A Closer Look at Healthcare Reform Outcomes in Massachusetts

Concerned that more than 10% of the state’s population were uninsured, lawmakers in Massachusetts passed a sweeping healthcare reform law in 2006.

At that time, the law mandated most Massachusetts residents obtain a minimum level of health insurance coverage. It also provided free healthcare for residents earning less than 150% of the federal poverty level and mandated employers with more than 10 full-time employees insure their employees.

Since that time, the law has been amended to align with the national Affordable Care Act. The state added healthcare industry price controls in 2012 and repealed the employer mandate in 2013. By 2012, only 4.3% of state’s residents were uninsured.

In light of all these changes, a study published online in Health Services Research examined the outcomes in uninsured patients with hyperlipidemia, diabetes and hypertension

Researchers from Massachusetts General Hospital used the PartnersHealthCare Research Patient Data Registry (RPDR) to identify 1,463 patients with hyperlipidemia, diabetes, or hypertension who were uninsured in the 3 years prior to 2006.

They hypothesized that patients that benefitted the most were those with poorly controlled chronic diseases, those who had no evidence of an established primary care provider at baseline, and those who gained insurance because of Massachusetts Health Reform (MHR).

Although they examined quarterly total cholesterol, glycosylated hemoglobin, and systolic blood pressure in all newly insured patients, they also looked specifically at the most disadvantaged groups for 5 years. They compared results with 3,448 matched controls who were consistently insured throughout the study period.

After their study was completed, the researchers found no detectable trend changes in total cholesterol, glycosylated hemoglobin, or systolic blood pressure.

The authors concluded that MHR did not improve hyperlipidemia, diabetes, or hypertension control after 5 years. They also suggested that altering health outcomes is so complex that it makes it difficult to address all of the necessary components to stimulate improvements.

Other reasons they pointed to in their research included fragmented healthcare, or a tendency for patients to choose less expensive plans with high out-of-pocket costs, which they said resulted in patients being unable or unwilling to seek care because of the expense.