Health Reform Works—Just Look at Massachusetts

Harvard School of Public Health researchers estimate that Massachusetts’ health reform law, which provided near-universal coverage beginning in 2006, has prevented approximately 320 deaths per year—one life saved for each 830 people gaining insurance, according to a new study published in Annals of Internal Medicine.

The study reports that in the first four years after Massachusetts instituted comprehensive health reform, mortality in the state decreased by 2.9 percent compared with similar populations in states that didn’t expand health coverage. This news is big enough for Time magazine to publish the following headline: “Obamacare Works, Massachusetts Proves It.”

The study looks at whether or not health insurance expansion can save lives, and it appears that answer is yes.

“Given that Massachusetts’ health reform was in many ways the model for the Affordable Care Act, it is critical to understand the law’s potential implications for population health,” said Benjamin Sommers, assistant professor of health policy and economics at HSPH and lead author of the study. “What we found in Massachusetts after reform was a significant reduction in deaths from the kinds of illnesses where we expect health care to have the biggest impact, including infections, cancer, and cardiovascular disease.”

Sommers and his team, including senior author Katherine Baicker, professor of health economics at HSPH, and economist Sharon Long of the Urban Institute, examined the changes in mortality rates for adults ages 20 to 64 in Massachusetts before the state’s health reform was implemented (2001 to 2005) and after (2007 to 2010). According to the study:

The researchers compared the changes in Massachusetts counties to changes in demographically similar counties in other states that had not enacted health reform during the same period. Data came from the U.S. Centers for Disease Control and Prevention and the Census Bureau.

The researchers found that the decline in mortality was concentrated among causes of death most likely to be preventable or treatable with timely health care, and they found that Massachusetts counties with lower median incomes and a higher percentage of uninsured adults before the law was passed—areas likely to have experienced the greatest increase in access to care under reform—gained the largest health benefits. In addition, the decline in mortality was nearly twice as large for minorities as it was for whites.

“Our findings add to a growing body of evidence showing that health insurance makes a positive difference in people’s lives,” Sommers said in a statement. “How closely the impact of the Affordable Care Act will mirror the Massachusetts’ experience is something we’ll have to continue watching closely, but this is certainly encouraging news for the law’s potential impact on public health.”

The results also showed that after the expansion there were fewer adults in Massachusetts without insurance, fewer cost-related barriers to care, more outpatient visits, and improvements in self-reported health.

UPDATED May 6, 10:35 a.m.: As pointed out by Yoni Appelbaum, a historian and doctoral candidate at Brandeis University, based on the math of 8.2 per 100,000 people, the number of prevented deaths should be approximately 350 by now, up from the previously reported 320.