The Impacts of State Health Reform Initiatives on Adults in New York and Massachusetts

Abstract

Objective. To analyze the effects of health reform efforts in two large states--New York and Massachusetts. Data Sources/Study Setting. National Health Interview Survey (NHIS) data from 1999 to 2008. Study Design. We take advantage of the ''natural experiments'' that occurred in New York and Massachusetts to compare health insurance coverage and health care access and use for adults before and after the implementation of the health policy changes. To control for underlying trends not related to the reform initiatives, we subtract changes in the outcomes over the same time period for comparison groups of adults who were not affected by the policy changes using a differences-in-differences framework. The analyses are conducted using multiple comparison groups and different time periods as a check on the robustness of the findings. Data Collection/Extraction Methods. Nonelderly adults ages 19-64 in the NHIS. Principal Findings. We find evidence of the success of the initiatives in New York and Massachusetts at expanding insurance coverage, with the greatest gains reported by the initiative that was broadest in scope--the Massachusetts push toward universal coverage. There is no evidence of improvements in access to care in New York, reflecting the small gains in coverage under that state's reform effort and the narrow focus of the initiative. In contrast, there were significant gains in access to care in Massachusetts, where the impact on insurance coverage was greater and a more comprehensive set of reforms were implemented to improve access to a full array of health care services. The estimated gains in coverage and access to care reported here for Massachusetts were achieved in the early period under health reform, before the state's reform initiative was fully implemented. Conclusions. Comprehensive reform initiatives are more successful at addressing gaps in coverage and access to care than are narrower efforts, highlighting the potential gains under national health reform. Tracking the implications of national health reform will be challenging, as sample sizes and content in existing national surveys are not currently sufficient for in-depth evaluations of the impacts of reform within many states.

Medicaid ‘Welcome-Mat’ Effect Of Affordable Care Act Implementation Could Be Substantial

“…Our approach was similar to that used in other analyses of the impact of state reforms, including Massachusetts's health reform. 6,7 We included state and year fixed effects to control for any stable state or year characteristic that could bias our result. We also controlled for demographic characteristics, as described below.…”

Health Reform In Massachusetts Increased Adult Dental Care Use, Particularly Among The Poor

“…However, the authors note that because of the limited sample size, they could detect with confidence only relative large changes in access to care and utilization. 22 In this article we build on previous analyses of how health reform in Massachusetts affected the dental care use of adults ages 19-64.We used data through 2010 and analyzed dental care use of the Massachusetts study population relative to the dental care use of a control population of adults ages 19-64 in eight states: Connecticut, Maine, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. The analysis included comparisons before and after the 2006 health reform was implemented in Massachusetts.…”

“…The analysis included comparisons before and after the 2006 health reform was implemented in Massachusetts. We relied on a large data set that is representative at the state level, has a much larger sample size than that used in previous research, 22 and spans a wider period.…”

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

“…As shown, a quarter (24.5%) of lower-income adults and 12.8% of higher-income adults reported problems getting care because they were told that a provider was not taking new patients or not taking patients with their type of insurance. While these questions were not included in the MHRS prior to health reform, the NHIS shows some increases in the delays in obtaining needed care because of difficulty getting an appointment under health reform in Massachusetts (Long and Stockley 2011).…”