Impact of Massachusetts healthcare reform on access to care and health outcomes

Over the past few years, there has been heated debate involving the Affordable Care Act (ACA) being placed into law in 2010 and its consequences on the number of uninsured and their health status. In order to inform the potential effects of the ACA, the following study will draw lessons from the 2006 Massachusetts Healthcare Reform, upon which the ACA was modeled, and assess the effects of this reform on insurance status, access to healthcare, and health outcomes. This study also provides valuable input towards a comprehensive assessment of the MA Healthcare Reform to date.

The analyses are based on multiple waves of the Behavioral Risk Factor Surveillance System (BRFSS), spanning 2003-2013, a period which enveloped the implementation of the reform. The BRFSS is a large-scale nationally-representative survey of individuals conducted by the Centers for Disease Control and Prevention (CDC).  The dataset yields information on over 3.3 million individuals surveyed over the sample period.  Three broad categories of outcomes are considered relating to 1) insurance status; 2) healthcare access; and 3) physical and mental health outcomes.   Estimates are based on difference-in-differences (DD) models, which compare MA against an array of counterfactual control states before and after the reform, controlling for a rich set of individual characteristics in addition to unobserved state-level differences and national trends through state and time fixed effects.

These estimates suggest that the healthcare reform in MA significantly reduced the rate of uninsurance by 3-4 percentage points relative to control states.  This increase in coverage also improved healthcare access, such that fewer individuals in MA reported forgoing needed medical care due to cost reasons.  Healthcare reform in MA is also associated with improvements in both physical and mental health, though these effects are small and imprecisely estimated.  This latter result is likely due to insurance and coverage affecting health outcomes in a cumulative manner and with some time lag; thus, stronger identifiable results on health may take time to materialize.  These estimates have implications for how the Affordable Care Act (ACA) may also potentially impact measures of insurance coverage, healthcare access, and health for the country as a whole.  Given that the ACA was partly modeled after the MA reform, we draw on our estimates for MA to project the effects of the ACA on outcomes related to access and health.