A summary of the Massachusetts health reform experience

Via NBER, Jon Gruber has published a paper today that summarizes the Massachusetts experience under health reform and includes projections for the ACA. Let’s start with the former. I may come back to the ACA projections later.

Gruber describes eleven results from the Massachusetts health reform law, all supported with citations and evidence. His conclusions:

  1. There has been a dramatic expansion of health insurance, reducing the uninsurance rate by 60-70%.
  2. No change in wait times for general and internal medicine practitioners have been observed.
  3. The share of the population with a usual source of care, receiving preventative care, and receiving dental care all rose.
  4. The rate of utilization of emergency care fell modestly.
  5. There has been a 40% decline in uncompensated care.
  6. The proportion of the population with employer-sponsored health insurance increased by 0.6%.
  7. The rate of employer offers of coverage grew from 70% to 76%.
  8. Mandate compliance has been very high: 98% compliance in reporting via tax filings of obtaining coverage or paying penalties.
  9. The administrative costs of health reform have been low. Overall implementation costs have been close to expectations.
  10. Premiums have fallen dramatically in the non-group market.
  11. Though group premiums have risen, they have not increased faster than one would expect from increases in other states in the region.

Those familiar with the literature on this will be able to cite results that seem to counter some of the above. In the paper, Gruber himself has done that, but also explained why some of that work is misleading or imprecise.

UPDATE: Typos fixed.

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