The Impact of Massachusetts Health Care Reform on Access, Quality, and Costs of Care for the Already‐Insured

Abstract

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

Insurance Transitions and Changes in Physician and Emergency Department Utilization: An Observational Study

“…We defined emergency department (ED) visits by any claim with an emergency care-associated E&M code (99281-99285, 99291, 99292) or an ED-associated revenue center code (0450-0459, 0981) in hospital claims. 18,19 Covariates To measure comorbidities, we calculated hierarchical condition category (HCC) scores using software available from the Centers for Medicare and Medicaid Services. 20 We assigned an HCC score from 2010 or 2011 for individuals who switched insurance in 2011 or 2012 plus January 1, 2013, respectively.…”

Impact of Massachusetts Health Reform on Enrollment Length and Health Care Utilization in the Unsubsidized Individual Market

“…; Long, Stockley, and Dahlen ; Miller 2012/2013; Joynt et al. ), reduced ED (Smulowitz, Lipton, and Wharam ; Kolstad and Kowalski ; Long, Stockley, and Dahlen ; Miller , 2012/2013; Lee, Ding, and Zeger ) and inpatient (Long, Stockley, and Dahlen ) visits, and reduced overall adverse selection in the individual market (Hackmann, Kolstad, and Kowalski , ).…”

“…To our knowledge, only three other studies—two of which focus on the subsidized individual market (i.e., Commonwealth Care) (Chandra, Gruber, and McKnight ; Lee, Ding, and Zeger ) and one of which focuses on the Medicare population (Joynt et al. )—have used longitudinal patient‐level data to measure the impact of the reform on health care utilization. This is the first study to use longitudinal, patient‐level data to evaluate the impacts of the MA reform in the unsubsidized individual insurance market and to examine effects on elective care that may be particularly susceptible to adverse selection.…”

“…), emergency department (Long ; Long and Stockley , ; Chen, Scheffler, and Chandra ; Smulowitz, Lipton, and Wharam ; Kolstad and Kowalski ; Long, Stockley, and Dahlen ; Miller , 2012/2013; Mulcahy, Harris, and Finegold ; Chua and Sommers ; Joynt et al. ; Smulowitz, O'Malley, and Yang ; Lee, Ding, and Zeger ), and inpatient (Long and Stockley , ; Long, Stockley, and Dahlen ; Chua and Sommers ) utilization. Evidence that enrollees' overall health care costs decreased following the reform suggests a reduction in adverse selection in the individual market (Hackmann, Kolstad, and Kowalski , ).…”

The Attitude of Hand Surgeons toward the Affordable Care Act: A Survey of Members of the American Society for Surgery of the Hand

“…It is unclear at this time to what extent this will be an issue and how exactly individual practices will be affected. Recent results from Massachusetts Health reform, a state-based precursor to the ACA, offer some basis for optimism, as insurance expansion in Massachusetts was not associated with worsening in access to or quality of outpatient care for the alreadyinsured [15,16].…”