Preparing for National HealthReform: Lessons fromMassachusettsSharon K. LongUniversity of MinnesotaApril 2, 2011Population...
Massachusetts Health Reform     • Legislation passed in April 2006     • Many parts, including:           – Medicaid (Mass...
National reform modeled on    Massachusetts’s 2006 legislation    • Expansion of eligibility for public programs    • Crea...
However, important differences between    ACA and Massachusetts’s health reform    • Expands subsidies to higher income le...
Massachusetts also started reform with a    stronger foundation than many states    • Prior expansions of Medicaid    • Pr...
Findings on impacts of health reform in    Massachusetts can help inform national policy    • Studies of the effects on in...
Hypothesized impact of Massachusetts     health reform on individuals    • Increase insurance coverage    • Improve access...
Data needed for an evaluation of     potential impacts on individuals    • State representative sample    • Large state sa...
Massachusetts Health Reform Survey    • Baseline MHRS survey in Fall 2006 with follow-up      surveys every year    • Adva...
Data sources used to estimate impacts    of health reform on individuals in MA                                            ...
Summary of study findings: impacts on    insurance coverage for non-elderly adults                                        ...
Summary of study findings: impacts on health     care access & use for non-elderly adults                            MHRS ...
Summary of study findings: impacts on health     care affordability for non-elderly adults                                ...
Potential impact of Massachusetts     health reform on employers    • Employers could stop offering insurance      coverag...
Available data to support estimates of    employers’ response to health reform    • Employer surveys      – RWJF/NORC Mass...
Summary of study findings: employer     responses to health reform                        DHCFP                  RWJF/NORC...
Studies show consistent impacts of    health reform in Massachusetts     • Increase in insurance coverage, with no       c...
Studies highlight need to improve data     for future evaluations of health reform    • National surveys          – Expand...
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Pres paa2011 apr2_long

