This article examines the impact of state health reforms in New York and Massachusetts. In 2006, Massachusetts enacted a comprehensive reform of health care with the goal of creating near-universal health coverage. New York enacted a narrower set of reforms to incrementally increase access to health care between 2000 and 2001.

The authors conducted multivariate analyses on data from the National Health Interview Survey between 1999 and 2008 to understand how health reforms in these states affected the health insurance and access of nonelderly adults in Massachusetts and New York. Data from other states were used to control for underlying trends that were unrelated to the health reforms.

Key Findings:

• The rate of uninsurance in Massachusetts fell by 3 percent following the state’s comprehensive health reform. The reforms lead to an increase in public health coverage with no significant change in employer-based insurance rates. Massachusetts also showed significant gains in access to health care.
• New York increased insurance coverage for the populations addressed in its health reform. The magnitude of the reforms was relatively small and there was no evidence of improvement in statewide access to health care.

This research suggests that state-based reforms influence insurance and access to health care. National policy changes with elements of the Massachusetts health reform may improve access to health insurance and health care.

This article appears in a special issue of the journal HSR: Health Services Research. The study was carried out through the Robert Wood Johnson Foundation’s State Health Access Reform Evaluation (SHARE). SHARE guides the implementation of health reform and supports research on the expansion of health insurance coverage.