“Good Job Mitt”: Romneycare Is Making Massachusetts Healthier and its certainly working and liked by the citizens
In newly released research, Charles Courtemanche and Daniela Zapata ask perhaps the most important question
about the Massachusetts health-care reforms: Did they improve health outcomes in Massachusetts?
The answer, which relies on self-reported health data, suggests they did. The authors document improvements “physical health, mental health, functional limitations, joint disorders, body mass index, and moderate physical
activity.” The gains were greatest for “women, minorities, near-elderly adults, and those with incomes low enough qualify for the law’s subsidies.”
Some of those results are a bit odd. Although it’s possible to tell yourself a story about how the Massachusetts reforms affected the body mass indexes of the newly insured, you have to stretch a bit.
But most of them make perfect sense. The reforms led to more people having insurance, which is to say more having more opportunities to see a doctor and get early and/or regular treatment for ailments. That led to
improvements in health. If that hadn’t led to improvements in health, it would be the worth of going to the doctor getting timely medical care that would be called into question. And if going to the doctor and getting timely medical
care isn’t worth doing, the Massachusetts reforms are pretty far down the list of practices and policies we need rethink.
The researchers end by asking whether the Massachusetts reforms provide a good guide to what will happen under
the Affordable Care Act. “The general strategies for obtaining nearly universal coverage in both the Massachusetts federal laws involved the same three-pronged approach of non-group insurance market reforms, subsidies, and
mandates, suggesting that the health effects should be broadly similar,” they write. “However, the federal legislation
included additional costcutting measures such as Medicare cuts that could potentially mitigate the gains in health
from the coverage expansions. On the other hand, baseline uninsured rates were unusually low in Massachusetts, the coverage expansions — and corresponding health improvements — from the Affordable Care Act could potentially
I’d add one point to their discussion: The national reforms, unlike the Massachusetts reforms, included major
investments in comparative-effectiveness research, electronic health records, accountable care organizations and
pay-for-quality pilots. If any or all of those initiatives pay off, they could dramatically improve our understanding of treatments work and force the health-care system to integrate that new knowledge into everyday treatment decisions
If that happens, medical care could become substantially more effective than it is now, which should also improve
health outcomes. Quality improvements like that could, for the already insured, be the largest payoff from the
Affordable Care Act.