MythBuster: Did Massachusetts Health Reform Reduce Health Disparities?
Just before the holidays struck, the Boston Globe published an article asking whether national health reform would close racial and ethnic disparities in health care. The answer in the article was clear: yes. The article states that as a result of the 2006 Massachusetts health reform law, “97.2 percent of Massachusetts residents now have health insurance, with whites and blacks covered at the same rate.” The article quotes John McDonough that this is “something never accomplished anywhere else in the United States, ever.” Rob Restuccia from Community Catalyst promises that national health reform when it is implemented will “have the biggest impact in terms of reducing disparities in this country of any piece of legislation since the Civil Rights Act.”
Sounds pretty good, right? Unfortunately, the article is entirely inaccurate. The truth is that health disparities (which are actually health inequities) did not decline after health reform in Massachusetts, and some actually grew larger. This is true for the gap in insurance coverage, access to care, and the limited evidence we have for health outcomes that should be impacted by access to care.
Advocates of the Massachusetts model like to refer to the results of two surveys – one by the Blue Cross Blue Shield of Massachusetts Foundation, the other by the state of Massachusetts, both conducted by the Urban Institute – to show that key health disparities in the state were reduced or eliminated by health reform. These are both surveys with a small sample size, though. Larger surveys in the state – those run by the Centers for Disease Control and the Census Bureau – show that disparities after health reform did not decline or actually grew larger in some areas, depending on how you measure disparities. Small surveys are poor tools for capturing inequities between large groups and very small groups in the population – racial and ethnic minorities are a relatively small share of the Massachusetts population, and the share of any particular minority group that is uninsured or has very poor access to care is even smaller.
Check out Mass-Care’s Presentation on Health Reform and Health Inequities in Massachusetts, which explains how disparities are measured (actually a complicated subject) and goes over all of the evidence about how the 2006 health reform law impacted disparities. The presentation comes with audio from Mass-Care’s Executive Director, and a downloadable slide show.