• Did people get healthier in Massachusetts after coverage expansion?

    Does Universal Coverage Improve Health? The Massachusetts Experience, by Charles J. Courtemanche, Daniela Zapata (NBER):

    In 2006, Massachusetts passed health care reform legislation designed to achieve nearly universal coverage through a combination of insurance market reforms, mandates, and subsidies that later served as the model for national health care reform. Using individual-level data from the Behavioral Risk Factor Surveillance System, we provide evidence that health care reform in Massachusetts led to better overall self-assessed health. An assortment of robustness checks and placebo tests support a causal interpretation of the results. We also document improvements in several determinants of overall health, including physical health, mental health, functional limitations, joint disorders, body mass index, and moderate physical activity. The health effects were strongest among women, minorities, near-elderly adults, and those with incomes low enough to qualify for the law’s subsidies. Finally, we use the reform to instrument for health insurance and estimate a sizeable impact of coverage on health. The effects on coverage were strongest for men, non-black minorities, young adults, and those who qualified for the subsidies, while the effects of coverage were strongest for women, blacks, the near-elderly, and middle-to-upper income individuals.

    That’s the abstract. I have not yet read the paper. The evidence is consistent with that from Oregon, as well as what one would expect if lack of coverage of the type now more widely accessible in Massachusetts led to under-use of effective care.

    UPDATE: Ezra Klein blogs about the paper here.


    • -Interesting anyone considers self-reported health status a sufficient indicator of actual health status for the purposes of evaluating the real health effects of Medicaid enrollment in Oregon, or the health-insurance expansion in Massachussetts. IIRC there was no measurable change in mortality/morbidity for the Oregon Medicaid patients (yet). It’s surprising that there’s no clinical data for the people who obtained coverage under the Massachussetts plan.

      I can’t imagine anyone in health policy circles accepting self reported health status as sufficient evidence for supporting efficacy claims when tendered by a pharmaceutical company, or a health insurance company, or for the performance of high-deductible vs comprehensive insurance plans – so the emphasis on self-reported health status in these cases is puzzling.

      If patients who had been seen by homeopaths or faith healers reported higher subjective well-being than MD’s would anyone (aside from the homeopaths or faith healers) accept that as sufficient evidence for the medical efficacy of homeopathy?

      -What’s your take on the significance of self-reported health metrics for establishing the real medical benefits of insurance coverage?

      Might be pedantic, but I’d be curious to see how cash transfer payments equal to the value of Medicaid coverage impacted self-reported well-being metrics amongst the people who applied for, but did not gain entry to the state’s Medicaid plan as a control for how much of the effect on well being was specificaly due to having medical coverage vs simply being the recipient of an asset transfer equal to a significant percentage of their annual earned income.

      • I see you ask a lot of questions (in this comment and others) and quite good ones. I apologize that I cannot address them all. I’ll say this much, try Google Scholar and look for papers on self-reported health and objective measures of morbidity. Another approach, get your hands on the paper I blogged about. No doubt they back up their use of self-reported health status. If they don’t some other paper that uses it likely does. I know they are out there. Feel free to report back what you find.

        That’s the best I can do for you right now. … teach a man to fish …

      • Robin Hanson has an interesting take the The Oregon Health Insurance Experiment, at the link below :


    • The fact that body mass index improved erodes confidence in the study.


      It is logical that insurance would improve the health of the poor but not anyone else because they could buy healthcare even if they do not have insurance.