Results from a Massachusetts pilot study

Abstract

The 2010 Affordable Care Act draws on many components of the Massachusetts 2006 healthcare reform law to expand health insurance coverage for millions of Americans. Both laws expand eligibility for low-income individuals to qualify for Medicaid, require individuals to have insurance if they have access to affordable coverage, include an employer penalty, and provide government subsidies to low-income people who are not eligible for Medicaid. In addition both envision an insurance exchange to create a market in which individuals and small businesses purchase affordable insurance. Contrary to the myths about the Massachusetts reform, it has not led to the rationing of care, to individuals and employers dropping private insurance, and has not bankrupted the state. The Massachusetts law has expanded healthcare coverage so that about only 2 % of Massachusetts residents are uninsured. The overwhelming percent of employers subject to the employer mandate have complied with the law; fewer than 5 % have been subjected to penalties. More people have a regular provider and fewer people delay getting health care due to costs compared to prior to the law. The law appears to have had a positive impact on the health of people in Massachusetts as, for example, more women are receiving early prenatal care, more people are getting preventive care like cancer screenings, and more people with diabetes are getting appropriate care related to diabetes. The high cost of health care in Massachusetts has been a long-standing problem and was not exacerbated by the law. Controlling healthcare costs is the subject of the next phase of reform in Massachusetts.