Health Reform in Massachusetts – One Year Later

This study examines the effects on insurance status and access to care of the recently implemented health care reforms in Massachusetts. Data from this study comes from random sampling of nearly 3,000 people in the fall preceding implementation and subsequent repeat sampling nearly another 3,000 people in the fall following implementation of the Massachusetts reforms. The survey response rate was just under 50 percent.

Results from the survey, indicate that the uninsured rate dropped from 13 percent to 7 percent. Among adults living under 300% of the federal poverty level (currently $63,600 for a family of 4), the results are even more promising. The uninsured rate among this group drops from 24 percent to 13 percent. Even after adjustment for other demographic factors such as race, gender, and citizenship status (among others), the effect of the Massachusetts reform plan on uninsured rate remains significantly strong.

An important measure of access to care is a person’s report that he or she has a regular physician or medical home (excluding an emergency department). The effect of the Massachusetts reform demonstrates significant, although small in magnitude, changes in this important factor (87% versus 89%). Additionally, respondents report a greater likelihood of having a doctor visit during the preceding year after the implementation of reforms (70% versus 73%). The magnitude of these effects is greater among persons with lower incomes.

Commentary:

Early results from the experiment that is the Massachusetts health reform demonstrate positive effects on critical outcomes such as reducing the percentage of uninsured and improving access to primary care. At this point “crowd out” appears to be minimal. Yet surprisingly, the only group unhappy with reforms to this date appears to be the uninsured themselves. If progress continues to be positive, perhaps other states, or the federal government itself, may wish to emulate the Massachusetts strategy of public expansions, private market reforms, mandates, and subsidies.

Health Aff. 2008 Jul-Aug;27(4):w270-84.

by

Cedric K. Dark, MD, MPH