Massachusetts’ 2006 health reform law is frequently a topic of research and debate. However, few studies have specifically focused on how children have fared as a result of the reform. That is until this recent study published in the American Economic Review that focuses solely on children under 18 and the impact that health reform had on their insurance coverage, care utilization and health outcomes. The report reminds readers that past research had linked better health during childhood to better health status and achievement in adulthood.
Miller, the author, finds that while health reform had only a small effect on the percentage of children that gained coverage, it was crucial to improving the type of coverage children had access to, increasing the use of primary care, and improving health outcomes.
The study uses data from the 2002-2008 National Health Interview Survey, which allowed comparisons of coverage before and after implementation of the law. Additionally, children’s coverage in Massachusetts is compared to children’s coverage in other Northeastern states (Connecticut, Maine, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont) in order to analyze trends.
Before the implementation of health reform, children in Massachusetts had relatively high coverage rates, about 96% – which increased an estimated 2.2 percentage points by 2008. While not unimportant, the more compelling story lies in what the composition of coverage and care utilization looked like. Enrollment increased in both Medicaid and private insurance, and declined in state funded programs CMSP and FreeCare, which do not offer comprehensive care, and are not generally considered insurance programs. Relative to the other Northeastern states, the increase in Medicaid enrollment was not significant, as other states experienced similar growth. The increased enrollment in private insurance (between 7.9 and 10.4 percentage points) and the slump in enrollment of the aforementioned state programs (between 7.3 and 7.6 percentage points), were both statistically significant.
Miller finds that the increase in comprehensive coverage notably reduced the probability of visiting the ER. The probability that a child received a check-up and the probability that a child visited a doctor’s office, both also increased, although to a lesser extent. Other terrific news; almost no children reported having to forgo care due to costs after the implementation of health reform, and the number of children described as being in excellent health increased between 5.5 and 6.0 percentage points.
These new findings highlight the success of the healthcare reform in Massachusetts as it impacts children, and has implications for the success our nation’s children stand to achieve once the ACA is fully implemented in 2014.