JudyAnn Bigby: Better Health After 10 Years of Mass. Health Care Law

One of a series of analyses on the 10th anniversary of the 2006 Massachusetts health care overhaul. Dr. JudyAnn Bigby served as secretary of health and human services for Massachusetts from 2007 to 2013. She's now a senior fellow at Mathematica Policy Research.

Are people healthier since the implementation of the 2006 Massachusetts health insurance reforms? For the most part, the answer is yes.

Some groups are clearly healthier, especially populations that benefited the most from insurance eligibility expansions -- people with low incomes, racial and ethnic minorities, and those with chronic health conditions. The pathway from expanding insurance eligibility to improved health is logical — making eligibility easier leads to increased coverage, better access to care, more effective use of clinical services, and improved or maintained health. Proving coverage leads to better health can take years, but after 10 years, outcomes from Massachusetts suggest promising results.

The evidence includes increased self-reports from residents who say they are in good or excellent health, and who accessed preventive services -- such as screening for HIV, cholesterol and colon cancer. People with diabetes report receiving more targeted preventive care — such as eye exams and influenza vaccines.

Another positive consequence of expanded coverage: resolution of disparities – the differences in access and treatment among demographic groups. One study showed that procedures (such as orthopedic surgeries) that require referral to a specialist increased after reform for low- and medium-income non-elderly adults. The same was true for blacks and Latinos.

In another large study of death rates in Massachusetts, researchers found that mortality rates decreased after 2006 by nearly 3 percent compared with rates in comparable populations in other states. Reductions in deaths were nearly twice as large for Latino and racial minorities than for white adults and were largest in lower-income counties. Most of the reduction occurred in deaths due to conditions that are avoidable or treatable if detected early, such as cancer and heart disease.

"Critical access issues continue to pose an obstacle for Massachusetts residents."

Dr. JudyAnn Bigby

Some adult women especially benefited from reform. Uninsured rates among women dropped, especially for lower-income women, racial and ethnic minorities, and women without dependent children. Importantly, younger women reported greater access to contraception with fewer costs barriers. The total number of abortions performed in Massachusetts after the 2006 law declined by more than the pre-reform trend, despite more women having new coverage for the procedure.

There are still challenges ahead. Critical access issues continue to pose an obstacle for Massachusetts residents. In the context of an archaic substance abuse treatment system, addiction treatment services did not increase after reform in spite of the mandate to cover these services. Health care affordability is a major barrier to access. Out-of-pocket costs have increased and the delivery system remains a complex maze to navigate. But Massachusetts has moved beyond the debate about whether to strive for universal coverage and is tackling these problems. The rest of the nation still has much to learn from the Massachusetts model.

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