pharmacy provision of contraception enhanced access as a result of the convenient location of pharmacies. New barriers to obtaining contraception included an inability to obtain more than 1 month of contraception at a time and lack of coverage for over-the-counter methods. Findings about changes in the affordability of contraception postreform were mixed. CONCLUSION: HCR in Massachusetts changed how low-income women access contraception, presenting new opportunities and challenges for women, family planning providers, and pharmacists. The results of this project provide valuable lessons for pharmacists around the country as national HCR is implemented.

Access to contraception after health care reform in Massachusetts: a mixed-methods study investigating benefits and barriers.

BACKGROUND: In 2006, Massachusetts passed sweeping health care reform legislation aimed at improving access to health care for residents. This study investigates how this landmark legislation affected contraceptive access for low-income women. STUDY DESIGN: This study included (a) 16 in-depth interviews with family planning providers, (b) 9 focus group discussions with 52 low-income English- and Spanish-speaking women, (c) 10 self-administered surveys of family planning administrators and (d) a systematic review of Web sites for government-subsidized insurance plans. RESULTS: Findings from all study components were highly consistent. We found that while most low-income women in Massachusetts continue to regularly obtain contraception, challenges such as maintaining insurance coverage, understanding benefits, securing an appointment with a provider and obtaining prescriptions were identified post reform. Findings about contraceptive affordability under reform were mixed. CONCLUSION: Though health care reform legislation has benefited many women, barriers remain to ensuring consistent access to contraception for low-income women.