US Health care: Massachusetts health-care reform increased access to care, particularly among disadvantaged

In a study published in the July edition of the American Journal of Preventive Medicine, the Harvard research team, led by first author Aakanksha Pande, a doctoral student in the Department of Population Medicine at HMS and Harvard Pilgrim Health Care Institute, found that Massachusetts health reform has effectively increased access to health care and reduced disparities. Massachusetts health reform is structurally similar to the 2010 Patient Protection and Affordable Care Act (PPACA), the federal statute signed into law by President Obama last year.

"As the political rhetoric heats up in advance of another presidential election cycle," said senior author Joshua Salomon, associate professor of international health at HSPH, "it's important to understand what the experience in Massachusetts tells us about the effects of health reform on access and affordability of care."

The researchers found that three years after being enacted in 2006, Massachusetts health reform was associated with a 7.6 percent increase in health insurance among residents, 4.8 percent decrease in those forgoing health care due to cost, and 6.6 percent increase in residents having a primary care physician. They also found that these improvements were most evident among socioeconomically disadvantaged groups.

Does Massachusetts health reform provide a good proxy for national reform? "Yes and no," said Pande. The terms of each act are similar, including the provision of a health mandate that requires all residents to obtain health insurance. However, Massachusetts health reform was passed with very little opposition in the state legislature, whereas the PPACA has been met with contention. For this reason, implementing health reform at the national level might prove more difficult.

According to Salomon, the success of Massachusetts health reform cannot be ignored. "Our study confirms that there has been a dramatic rise in health care coverage in Massachusetts since health reform was passed," he said.

"There had been lots of discussion in the media about the political and ethical aspects of requiring health insurance," said Pande. "But evidence of whether or not a health mandate works had not been established in a rigorous manner. We approached the issue from a neutral perspective and determined that, in Massachusetts, it does."

This research was funded by the Harvard Medical School Fellowship in Pharmaceutical Policy Research and Harvard Pilgrim Health Care Institute, the Harvard University PhD Program in Health Policy, and a fellowship for students from India in honor of Amartya Sen, the Thomas W. Lamont Harvard University Professor] from the Graduate School of Arts and Sciences at Harvard.