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Pres paa2011 apr2_long

  1. 1. Preparing for National HealthReform: Lessons fromMassachusettsSharon K. LongUniversity of MinnesotaApril 2, 2011Population Association of America2011 Annual MeetingsWashington, DC
  2. 2. Massachusetts Health Reform • Legislation passed in April 2006 • Many parts, including: – Medicaid (MassHealth) expansions – CommCare--new program that provides income- related subsidies for private coverage – CommChoice-new purchasing arrangement – Special provisions for young adults – Insurance market reforms – Requirements for employers – Individual mandate – Standards for covered benefitswww.shadac.org 2
  3. 3. National reform modeled on Massachusetts’s 2006 legislation • Expansion of eligibility for public programs • Creation of health insurance exchanges • Subsidies for low- and moderate- income individuals • Expansion of dependent coverage • Requirements for employers • Individual mandate • Standards for covered benefitswww.shadac.org 3
  4. 4. However, important differences between ACA and Massachusetts’s health reform • Expands subsidies to higher income levels (400% FPL versus 300% FPL) but provides lower subsidies for some • Imposes lower standards for affordability under the individual mandate • Provides more generous expansion of dependent coverage (doesn’t require that child be claimed as dependent for tax purposes) • Provides tax credits for small businesses • Limits penalties for employers who do not offer insurance coverage to larger firms (>50 workers versus >10 workers) • Extends some insurance protections to workers in self- insured plans which are not under the purview of state regulatorswww.shadac.org 4
  5. 5. Massachusetts also started reform with a stronger foundation than many states • Prior expansions of Medicaid • Prior insurance market reforms—modified community rating and guaranteed issue • Strong employer-sponsored insurance coverage • Relatively low uninsurance • Culture of collaborationwww.shadac.org 5
  6. 6. Findings on impacts of health reform in Massachusetts can help inform national policy • Studies of the effects on individuals • Studies of the response by employers— offer rates, scope of coverage, premiums • Studies of the effects on providers—safety net providers, hospitals, emergency departmentswww.shadac.org 6
  7. 7. Hypothesized impact of Massachusetts health reform on individuals • Increase insurance coverage • Improve access to health care • Increase use of health care services – For those who gain insurance coverage – For those who gain expanded benefit package with ―Minimum Creditable Coverage‖ • Make care more affordable for individualswww.shadac.org 7
  8. 8. Data needed for an evaluation of potential impacts on individuals • State representative sample • Large state sample size • Relevant outcome measures – Insurance coverage – Access to and use of care – Affordability of care – Quality of care • Timely datawww.shadac.org 8
  9. 9. Massachusetts Health Reform Survey • Baseline MHRS survey in Fall 2006 with follow-up surveys every year • Advantages: – Oversamples populations targeted by health reform – Rich set of measures of coverage, access, use, and affordability – Findings available fairly quickly (Spring/Summer) • Disadvantage: – Relies on pre-post comparisons to estimate the impacts of health reform – Doesn’t cover all state residentswww.shadac.org 9
  10. 10. Data sources used to estimate impacts of health reform on individuals in MA Administrative MHRS CPS NHIS BRFSS Data Sample size ~3,000 each ~3,000 each ~1,700 each ~17,000 NA for MA? year year year each year Insurance, Insurance, Limited Outcome access, use, Insurance access, use, insurance, Insurance, measures? affordability limited access, use, use affordability affordability Data for other No Yes Yes Yes No states? Difference- Difference- Difference- Evaluation Pre-post in- in- in- Pre-post; framework? differences differences differences trendswww.shadac.org 10
  11. 11. Summary of study findings: impacts on insurance coverage for non-elderly adults Admin. MHRS CPS NHIS BRFSS Data (through (through (through (through (through 2009) 2008) 2008) 2008) 2010) 3 studies 2 studies 1 study 3 studies 1 study Insurance Up 6 to 8 Up 7 Up 2 to 3 Up 5 to 8 Up by 8 coverage percentage percentage percentage percentage percent points points points points Evidence of Not crowd-out of No No No available No ESI coveragewww.shadac.org 11
  12. 12. Summary of study findings: impacts on health care access & use for non-elderly adults MHRS NHIS BRFSS (through 2009) (through 2008) (through 2008) 3 studies 1 study 3 studies Access to care Same or improved Same, with one Same or improved access indicator of reduced access access Use of care Same or increased Same or increased Same or increased use use usewww.shadac.org 12
  13. 13. Summary of study findings: impacts on health care affordability for non-elderly adults MHRS NHIS BRFSS (through 2009) (through 2008) (through 2008) 3 studies 1 study 3 studies Affordability of care Same or improved Same or improved Improved affordability affordability affordabilitywww.shadac.org 13
  14. 14. Potential impact of Massachusetts health reform on employers • Employers could stop offering insurance coverage to workers, shifting employees from private coverage to public coveragewww.shadac.org 14
  15. 15. Available data to support estimates of employers’ response to health reform • Employer surveys – RWJF/NORC Massachusetts Employer Benefits Survey – Massachusetts DHCFP Employer Survey • Employer response from perspective of workers – Massachusetts Health Reform Surveywww.shadac.org 15
  16. 16. Summary of study findings: employer responses to health reform DHCFP RWJF/NORC MHRS Employer Survey Employer Survey Employer Increase in share of Increase in share of No change in share offer rate firms offering coverage firms offering coverage of workers in firms in MA, while national in MA, while national that offered share offering share offering coverage coverage pre- and coverage dropped dropped post- reformwww.shadac.org 16
  17. 17. Studies show consistent impacts of health reform in Massachusetts • Increase in insurance coverage, with no crowding out of private coverage • Improvements in access to and use of health care • Improvements in affordability of health care for individuals • Employer role in health insurance coverage remains strongwww.shadac.org 17
  18. 18. Studies highlight need to improve data for future evaluations of health reform • National surveys – Expand state samples – Expand survey content – Speed up the release of data files • State surveys – Expand coordination efforts to increase comparability • Administrative data – Establish uniform data collection efforts for Medicaid, CHIP, and the new exchangeswww.shadac.org 18

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