Massachusetts health care reform associated with improved health outcomes in adults

Health care reform in Massachusetts, which has been considered a model for the Affordable Care Act, was associated with reduced all-cause mortality and deaths from causes potentially affected by access to health care, according to a new study.

Researchers compared mortality rates before and after introduction of health care reform in Massachusetts counties with rates among a control group in counties in other states to determine whether the Massachusetts law affected outcomes. The pre-reform period was defined as 2001 to 2005, while the post-reform period was defined as 2007 to 2010. The primary outcome measures were annual county-level all-cause mortality in age-, sex-, and race-specific cells (n=146,825) obtained from the CDC's Compressed Mortality File. Secondary outcomes were deaths from causes that could be affected by access to health care, insurance coverage, access to care, and self-reported health. Data on coverage, health care access, and self-reported health were obtained from the CDC's Behavioral Risk Factor Surveillance System and the Census Bureau's Current Population Survey. The study involved adults 20 to 64 years of age.

Results appeared in the May 6 Annals of Internal Medicine.

Researchers found that Massachusetts health care reform was associated with a significant decrease in all-cause mortality versus the control group (−2.9%; P=0.003; absolute decrease, 8.2 deaths per 100,000 adults). Deaths from causes that could be affected by access to health care, such as cardiovascular disease and cancer, also saw a significant decrease (−4.5%; P<0.001). Counties that had lower household incomes and higher proportions of uninsured persons before health care reform experienced greater changes.

In secondary analyses, post-reform counties in Massachusetts had significant gains in coverage, access to care, and self-reported to health. The researchers calculated that approximately 830 adults needed to gain health insurance to avoid 1 death annually.

The study's design was nonrandomized and the data may have been affected by unmeasured confounders, the authors noted. However, they concluded that health reform in Massachusetts was associated with reduced all-cause mortality and reductions in deaths from causes that could be affected by access to health care.

“Although this analysis cannot demonstrate causality, the results offer suggestive evidence that the Affordable Care Act—modeled after the Massachusetts law—may impact not only coverage and access but also mortality,” the authors wrote. However, they said, the Massachusetts results might not be generalizable to the country as a whole, “which underscores the need to monitor closely the Affordable Care Act's effect on coverage, access, and population health across all states.”

The author of an accompanying editorial said that the study adds to a large body of existing evidence that suggests insurance has a positive effect on health and that it seems reasonable to concluded that coverage expansion benefits health by facilitating health care access.

“What is unreasonable and, in my view, unconscionable is to leverage a selective reading of the evidence on the benefits of health insurance in an argument to deny assistance to Americans who cannot afford to purchase basic coverage,” the editorialist concluded.