Impacts of Health Reform in Massachusetts

The Massachusetts Health Reform Survey (MHRS) has provided the foundation for a number of studies on the impacts of health reform in Massachusetts, generating a wealth of information for researchers and policy makers to draw on.

Massachusetts enacted a health care reform bill in 2006 that sought to move the state to near universal coverage and improve access to care in the state. In order to track the impacts of reform, the Blue Cross Blue Shield of Massachusetts Foundation began funding an annual survey of nonelderly adults in the Commonwealth. That survey has been fielded in the fall of each subsequent year. (The first three years of the survey were funded jointly with the Commonwealth Fund and the Robert Wood Johnson Foundation.)

The survey relies on telephone interviews with a stratified, random sample of adults aged 18-64 years old, with detailed questions on insurance status; access to and use of health care; out-of-pocket health care costs and medical debt; insurance premiums and covered services (for those with insurance); health and disability status; and support for reform.

Health Reform in Massachusetts: An Update as of Fall 2009
Sharon Long, Karen Stockley

This report provides a comprehensive update on the status of health reform in Massachusetts as of fall 2009. The report examines the overall impact of reform on non-elderly adults; the impacts on vulnerable population subgroups of adults; impacts on racial/ethnic disparities; the status of the remaining uninsured adults in the state; an assessment of the adequacy of coverage under health reform; and support for reform over time. The authors find that Massachusetts has made significant progress in accomplishing the goals of the legislation, although some challenges with respect to the cost of health care remain. A chartbook of key findings was also released as a supplement to the full report.

The Impacts of Health Reform on Health Insurance Coverage and Health Care Access, Use, and Affordability for Women in Massachusetts
Sharon Long, Karen Stockley, Lauren Birchfield, Shanna Shulman

This policy brief examines the progress women have made in under health reform in Massachusetts. The authors find that women achieved significant gains in coverage, access, use, and affordability under health reform, although gains in affordability were more limited. Gains were particularly strong for vulnerable subgroups of women, including lower-income women and racial/ethnic minority women.

Sustaining Health Reform in a Recession: An Update on Massachusetts as of Fall 2009
Sharon Long, Karen Stockley

This Health Affairs article provides an update on the progress of health reform in Massachusetts as of fall 2009 using data from surveys of working-aged adults. Massachusetts continues to sustain record high levels of insurance coverage in the midst of the economic recession, with uninsurance at 4.8 percent for non-elderly adults in fall 2009. In addition, the authors find that the gains in access and affordability reported in Massachusetts under the initial years of health reform persisted into fall 2009. However, some barriers to accessing care persist and problems affording care continue to be an issue for some residents.

Emergency Department Visits in Massachusetts: Who Uses Emergency Care and Why?
Sharon Long, Karen Stockley

Massachusetts residents are frequent users of emergency department (ED) care, with high levels of use continuing despite significant improvements in access to care as a result of the state?s 2006 health reform initiative. In an effort to better understand ED use in Massachusetts, this policy brief looks at ED use among working-age adults, focusing on reported reasons for using the ED and barriers to obtaining needed health care among ED users. Findings show adult ED users in Massachusetts are a sicker, more disabled, and more chronically ill population and report more difficulties obtaining care in the community and more unmet need for care than other adults in the state. Potential strategies for addressing preventable ED use include efforts targeted to specific care settings and particular population groups.

Massachusetts Health Reform: Employer Coverage from Employee's Perspective
Sharon Long, Karen Stockley

The national health reform debate continues to draw on Massachusetts' 2006 reform initiative, with a focus on sustaining employer-sponsored insurance. This study provides an update on employers' responses under health reform in fall 2008, using data from surveys of working-age adults. Results show that concerns about employers' dropping coverage or scaling back benefits under health reform have not been realized. Access to employer coverage has increased, as has the scope and quality of their coverage as assessed by workers. However, premiums and out-of-pocket costs have become more of an issue for employees in small firms.

Health Reform in Massachusetts: An Update on Insurance Coverage and Support for Reform as of Fall 2008
Sharon Long, Karen Stockley

Massachusetts began an ambitious push toward near universal health insurance coverage in 2006. This policy brief provides an update of the impacts of health reform in Massachusetts on insurance coverage as of Fall 2008 for working-age adults, the primary target population of the reform initiative, along with an update on support for health reform in the state. Findings demonstrate that the state has achieved its goal of near universal health insurance coverage and that state residents continue to show strong support for health reform, even in the face of increasing program costs and the recession that began in December 2007. Given the success of the coverage expansion, Massachusetts policymakers are turning to the next phase of health reform – reigning in health care costs.

