Abstract
The Massachusetts 2006 health care reform has been called a model for the Affordable Care Act. The law attained near-universal insurance coverage and increased access to care. Its effect on population health is less clear. To determine whether the Massachusetts reform was associated with changes in all-cause mortality and mortality from causes amenable to health care. Comparison of mortality rates before and after reform in Massachusetts versus a control group with similar demographics and economic conditions. Changes in mortality rates for adults in Massachusetts counties from 2001 to 2005 (prereform) and 2007 to 2010 (postreform) were compared with changes in a propensity score-defined control group of counties in other states. Adults aged 20 to 64 years in Massachusetts and control group counties. Annual county-level all-cause mortality in age-, sex-, and race-specific cells (n = 146,825) from the Centers for Disease Control and Prevention's Compressed Mortality File. Secondary outcomes were deaths from causes amenable to health care, insurance coverage, access to care, and self-reported health. Reform in Massachusetts was associated with a significant decrease in all-cause mortality compared with the control group (-2.9%; P = 0.003, or an absolute decrease of 8.2 deaths per 100,000 adults). Deaths from causes amenable to health care also significantly decreased (-4.5%; P < 0.001). Changes were larger in counties with lower household incomes and higher prereform uninsured rates. Secondary analyses showed significant gains in coverage, access to care, and self-reported health. The number needed to treat was approximately 830 adults gaining health insurance to prevent 1 death per year. Nonrandomized design subject to unmeasured confounders. Massachusetts results may not generalize to other states. Health reform in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care. None.
Highlights
Massachusetts passed comprehensive health reform in 2006 with the goal of nearuniversal coverage
Changes were larger in counties with lower household incomes and higher pre-reform uninsured rates
The Massachusetts law had several components: a Medicaid expansion starting in July 2006 for adults; subsidized private plans for adults under 100% of the federal poverty level (FPL) in October 2006; and expanded coverage subsidies for adults up to 300% of FPL in January 2007
Summary
Massachusetts passed comprehensive health reform in 2006 with the goal of nearuniversal coverage. The law – which expanded Medicaid, offered subsidized private insurance, and created an individual mandate – was a model for the Affordable Care Act (ACA).[1] understanding the Massachusetts law’s impact has important policy implications. Previous research documents that Massachusetts’ reform succeeded in expanding health insurance among adults ages 19 to 64 by 3-8 percentage points.[1,2,3,4,5] Studies indicate improvements in access to care,[6,7,8] self-reported physical and mental health,[9] use of preventive services,[2,10] and functional status.[1,11] there has been no evidence on the law’s effect on mortality. Massachusetts’ 2006 health reform has been called a model for the Affordable Care Act. The law attained near-universal insurance coverage and increased access to care.
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