Background
The 2010 Patient Protection and Affordable Care Act (PPACA) has been controversial.
The potential impact of national healthcare reform may be considered using a similar
set of state-level reforms including exchanges and a mandate, enacted in 2006 in Massachusetts.
Purpose
To evaluate the effects of reforms on healthcare access, affordability, and disparities.
Design
Interrupted time series with comparison series.
Setting/participants
Longitudinal survey data from 2002 to 2009 from the Behavioral Risk Factor Surveillance
System including 178,040 nonelderly adults residing in Massachusetts, Vermont, New
Hampshire, Rhode Island, and Connecticut. Analysis was conducted from January to August
2010.
Intervention
Massachusetts 2006 healthcare reform, which included an individual health insurance
mandate.
Main outcome measures
Being uninsured, having no personal doctor, and forgoing care because of cost, evaluated
in Massachusetts and four comparison states before (2002–2005) and after (2007–2009)
the healthcare reform. Effects on disparities defined by race, education, income,
and employment also were assessed.
Results
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 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.
Conclusions
Healthcare reforms in Massachusetts, which included a health insurance mandate, were
associated with significant increases in insurance coverage and access. The absolute
effects of the reform were greater for disadvantaged populations. This is important
evidence to consider as debate over national healthcare reform continues.
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© 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
