Changes in Mortality After Massachusetts Health Care Reform

Sommers, Benjamin D.; Long, Sharon K.; Baicker, Katherine

doi:10.7326/l15-5085-2

Cited by 36 publications

(39 citation statements)

References 9 publications

(9 reference statements)

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“…12 These healthcare reforms were not only associated with improved access to care, but also associated with reduced mortality and improved self-rated health. 13,14 Surveillance data from the National Health Interview Survey (NHIS) have shown a generally increasing trend in the prevalence of lack of insurance among US adults aged 18e64 years between 1997 and 2010 and then a decreasing trend between 2010 and the first nine months of 2014. 15 These findings are similar to those from the US Census.…”

Section: Introductionmentioning

confidence: 99%

Trends of lack of health insurance among US adults aged 18–64 years: findings from the Behavioral Risk Factor Surveillance System, 1993–2014

et al. 2017

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a b s t r a c tObjective: To examine the prevalence of lack of health insurance and its changes over time among adult residents (aged 18e64 years) in 50 states and the District of Columbia (DC).Study design: Cross-sectional surveys. Methods:We aggregated annual state-based Behavioral Risk Factor Surveillance System (BRFSS) data from 1993 through 2014 to provide nationwide and state-based prevalence estimates for lack of insurance among adults aged 18e64 years. The adjusted prevalence was estimated using log-linear regression analyses with a robust variance estimator after controlling for demographic variables. The trend was assessed separately for the periods 1993e2010 and 2011e2014 due to methodologic changes in the BRFSS.Results: From 1993 through 2010, the adjusted prevalence of lack of health insurance increased by 0.54% (P < 0.0001) annually (range: 16.3% in 1995 to 19.1% in 2005); this prevalence decreased significantly in 2014 (15.1%). In 2014, Georgia, Mississippi, and Texas had the highest adjusted prevalences (range: 23.0e24.6%) of lack of health insurance, and DC, Massachusetts, and Rhode Island had the lowest (range: 6.2e10.1%). The changes in the prevalence of lack of insurance over time varied significantly by state. Conclusions:The nationwide prevalence of lack of health insurance decreased significantly in the past few years, especially in 2014 when about one-seventh of Americans aged 18e64 years reported lack of health insurance coverage. The huge variations in the prevalence of lack of health insurance and its changes over time among states suggest continuing efforts to ensure healthcare access for all Americans are needed to improve the overall health of the population.

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Section: Introductionmentioning

confidence: 99%

Trends of lack of health insurance among US adults aged 18–64 years: findings from the Behavioral Risk Factor Surveillance System, 1993–2014

et al. 2017

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“…[34][35][36][37][38] Previous reports from the state also suggest that measured disparities in overall health status and severity of presentation may indeed decrease as newly insured patients gain access to health systems. 39 Multiple studies have suggested increased surgical referrals and decreased disparities in the receipt of certain procedures after expanded insurance coverage. [40][41][42][43][44][45] However, our data do contrast another recent study that found no change in disparities of coronary revascularization procedures after Massachusetts health care reform, although their analysis was limited by short follow-up data ending in September of 2008, only nine months after implementation of mandate requiring insurance coverage.…”

Section: Discussionmentioning

confidence: 99%

Impact of Expanded Insurance Coverage on Racial Disparities in Vascular Disease: Insights from Massachusetts

Loehrer¹,

Hawkins²,

Auchincloss³

2016

Journal of Vascular Surgery

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STRUCTURED ABSTRACTObjective-To evaluate the impact of health insurance expansion on racial disparities in severity of peripheral arterial disease.Summary Background Data-Lack of insurance and non-white race are associated with increased severity, increased amputation rates, and decreased revascularization rates in patients with peripheral artery disease (PAD). Little is known about how expanded insurance coverage affects disparities in presentation with and management of PAD. The 2006 Massachusetts health reform expanded coverage to 98% of residents and provided the framework for the Affordable Care Act.Methods-We performed a retrospective cohort study of non-elderly, white and non-white patients admitted with PAD in Massachusetts (MA) and four control states. Risk-adjusted difference-in-difference models were used to evaluate changes in probability of presenting with severe disease. Multivariable linear regression models evaluated disparities in disease severity before and after the 2006 health insurance expansion.Results-Prior to the 2006 MA insurance expansion, non-white patients in both MA and control states had a 12-13 percentage-point higher probability of presenting with severe disease (P<0.001) than white patients. After the expansion, measured disparities in disease severity by patient race were no longer statistically significant in Massachusetts (+3.0 percentage-point difference, P=0.385) while disparities persisted in control states (+10.0 percentage-point difference, P<0.001). Overall, non-white patients in MA had an 11.2 percentage-point decreased probability of severe PAD (P=0.042) relative to concurrent trends in control states. Conclusions-The 2006Massachusetts insurance expansion was associated with a decreased probability of patients presenting with severe PAD and resolution of measured racial disparities in severe PAD in MA.

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“…One study found no improvements in hyperlipidemia, diabetes, or blood-pressure control [7], and while overall population mortality improved, particularly in low-income areas, the effect was minor [6]. Although Massachusetts residents selfreported better health than patients in neighboring states, usage of preventative care in Massachussetts was only slightly greater [9].…”

Section: N 2006 Massachusetts Becamementioning

confidence: 99%

Editor's Spotlight/Take 5: Universal Health Insurance Coverage in Massachusetts Did Not Change the Trajectory of Arthroplasty Use or Costs

Manner

2016

Clinical Orthopaedics &Amp; Related Research

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Changes in Mortality After Massachusetts Health Care Reform

Cited by 36 publications

References 9 publications

Trends of lack of health insurance among US adults aged 18–64 years: findings from the Behavioral Risk Factor Surveillance System, 1993–2014

Trends of lack of health insurance among US adults aged 18–64 years: findings from the Behavioral Risk Factor Surveillance System, 1993–2014

Impact of Expanded Insurance Coverage on Racial Disparities in Vascular Disease: Insights from Massachusetts

Editor's Spotlight/Take 5: Universal Health Insurance Coverage in Massachusetts Did Not Change the Trajectory of Arthroplasty Use or Costs

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