On The Road To Universal Coverage: Impacts Of Reform In Massachusetts At One Year

Abstract

In April 2006, Massachusetts passed legislation intended to move the state to near-universal coverage within three years and, in conjunction with that expansion, to improve access to affordable, high-quality health care. In roughly the first year under reform, uninsurance among working-age adults was reduced by almost half among those surveyed, dropping from 13 percent in fall 2006 to 7 percent in fall 2007. At the same time, access to care improved, and the share of adults with high out-of-pocket costs and problems paying medical bills dropped. Despite higher-than-anticipated costs, most residents of the state continued to support reform. U n i n s u r an c e , pa rt i c u l a r ly a m o n g working-age adults, is one of the most pressing challenges facing the United States, and much of the policy innovation aimed at expanding coverage is occurring at the state level. In April 2006, Massachusetts enacted a comprehensive health care reform bill that seeks to move the state to (almost) universal coverage through a combination of Medicaid expansions, subsidized private insurance coverage, insurance market reforms, and required actions for both individuals and employers. Funding for the reform initiative includes federal and state dollars, along with assessments on hospitals, insurers, and employers, as well as consumer cost sharing.This paper provides an early look at the impacts of health reform in Massachusetts on working-age adults-the primary target population for the initiative. The focus here is on changes in insurance coverage, access to health care, and the costs of obtaining health care for adults during the first year under reform. Overview Of The Policy Changes In MassachusettsMassachusetts's health reform includes expansions to the Medicaid program (called MassHealth), the creation of a new program that provides income-related w 2 7 0 3 J u n e 2 0 0 8 M a s s a c h u s e t t s

Dependence on Emergency Care among Young Adults in the United States

“…The Commonwealth Fund has proposed several potential options and policies to extend health coverage to young adults. 6,[26][27][28] Additionally, several states have adopted measures to extend coverage and several federal bills have been proposed, [29][30][31][32][33] but tangible measures have yet to take hold nationally.…”

Changes in Mortality After Massachusetts Health Care Reform

“…We adapted previous work by Nolte & McKee (2003, 2008 [12][13][14] defining mortality amenable to medical care (Appendix Table 1). Our definition was more inclusive, and included all infectious and malignant causes of death (rather than a subset), congestive heart failure, and certain treatable arrhythmias.…”

The Future of Emergency Medicine

“…This was demonstrated in Massachusetts where insurance coverage for 97% of their population resulted in a significant increase in the number of emergency department (ED) visits. 2 A similar phenomenon occurred in Australia after adoption of measures providing universal coverage for diabetes.…”