Who Gained the Most Under Health Reform in Massachusetts?

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Abstract

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.

Introduction

Massachusetts' health reform legislation contains many elements, including Medicaid expansions, subsidized private insurance coverage for lower-income adults (defined as those with family income less than 300 percent of the federal poverty level (FPL)), and the creation of a purchasing pool for workers in small firms and individuals without access to employer-sponsored insurance (ESI) (table 1). The state’s health reform initiative also includes expanded coverage options for young adults, insurance market reforms, an individual mandate that requires that adults have health insurance if they have access to an affordable health plan, and requirements for employers.

We know from earlier work that Massachusetts’ health reform effort led to a substantial drop in uninsurance in Massachusetts in roughly the first year after implementation—falling from 13 to 7 percent for working-age adults aged 18 to 64 between fall 2006 and fall 2007. Not surprising given the focus of many elements of health reform on lower-income adults, those with lower incomes reported greater increases in coverage than those with higher incomes. Uninsurance for adults with family income less than 300 percent of poverty dropped by almost 11 percentage points, while the decline among higher-income adults (those with family income at 300 percent of poverty or more) was about 2 percentage points (Long 2008). This policy brief expands on that analysis to consider variations in the impacts of health reform on insurance coverage across different population groups in the state. Specifically, it examines differences in insurance coverage by demographic characteristics (e.g., age, race/ethnicity, and gender), health status, employment, and geography.

Data and Methods

The analysis uses two rounds of interviews with adults age 18 to 64 years old, conducted in fall 2006, just prior to the implementation of many of the key elements of reform, and fall 2007, approximately a year after the reform efforts began.1 In the analyses reported here, we compare working-age adults (18 to 64) in the period following the implementation of health reform (fall 2007) to a similar sample of adults in the period just prior to the implementation of key elements of reform (fall 2006).2 Since Massachusetts’ health reform initiative was not fully implemented by fall 2007, this provides an interim assessment of the impacts of health reform.

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