BOSTON — On Beacon Hill and in Washington, there are few issues thornier than health care: how many people are insured, how many aren’t, how many have some insurance but not enough, and what’s the best way to plug all those holes.
A decade after the state’s landmark 2006 health care law took effect, Massachusetts is still grappling with those issues. The latest check-up came in the form of a report released this week by the state’s Center for Health Information and Analysis.
The report includes some warning signs as the lawmakers hope to prevent Massachusetts — with its highest-in-the-nation rate of insured residents — from slipping back.
The annual report had some reassuring news.
The rate of uninsured residents in Massachusetts during 2017 was 3.7 percent. That’s not zero, but it’s still well ahead of the 8.8 percent rate of uninsured for the rest of the country based on early estimates.
But there were some statistics to keep an eye on.
One of the more concerning was the rate of so-called “underinsured” residents. The report defines the underinsured as residents who reported spending 10 percent or more of their family income on out-of-pocket health care expenses. The report found almost one out of every 10 Massachusetts residents remains underinsured.
While the vast majority of residents of all racial backgrounds were insured in Massachusetts during the past 12 months, there were some persistent disparities.
White residents had the highest rate of insurance for all 12 months at nearly 95 percent, compared with 84 percent of black residents and 79 percent of Hispanic residents.
The report also tried to determine who had no insurance during 2017. Four percent of Hispanics fell into that group, compared with 1 percent of white residents and less than 1 percent of black residents.
Overall, the report found that uninsured residents were more likely than the general population to be male, single without children, Hispanic and low income.
HEALTH CARE ACCESS
While more than 82 percent of respondents reported having made a doctor visit over the past 12 months, there were still some concerns about access to health care services.
More than three in 10 respondents did not have an annual dental visit, with lower-income residents significantly more likely to have skipped a visit in 2017.
The report also found that about a third of respondents reported making an emergency room visit in the past 12 months.
Of those who visited an emergency room, more than 35 percent sought care for a non-emergency condition — most because they were unable to get an appointment at a doctor’s office or clinic as soon as needed or because they needed after-hours care.
Over one in eight respondents also reported being told that a doctor’s office or clinic was not accepting their insurance type.
In recent years, there has been an overall drop in those reporting difficulty paying medical bills — 15.8 percent in 2017, down from 19.6 percent in 2014.
Still, Massachusetts has long had health care costs that are higher than that of the nation as a whole, and not all those costs are met by insurance. The report found more than one in seven respondents reported problems paying family medical bills in the past 12 months.
About 17 percent reported family medical debt — with more than three out of four incurring the medical debt while insured.
Over a quarter of respondents also reported an unmet need for medical or dental care in the past 12 months due to cost — with two-thirds reporting an unmet need despite being insured.
When asked the most important reasons for being uninsured in 2017, 61.0 percent of the uninsured respondents in Massachusetts reported the cost of coverage as a key factor.
Another concern is medical errors.
The report found nearly 20 percent of adults reporting that a medical error occurred to them or a family member over the past five years.
Among those reporting a medical error, more than half — 57.6 percent — said the most recent error resulted in serious health consequences, while just 13.2 percent reported that the most recent medical error resulted in no health consequences.