Massachusetts health reform and disparities in coverage, access and health status

Background: Massachusetts health reform has achieved near-universal insurance coverage, yet little is known about the effects of this legislation on disparities. Objective: Since racial/ethnic minorities and low-income individuals are over-represented among the uninsured, we assessed the effects of health reform on disparities. Design: Cross-sectional survey data from the Behavioral Risk Factor Surveillance Survey (BRFSS), 2006-2008. Participants: Adults from Massachusetts (n=36,505) and other New England states (n=63,263). Main Measures: Self-reported health coverage, inability to obtain care due to cost, access to a personal doctor, and health status. To control for trends unrelated to reform, we compared adults in Massachusetts to those in all other New England states using multivariate logistic regression models to calculate adjusted predicted probabilities. Key Results: Overall, the adjusted predicted probability of health coverage in Massachusetts rose from 94.7% in 2006 to 97.7% in 2008, whereas coverage in New England remained around 92% (p<0.001 for difference-in-difference). While cost-related barriers were reduced in Massachusetts, there were no improvements in access to a personal doctor or health status. Although there were improvements in coverage and cost-related barriers for some disadvantaged groups relative to trends in New England, there was no narrowing of disparities in large part because of comparable or larger improvements among whites and the non-poor. Conclusions: Achieving equity in health and health care may require additional focused intervention beyond health reform.