Coverage, Access, and Affordability under Health Reform: Learning from the Massachusetts Model

Long, Sharon K.; Stockley, Karen; Nordahl, Kate

doi:10.5034/inquiryjrnl_49.04.03

Cited by 25 publications

(14 citation statements)

References 18 publications

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“…Like Texas, Florida is a southern state that resisted the ACA's Medicaid expansion, and home to almost a fifth of uninsured Latinos living in non-Medicaid expansion states by 2016. Massachusetts, by contrast, is not only an expansion state; it enacted its own near-universal health reform plan (Chapter 58) in 2006 which became the model for the ACA (Long, Stockley, and Nordahl 2013;Patel and McDonough 2010). Interestingly, Chapter 58 was more inclusive than the ACA towards federally ineligible immigrants, allotting state funds to provide coverage for this population (Joseph 2016(Joseph , 2017.…”

Section: Layout Of the Special Issuementioning

confidence: 99%

Health care, immigrants, and minorities: lessons from the affordable care act in the U.S.

Joseph

Marrow

2017

Journal of Ethnic and Migration Studies

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Section: Layout Of the Special Issuementioning

confidence: 99%

Health care, immigrants, and minorities: lessons from the affordable care act in the U.S.

Joseph

Marrow

2017

Journal of Ethnic and Migration Studies

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“…With its 2006 landmark health reform law, Massachusetts took enormous strides toward nearly universal health insurance coverage. Between 2006 and 2009, the state uninsurance rate for nonelderly adults dropped from 13.4 percent to 5.8 percent through many of the same legislative components included in national health reform (Long, Stockley, and Nordahl /2013). Both pieces of legislation contain a Medicaid expansion and the creation of a health insurance exchange for both the near poor who receive subsidies and those in the small or individual group market who are unsubsidized.…”

Section: Massachusetts Health Reform and Its Parallels To National Hementioning

confidence: 99%

“…In particular, the Urban Institute has published many reports on their biannual Massachusetts Health Reform Survey, which samples the nonelderly. From 2006 to 2010 the percent of the population with a usual source of care increased by 4.7 percentage points, and the percent of the population with a preventative health visit increased by 5.9 percentage points (Long, Stockley, and Nordahl /2013). The percentage of the population with visits to specialists, multiple physicians, and dentists also increased (Long, Stockley, and Dahlen ).…”

Section: Massachusetts Health Reform and Its Parallels To National Hementioning

confidence: 99%

Massachusetts Coverage Expansion Associated with Reduction in Primary Care Utilization among Medicare Beneficiaries

Bond

White

2013

Health Services Research

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Objective. To examine whether expanding coverage for the nonelderly affects primary care utilization among Medicare beneficiaries. Data Source. Study Design. We use two zip code-level outcomes: arc percent change in primary care visits per Medicare beneficiary per year, and percentage point change in the share of beneficiaries with one or more primary care visits. We use a regression-based difference-in-difference analysis that compares Massachusetts with surrounding states, and zip codes with high, medium, and low uninsurance rates in 2005. The 2005 uninsurance rates correspond to the size of Massachusetts' coverage expansion. We use propensity scores for identification of comparable zip codes and for weighting. Principal Findings. In areas of Massachusetts with the highest uninsurance rateswhere insurance expansion had the largest impact-visits per beneficiary fell 6.9 percent (p < .001) relative to areas of Massachusetts with the smallest uninsurance rates. Conclusions. The expansion of coverage for the nonelderly reduced primary care visits, but it did not reduce the percent of beneficiaries with at least one visit. These results could imply restricted access, increased efficiency, or some blend.

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“…Less commonly reported is the fact that millions have lost their health insurance coverage, and more Americans are foregoing necessary care (15)(16)(17)(18). Beyond that, there is meaningful evidence demonstrating that the ACA model may leave some of those who are insured actually compromised (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). Thus, insurance (affordability) and coverage (accessibility) are 2 areas that are intertwined, and which provide a policy focus for the discussion as to whether to save, replace, or repair the ACA.…”

Section: Impetus For Reformmentioning

confidence: 99%

A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few?

Manchikanti¹,

Helm²,

Benyamin³

et al. 2017

Pain Phys

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The Affordable Care Act (ACA), of 2010, or Obamacare, was the most monumental change in US health care policy since the passage of Medicaid and Medicare in 1965. Since its enactment, numerous claims have been made on both sides of the aisle regarding the ACA’s success or failure; these views often colored by political persuasion. The ACA had 3 primary goals: increasing the number of the insured, improving the quality of care, and reducing the costs of health care. One point often lost in the discussion is the distinction between affordability and access. Health insurance is a financial mechanism for paying for health care, while access refers to the process of actually obtaining that health care. The ACA has widened the gap between providing patients the mechanism of paying for healthcare and actually receiving it. The ACA is applauded for increasing the number of insured, quite appropriately as that has occurred for over 20 million people. Less frequently mentioned are the 6 million who have lost their insurance. Further, in terms of how health insurance is been provided, the majority the expansion was based on Medicaid expansion, with an increase of 13 million. Consequently, the ACA hasn’t worked well for the working and middle class who receive much less support, particularly those who earn more than 400% of the federal poverty level, who constitute 40% of the population and don’t receive any help. As a result, exchange enrollment has been a disappointment and the percentage of workers obtaining their health benefits from their employer has decreased steadily. Access to health care has been uneven, with those on Medicaid hampered by narrow networks, while those on the exchanges or getting employer benefits have faced high out-of-pocket costs. The second category relates to cost containment. President Obama claimed that the ACA provided significant cost containment, in that costs would have been even much higher if the ACA was not enacted. Further, he attributed cost reductions generally to the ACA, not taking into account factors such as the recession, increased out-of-pocket costs, increasing drug prices, and reduced coverage by insurers. The final goal was improvement in quality. The effort to improve quality has led to the creation of dozens of new agencies, boards, commissions, and other government entities. In turn, practice management and regulatory compliance costs have increased. Structurally, solo and independent practices, which lack the capability to manage these new regulatory demands, have declined. Hospital employment, with its associated increased costs, has been soaring. Despite a focus on preventive services in the management of chronic disease, only 3% of health care expenditures have been spent on preventive services while the costs of managing chronic disease continue to escalate. The ACA is the most consequential and comprehensive health care reform enacted since Medicare. The ACA has gained a net increase in the number of individuals with insurance, primarily through Medicaid expansion. The reduction in costs is an arguable achievement, while quality of care has seemingly not improved. Finally, access seems to have diminished.This review attempts to bring clarity to the discussion by reviewing the ACA’s impact on affordability, cost containment and quality of care. We will discuss these aspects of the ACA from the perspective of proponents, opponents, and a pragmatic point of view. Key words: Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, Medicare Modernization Act (MMA), cost of health care, quality of health care, Merit-Based Incentive Payments System (MIPS)

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Coverage, Access, and Affordability under Health Reform: Learning from the Massachusetts Model

Cited by 25 publications

References 18 publications

Health care, immigrants, and minorities: lessons from the affordable care act in the U.S.

Health care, immigrants, and minorities: lessons from the affordable care act in the U.S.

Massachusetts Coverage Expansion Associated with Reduction in Primary Care Utilization among Medicare Beneficiaries

A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few?

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