Does Universal Coverage Improve Health? The Massachusetts Experience

Abstract

In 2006, Massachusetts passed health care reform legislation designed to achieve nearly universal coverage through a combination of insurance market reforms, mandates, and subsidies that later served as the model for national health care reform. Using individual-level data from the Behavioral Risk Factor Surveillance System, we provide evidence that health care reform in Massachusetts led to better overall self-assessed health. Several robustness checks and placebo tests support a causal interpretation of the results. We also document improvements in several determinants of overall health, including physical health, mental health, functional limitations, joint disorders, body mass index, and moderate physical activity. The health effects were strongest among women, minorities, near-elderly adults, and those with low incomes. Finally, we use the reform to instrument for health insurance and estimate a sizeable impact of coverage on health.

Keywords: Massachusetts, health care reform, universal coverage, health insurance, health, self-assessed health, self-reported health

JEL Classification: I12, I13, I18