Access And Affordability: An Update On Health Reform In Massachusetts, Fall 2008
Sharon Long, Paul Masi

Massachusetts continues to move forward on comprehensive health reform. Uninsurance is at historically low levels, despite the recent economic downturn. Building on that coverage expansion, there have been improvements in access to care and the affordability of care in the commonwealth. Notwithstanding these successes, some of the early gains under health reform in reducing barriers to care and improving the affordability of care had eroded by Fall 2008, reflecting trends that predate health reform in Massachusetts-constraints on provider capacity and increasing health care costs. Because these are national concerns as well, Massachusetts continues to offer lessons for national health reform efforts.

Access to and Affordability of Care in Massachusetts as of Fall 2008: Geographic and Racial/Ethnic Differences
Sharon Long, Paul Masi

Massachusetts continues to move forward on comprehensive health reform, with improvements in coverage, access to care and the affordability of care in the state. This policy brief provides a supplement to a recent Health Affairs article on health reform in Massachusetts, examining geographic and racial/ethnic differences in access to care and affordability of care across the commonwealth in Fall 2008.

How Have Employers Responded to Health Reform in Massachusetts?: Employee's Views at the End of One Year
Sharon Long, Paul Masi

In April 2006, Massachusetts passed legislation intended to move the state to near-universal coverage within three years, with key components of the reform effort targeting the role of employers. Based on surveys of working-age adults in the state in 2006 and 2007, this paper examines employers’ responses to health reform as reported by their employees. At roughly the end of the first year under health reform, employers in Massachusetts had made few changes in the insurance coverage they offered their workers. Long and Masi find no evidence that employers have dropped coverage, tightened eligibility for coverage, or changed the scope of benefits, network of providers or quality of care available under the health plans. Nor is their evidence that employers have shifted a greater share of the cost of health care onto their workers in response to health reform.

Who Gained the Most Under Health Reform in Massachusetts?
Sharon Long

We know that health insurance coverage rose dramatically in the past year in Massachusetts. This study examines what the effect has been on specific populations, finding that the greatest gains in insurance coverage were reported by lower-income adults, younger adults and those in minority groups. Further, the reductions in uninsurance tended to be largest for subgroups that started out with higher levels of uninsurance.

Impact of Health Reform on Underinsurance in Massachusetts: Do the Insured Have Adequate Protection?
Sharon Long

Although health insurance coverage rose dramatically in the past year in Massachusetts, some questioned whether health reforms simply moved people from being uninsured to underinsured. This study explores whether requiring individuals to have health insurance has forced some people, particularly those with modest incomes, into plans that offer little financial protection. The findings suggest, however, that health reform in Massachusetts is both providing new coverage for many of those who were previously uninsured and improving the quality of coverage for those with insurance coverage.

On the Road to Universal Coverage: Impacts of Reform in Massachusetts at One Year
Sharon Long

In April 2006, Massachusetts passed legislation intended to move the state to almost universal coverage within three years and, in conjunction with that expansion, to improve access to affordable, high-quality health care. In roughly the first year under reform, uninsurance among working-age adults was reduced by almost half among those surveyed, dropping from 13% in Fall 2006 to 7% in Fall 2007. At the same time, access to care improved and the share of adults with high out-of-pocket costs and problems paying medical bills dropped. Despite higher than anticipated costs, most residents of the state continued to support reform.

The Massachusetts Health Reform Survey
Sharon Long

In April 2006, Massachusetts enacted a health care reform bill that seeks to move the state to (almost) universal coverage through a combination of Medicaid expansions, subsidized private health insurance coverage, and insurance reforms. As part of an evaluation of the impacts of the state's reform effort, we conducted surveys of adults aged 18 to 64 years old in Massachusetts in Fall 2006, Fall 2007 and Fall 2008. This document provides an overview of the survey approach and the three survey instruments.

Getting Ready for Reform: Insurance Coverage and Access to and Use of Care in Massachusetts in Fall 2006
Sharon Long, Mindy Cohen

In April 2006, Massachusetts enacted a health care reform bill that seeks to move the state to (almost) universal coverage through a combination of Medicaid expansions, subsidized private health insurance coverage, and insurance reforms. As part of an evaluation of the impacts of the state's reform effort, we conducted a baseline survey of 3010 adults aged 18 to 64 years old in Massachusetts. The survey was conducted by ICR/International Communications Research between October 16, 2006, and January 7, 2007, using a Computer Assisted Telephone (CATI) interviewing system. This report provides a detailed overview of the Massachusetts population in Fall 2006.