Field of Work: The impact of Massachusetts' health reform.

Problem Synopsis: Research by the Institute of Medicine found that having health insurance is associated with better health outcomes for adults and with their receiving appropriate care across a range of preventive, chronic and acute care services. Adults without health insurance coverage die sooner and experience greater declines in health status over time than do adults with continuous coverage.

In 2006, Massachusetts Governor Mitt Romney signed into law far-reaching legislation aimed at providing nearly universal health care coverage to state residents.

Synopsis of the Work: Through subcontracts from the Blue Cross Blue Shield of Massachusetts Foundation, staff at the Urban Institute and International Communications Research surveyed adult residents in 2006—before Massachusetts' health reform took effect—and again in 2007 and 2008. Researchers analyzed survey results to determine how the law affected coverage, residents' access to and use of health care and their out-of-pocket medical expenses.

Key Findings: In journal articles and policy briefs, researchers cited the following findings:

• In 2006, 13.3 percent of all adults in Massachusetts were uninsured, and 24 percent of adults with incomes below 300 percent of the federal poverty level were uninsured.
• By 2008, only 4 percent of all adults were uninsured (a 69.9 percent decline), and 7.6 percent of adults with incomes below 300 percent of the poverty level were uninsured (a 68.3 percent decline).
• There was no evidence that employers were less likely to offer insurance to employees after the reform took effect, even though public insurance options were available.
• Access to and use of health care improved among all adults and lower-income adults. However, some adults found it hard to obtain care or paid high out-of-pocket costs.
• Black and Hispanic adults had somewhat poorer access to care than did White adults.

Key Results: The researchers cited the following result:

• The study—the only pre- and post-reform assessment of health care reform in Massachusetts—has helped shape the national health care debate and underscores the important role of health services research in supporting the policy community.