Access And Affordability: An Update On Health Reform In Massachusetts, Fall 2008

Urban Institute in Washington, D.C., USA.
Health Affairs (Impact Factor: 4.97). 06/2009; 28(4):w578-87. DOI: 10.1377/hlthaff.28.4.w578
Source: PubMed


Massachusetts continues to move forward on comprehensive health reform. Uninsurance is at historically low levels, despite the recent economic downturn. Building on that coverage expansion, access to and affordability of care in the commonwealth have improved. Notwithstanding these successes, some of the early gains in reducing barriers to care and improving the affordability of care had eroded by fall 2008, reflecting trends that predate health reform in Massachusetts: constraints on provider capacity and increasing health care costs. Because these are national concerns as well, Massachusetts continues to offer lessons for national reform efforts.

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Available from: Sharon Long, Apr 16, 2015
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    • "Work and student visa holders may participate in the exchanges but are ineligible for Medicaid (see the last column in table 1 for immigrant coverage options).). The state has also struggled to lower health care costs and has implemented additional policies for this purpose (Long and Masi 2009; McDonough et al. 2011). Scholars, lawmakers, and health care professionals have applauded the policy as an overall success. "
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    ABSTRACT: The 2010 Patient Protection and Affordable Care Act (ACA) was passed to provide more affordable health coverage to Americans beginning in 2014. Modeled after the 2006 Massachusetts health care reform, the ACA includes an individual mandate, Medicaid expansion, and health exchanges through which middle-income individuals can purchase coverage from private insurance companies. However, while the ACA provisions exclude all undocumented and some documented immigrants, Massachusetts uses state and hospital funds to extend coverage to these groups. This paper examines the ACA reform using the Massachusetts reform as a comparative case study to outline how citizenship status influences individuals' coverage options under both policies. The paper then briefly discusses other states that provide coverage to ACA-ineligible immigrants and the implications of uneven ACA implementation for immigrants and citizens nationwide.
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    • "Sixth, the reform has generally been popular. Sixty-nine percent of state residents supported reform in 2006, and that number has remained essentially unchanged, with 67% support in 2009 (Long and Stockley, 2009). "
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    ABSTRACT: The Patient Protection and Affordable Care Act (ACA) is the most comprehensive reform of the U.S. medical system in at least 45 years. The ACA transforms the non-group insurance market in the United States, mandates that most residents have health insurance, significantly expands public insurance and subsidizes private insurance coverage, raises revenues from a variety of new taxes, and reduces and reorganizes spending under the nation’s largest health insurance plan, Medicare. Projecting the impacts of such fundamental reform to the health care system is fraught with difficulty. But such projections were required for the legislative process, and were delivered by the Congressional Budget Office (CBO). This paper discusses the projected impact of the ACA in more detail, and describes the evidence that sheds light upon the accuracy of the projections. It begins by reviewing in broad details the structure of the ACA and then reviews evidence from a key case study that informs our understanding of the ACA’s impacts: a comparable health reform that was carried out in Massachusetts four years earlier. The paper discusses the key results from that earlier reform and what they might imply for the impacts of the ACA. The paper ends with a discussion of the projected impact of the ACA and offers some observations on those estimates.Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at
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    • "To make health care costs less of an issue for American households, federal legislation similar to the 2007 state-wide health insurance mandate, the Massachusetts Health Care Program, is being proposed (Blumberg & Holahan, 2009). By implementing a healthcare program that created a public plan, increasing welfare eligibility standards, and serving as a " broker " for small businesses and individuals to affordable health insurance, the Massachusetts healthcare plan reduced their uninsured rates for all income levels and ages (Long, 2008). These uninsured rates in Massachusetts were significantly affected by the implementation of the state-wide insurance plan, witnessing a 48% drop in the uninsurance rates for all ages and incomes in the first year alone (Massachusetts Health Connector, 2009). "

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