Evaluating Health Reform at the State Level

Assessing the impact of premium requirements and participant cost-sharing on access to care in Maine and Massachusetts

Dates of Project: 2008–2011

Field of Work: State-level health reform.

Problem Synopsis: Maine and Massachusetts took significant steps in 2005 and 2006 to expand health insurance to individuals who would otherwise be uninsured by creating new plans. How those plans affected coverage use of health services by low-income residents was not known.

Synopsis of the Work: The researchers analyzed the impact of the size of premiums on enrollment in the plans, and the impact of out-of-pocket payments on the use of health services by low-income individuals and those with chronic illnesses. The researchers had planned to also examine Vermont's plan but dropped the state from their analysis because they could not obtain all the needed data.

For their analysis, the researchers used data from administrative records and insurance claims for two groups of adults aged 18 to 64 in each state: new enrollees in each state's new insurance plan, and a control group of insured state employees in each state.

Key Findings:

  • The design of a publicly subsidized health insurance plan has a major impact on who enrolls. The Massachusetts plan requires individuals who qualify to enroll, and the lowest-income participants do not pay premiums. In Maine, in contrast, coverage is voluntary, and participants of all income levels pay premiums on a sliding scale. Enrollees in the Massachusetts plan were younger and healthier, on average, than enrollees in the Maine plan.
  • Low-income residents enrolled in the new state plans used fewer health care services than comparable state employees. However, the researchers may revise this finding as they continue to analyze the data.