Changes in mortality after Massachusetts health care reform law

 
Massachusetts health center (Dominic Chavez, New York Times)
(Dominic Chavez, New York Times)
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Massachusetts’ statewide healthcare reform, signed into law in 2006 by then-governor Mitt Romney, served as a model for the federal Patient Protection and Affordable Care Act of 2010. Both the state and federal laws aim to increase the number of people with health insurance coverage through a variety of mechanisms: expanding public insurance programs such as Medicaid, requiring employers to insure workers, mandating that individuals obtain coverage, regulating insurance plans and establishing health insurance exchanges.

Some of the Affordable Care Act’s provisions have already come into effect, including the requirement for private insurance plans to cover beneficiaries’ children up to age 26. Other key provisions will not be implemented until 2016, however. As a result, it is difficult to predict law’s impacts on the public’s health and financial well-being. In the meantime, studying the effects of Massachusetts’ health care reform law may provide insight into the future of U.S. health care.

A number of studies have already examined the effects of the Massachusetts health law. A 2011 study from the City University of New York found no evidence suggesting that the law had decreased health care-related bankruptcies. Research published the same year in New England Journal of Medicine examined emergency facility under the law, but found mixed results.

A 2014 study published in Annals of Internal Medicine, “Changes in Mortality After Massachusetts Health Care Reform Law” looks at the Massachusetts law’s effects on death rates among state residents. The researchers — Benjamin D. Summers and Katherine Baicker of the Harvard School of Public Health and Sharon K. Long of the Urban Institute — matched counties in Massachusetts to similar counties in states without health care reform laws. Using data from the Centers for Disease Control and Prevention, they compared changes in death rates among county residents ages 20 to 64 in the years before and after the implementation of the Massachusetts law.

The study’s findings include:

  • Compared to counties in other states, Massachusetts counties experienced a 2.9% decrease in mortality following the implementation of the health care reform bill. This corresponds to 8.2 fewer annual deaths per 100,000 residents.
  • Massachusetts counties with low household incomes and those with high proportions of uninsured residents in the pre-reform period experienced the greatest reductions in mortality rates.
  • When the researchers focused on deaths caused by conditions amendable to health care such as cancer, infections and heart disease, the reduction in mortality rate associated with the Massachusetts law was 4.9%.
  • Providing health insurance coverage for approximately 830 adults can prevent 1 death per year according to the authors’ analysis.

The researchers caution readers that the results may not be generalizable to the rest of the United States, stating that “it is critical to note the many dimensions in which Massachusetts differs from the rest of the nation, including lower mortality, higher income and baseline insurance coverage rates, fewer minorities, and the most per capita physicians in the country.”

Related research: A 2011 study in the New England Journal of Medicine, “Massachusetts’ Health Care Reform and Emergency Department Utilization,” looks at emergency department utilization in Massachusetts following its health care reform law.

Keywords: Obamacare, health care exchanges, insurance mandate, universal care, consumer affairs, poverty

Last updated: June 19, 2014

 

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Citation: Summers, Benjamin D.; Long, Sharon, K.; Baicker, Katherine. “Changes in Mortality After Massachusetts Health Care Reform Law.” Annals of Internal Medicine, May 2014, Vol. 160, No. 9, 585-593. doi: 10.7326/M13-2275.