In April 2006, Massachusetts enacted a health care reform bill that seeks to move the state to (almost) universal coverage through a combination of Medicaid expansions, subsidized private health insurance coverage, and insurance reforms. As part of an evaluation of the impacts of the state's reform effort, we conducted surveys of adults aged 18 to 64 years old in Massachusetts in Fall 2006 and Fall 2007. This document provides an overview of the survey approach and the two survey instruments.
The Massachusetts Health Reform Survey is a random-digit-dial (RDD) telephone interview conducted with adults aged 18 to 64 years old in Massachusetts. To date, surveys have been conducted in Fall 2006, Fall 2007, and Fall 2008. The surveys were fielded by ICR/International Communications Research, using a Computer Assisted Telephone (CATI) interviewing system. Interviews were conducted in English, Spanish and (in 2007 and 2008) Portuguese.
The surveys relied on a stratified random sample of telephone households, with oversamples of the low and moderate-income populations likely to be most affected by the reforms--uninsured adults, adults with family income below 300% FPL, and adults with family income between 300 and 500% FPL. To draw the sample, we examined all telephone exchanges within Massachusetts and listed them in descending order by concentration of household income. We then divided these exchanges into strata based on household income, with households with the highest incomes contained in the first stratum, followed by a stratum containing those with the next highest incomes, and a final stratum that contained households with the lowest incomes. In order to identify uninsured working age adults, the survey included a set of screening questions that determined whether there were any household members aged 18 to 64 years old and, if there were, whether those household members were currently covered by any type of health insurance. The question noted that we were interested in all types of health insurance coverage, including insurance obtained through a job or purchased directly from an insurance company, government programs like Medicare, MassHealth (or Medicaid) and Commonwealth Care, and programs that provide health care to military personnel and their families. Based on the responses to that question, one working-age adult was selected at random from each eligible household to complete the full survey. The full survey included more detailed insurance questions to identify the specific types of coverage held by the survey respondents.
In addition to questions on insurance status, the survey included sections that focused on the individual’s access to and use of health care; out-of-pocket health care costs and medical debt; insurance premiums and covered services (for those with insurance); and health and disability status. Respondents were also asked about their impressions of Massachusetts’s health reform law (based on a question from an earlier survey by Blendon, Buhr, Fleischfresser and Benson, 2006) and the individual mandate.
With few exceptions, the survey relied on questions drawn from established, well-validated surveys. While we sought to maintain consistency with those prior surveys, we have modified some questions to ensure that they address the issues of particular concern for this study. In addition, we developed new questions for some issues specific to the context of Massachusetts’s reform initiative.