The Massachusetts “Obamacare” Model Works

The partial model for Obamacare—Massachusetts’ near-universal health care program, adopted in 2006—has resulted in measurably improved health.

According to a study conducted by researchers from Harvard University and the University of Michigan—with help from the Centers for Disease Control (CDC)—the health of Massachusetts residents rose more in the first five years of the program than did the health of residents in other New England states.

Also rising was the use of some preventive care—including tests that identify early colon, breast, and cervical cancers—and cholesterol tests for heart disease risk. Massachusetts residents were also increasingly likely to say they had health insurance and access to a personal doctor after 2006. They were less likely to say costs stood in the way of getting care than were other New Englanders.

For the study, annual random telephone surveys were made between 2001 and 2011 asking 345,211 New Englanders aged 18-64 questions about their general, physical, and mental health. The data were gathered by the CDC and state health departments.

The researchers used approaches utilized by the CDC's Behavioral Risk Factor Surveillance System. This let them identify subtle differences in health status and behaviors, and to analyze these differences further by income and race/ethnicity.

The research didn't show large jumps in health care, or access, but the pattern is consistent when comparing Massachusetts improvements to those in states without reform efforts. Even when the researchers excluded data from Vermont and Maine, which launched smaller-scale reform efforts, Massachusetts showed bigger improvements.

The numbers were as follows: In comparing the periods before and after health care reform compared to those in other New England states, Massachusetts residents reported greater improvements in general health (1.7 percent), physical health (1.3 percent), and mental health (1.5 percent). Massachusetts residents reported relative increases in rates of Pap screening (2.3 percent), colonoscopy (5.5 percent), and cholesterol testing (1.4 percent).

Adults in Massachusetts households who earned up to 300% of the federal poverty level gained more in health status than did those above that level, with differential changes ranging from 0.2% to 1.3%. Relative gains in health status were comparable among white, black, and Hispanic residents in Massachusetts.

First author Philip J. van der Wees is with Harvard, and the Scientific Institute for Quality of Healthcare. He tells Bioscience Technology, “There are two related reasons why the effects may seem relatively small. First, the insurance rate of Massachusetts' residents was already high prior to health care reform compared to other US states. The reform affected therefore a relative small portion of the population.  Second, we were unable to create a specific subgroup of the previously uninsured population. That would probably have resulted in larger effects. In creating a subgroup of low income residents at whom the reform was aimed, we indeed found larger effects.”

He continues, “Knowing that many other states have lower insurance rates for their populations than Massachusetts, we may expect more impact with the implementation of the federal Affordable Care Act. On the other hand, Massachusetts is not the average state. There was large consent for the reform in Massachusetts, which had a positive impact on the implementation. Our biggest question was whether the reform had a positive effect on the health of Massachusetts residents. We indeed saw this effect four years after the implementation.”

He clarifies, “We used data from the CDC with anonymous data of an annual sample of residents in Massachusetts and other New England States. The data does not allow for tracking insurance status of individuals over the years and we were therefore unable to identify a specific subgroup that was uninsured before healthcare reform and insured after the reform.”

To assess effects of the federal version, it is likely that tracking federal insurance numbers before and after will be easier.