BOSTON — A recent survey reveals that while the vast majority of Massachusetts residents have health insurance, many are still avoiding necessary medical care due to financial constraints. The biennial Massachusetts Health Insurance Survey, released on March 15, 2024, indicates that approximately 28% of residents or their family members refrained from seeking care in the past year because of costs, despite the state’s low uninsured rate of just 2.1%, significantly lower than the national rate of 8.2%.
The survey, conducted by the Center for Health Information and Analysis (CHIA) between January and April, involved interviews with 5,365 households. Although 90% of respondents reported continuous health insurance coverage for all family members over the past 12 months, issues related to affordability are becoming increasingly evident. A law enacted in 2006 under former Governor Mitt Romney aimed to ensure universal coverage, but it appears that access to affordable care remains a significant challenge.
Executive Director of CHIA, Lauren Peters, emphasized the urgency of addressing these intertwined issues. “In light of impending federal health care policy changes, it is more critical than ever that we confront the intertwined challenges of access and affordability in Massachusetts,” Peters stated. The survey found that 139,741 residents remain uninsured, a number that may rise as federal policy changes loom.
During the ongoing open enrollment period for the Massachusetts Health Connector, over 10,000 members have dropped their coverage, primarily due to rising premiums linked to the expiration of federal tax credits. The majority of uninsured individuals are aged 19 to 64, highlighting the availability of MassHealth for children and Medicare for seniors aged 65 and older.
The survey results also indicate that a disproportionate number of uninsured residents belong to marginalized communities, particularly those who are Hispanic, male, or have a family income below 300% of the federal poverty level. Many residents cited the steep cost of coverage and a lack of awareness about how to obtain insurance as the primary reasons for their uninsured status.
Under state law, residents must maintain health insurance or face a tax penalty. However, recent estimates suggest that the uninsured rate could double due to Medicaid changes proposed in the One Big Beautiful Bill Act, according to Audrey Shelto, CEO of the Blue Cross Blue Shield of Massachusetts Foundation.
“Even with near-universal coverage, many people continue to struggle to get care when they need it or delay care because of cost, and the problem is magnified for marginalized communities,” Shelto remarked. “These findings will help policymakers focus on the issues that are getting in the way of timely, affordable care.”
The survey highlighted that around 46% of commercially insured residents are enrolled in high-deductible health plans, defined by the Internal Revenue Service as having deductibles of at least $1,650 for individuals or $3,300 for families. These high deductibles often lead to increased out-of-pocket expenses, as patients must pay their deductibles before their plans cover specific services.
Despite the challenges, the report noted a downward trend in the percentage of residents struggling with medical debt. The percentage decreased from 19.6% in 2014 to 13.7% in 2025. Among those with medical debt, nearly 90% reported incurring that debt while having insurance, with 72% attributing it to deductible payments and over half citing copays or coinsurance as contributing factors.
Administrative hurdles also complicated care access for many residents. One in five Bay Staters experienced issues related to healthcare administration, including difficulty resolving bills with insurance companies and obtaining information about their coverage. Despite these barriers, the survey found that 87.5% of residents had a “usual source of care,” and 90.4% had a primary care provider. However, disparities emerged along racial lines, with 92.4% of white residents reporting having a primary care provider compared to 87.4% of Black residents and 83.7% of Asian residents.
Accessing primary care remains a challenge for many, with 30% of residents reporting difficulties in securing timely appointments. This issue is compounded by a growing number of clinic and office closures. In response, the Senate is expected to address a primary care bill in 2026, aimed at reinforcing the primary care system and enhancing access to basic healthcare services.
Behavioral health care access also posed challenges. The survey indicated that more than one in six residents paid for appointments entirely out of pocket, primarily due to providers not accepting their insurance. Additionally, 10% of residents reported unmet behavioral health needs in the past year, with 5.4% attributing this to cost issues.
While the overall emergency department visit rates have remained stable, with nearly one in four residents visiting in the past year, a significant portion of these visits may have been avoidable had non-emergency providers been accessible. The survey indicates that addressing these access issues is critical as state policymakers consider reforms to improve healthcare delivery for all residents.
