Objective. To assess the impact of Massachusetts Health Reform (MHR) on access, quality, and costs of outpatient care for the already-insured. Data Sources/Study Setting. Medicare data from before (2006) and after (2009) MHR implementation. Study Design. We performed a retrospective difference-in-differences analysis of quantity of outpatient visits, proportion of outpatient quality metrics met, and costs of care for Medicare patients with ≥1 chronic disease in 2006 versus 2009. We used the remaining states in New England as controls. Data Collection/Extraction Methods. We used existing Medicare claims data provided by the Centers for Medicare and Medicaid Services. Principal Findings. MHR was not associated with a decrease in outpatient visits per year compared to controls (9.4 prereform to 9.6 postreform in MA vs. 9.4-9.5 in controls, p = .32). Quality of care in MA improved more than controls for hemoglobin A1c monitoring, mammography, and influenza vaccination, and similarly to controls for diabetic eye examination, colon cancer screening, and pneumococcal vaccination. Average costs for patients in Massachusetts increased from $9,389 to $10,668, versus $8,375 to $9,114 in control states (p < .001). Conclusions. MHR was not associated with worsening in access or quality of outpatient care for the already-insured, and it had modest effects on costs. This has implications for other states expanding insurance coverage under the Affordable Care Act. Key Words. Insurance expansion, costs, quality, outpatient careAs states implement the Affordable Care Act, there is mounting concern that the influx of large numbers of newly insured individuals into the health care system could have a negative effect on access to care for the already-insured. Recent studies have shown, for example, that Medicaid expansion is associated with higher rates of use of office and emergency department visits (Baicker et al. 2013;Taubman et al. 2014); in the setting of a fixed supply of providers

Hospitals with MU Stage 1 designation did not show significantly higher improvement on post-acute utilization compared to their counterparts without. To achieve gains in quality and safety, potentially associated with EHRs, and to advance care coordination and patient engagement, the regulators should strengthen accountability by linking comprehensive, outcomes-based performance measures to specific MU objectives.