Effects of Health Care Reforms on Coverage, Access, and Disparities in Massachusetts

Health care reforms enacted in Massachusetts in 2006, which included a health insurance mandate, were associated with significant increases in insurance coverage and access, according to a study from researchers at the Harvard Medical School.

“The absolute effects of the reform were greater for disadvantaged populations. This is important evidence to consider as debate over national health care reform continues,” the researchers wrote.

The Patient Protection and Affordable Care Act (PPACA) has been controversial before, and after, it’s approval in 2010. According to researchers writing in the American Journal of Preventive Medicine, the potential impact of national health care reform can be considered using a set of state-level reforms including exchanges and a mandate enacted in Massachusetts.

The research team examined longitudinal survey data from 2002 to 2009 from the Behavioral Risk Factor Surveillance System, which included 178,040 nonelderly adults residing in Massachusetts, Vermont, New Hampshire, Rhode Island, and Connecticut.

As main outcome measures, the researchers considered being uninsured, having no personal doctor, and forgoing care because of cost. These outcomes were evaluated in Massachusetts and four comparison states before (2002—2005) and after (2007–2009) the health care reform was enacted. Effects on disparities defined by race, education, income, and employment also were assessed.

“Living in Massachusetts in 2009 was associated with a 7.6 percentage point (95% CI=3.9, 11.3) higher probability of being insured; 4.8 percentage point (—0.9, 10.6) lower probability of forgoing care because of cost; and a 6.6 percentage point (1.9, 11.3) higher probability of having a personal doctor, compared to expected levels in the absence of reform, defined by trends in control states and adjusting for socioeconomic factors,” the researchers wrote.

“The effects of the reform on insurance coverage attenuated from 2008 to 2009. In a socioeconomically disadvantaged group, the reforms had a greater effect in improving outcomes on the absolute but not relative scale.”

SourceEffects of Healthcare Reforms on Coverage, Access, and Disparities: Quasi-Experimental Analysis of Evidence from Massachusetts [American Journal of Preventive Medicine]