Massachusetts’ Experience with Universal Coverage and Health

For all the political wrangling on the national stage, it is pretty clear that the people of Massachusetts wanted and still generally favor their version of health reform, although health spending continues to spiral higher, requiring ever greater government intervention.  The effects on things like ER utilization or physician wait times have been mixed, but a new paper from the National Bureau of Economic Research does a more comprehensive assessment of what should matter most:  did the law positively affect the overall health of the residents of the state?   (NBER Paper)  Obviously from a methodological perspective it is difficult to draw a casual relationship, particularly when largely self-reported survey data is used and in a system as complex as human health and health care, but the authors believe that health did improve following passage of the reform act in Massachusetts.  The change supposedly helped women, African-Americans, the near-elderly and middle to upper-income people the most in health improvement, but some of these categories are relatively implausible and suggest other factors were at work during the same period of time.  Overall the effects the authors find are on the order of a percent or less in the probability of a person being in better health.  That is a very minor change.  And the cost per person of this change: $9,782 in government spending alone.  Almost non-existent effect was shown on actual health behaviors like exercise or smoking, and this during a period when wellness programs were also in full flower.

So far research suggests that the number of people with health care coverage has increased in the state and this has likely had positive effects on the health of people who previously didn’t have coverage, but that aspects of system performance like wait times and ER use may have actually declined in performance.  Reform increased the state’s insurance premiums by an estimated 6% (watch out proponents of the ACA who said it would lower insurance costs) and has put the state in a much deeper deficit position that originally projected.  While this paper purports to show an improvement in health status among adults in Massachusetts, it is based on self-assessments, which are notoriously unreliable, and the effects are extremely small and could very likely be associated with other factors, like the growth in wellness programs.  The effect is largely attributed by the authors to the increase in health care coverage, which past research has shown has a mixed effect on health, with the strongest evidence for improvement occurring among the poorest segment of the population.