Studying Expansion of Coverage and Access to Care in Three States

An evaluation of the impacts of state health reform initiatives in Illinois, Massachusetts, and New York

Dates of Project: 2008–2011

Field of Work: State-level health reform

Problem Synopsis: Massachusetts passed a comprehensive health care reform law in 2006 designed to move the state to near-universal insurance coverage. New York and Illinois approved more incremental health reform laws around the same time.

Synopsis of the Work: From 2008 to 2011, Urban Institute researchers analyzed the impact of state health reform efforts on residents' insurance coverage, access to and use of health care, and out-of-pocket health costs in Massachusetts, New York, and Illinois. The researchers tapped three national surveys for their analyses: the National Health Interview Survey, the Current Population Survey, and the American Community Survey.

Key Findings: Researchers dropped their analysis of Illinois because they found no significant changes in Illinois, and reviewers urged them to remove information on that state.

In an article in Health Services Research (2011) on Massachusetts and New York, the researchers found:

  • In first the two years after health reform in Massachusetts (2007 and 2008), the share of residents with health insurance rose 4 to 6 percentage points. The share of needed care that went unmet because of cost fell by 6.7 to 10.3 percentage points.
  • In first the two years after health reform in New York (2003 and 2004), insurance coverage expanded by 3 to 5 percentage points, but access to care and the use of care did not.

Based on those findings as well as others they published in other articles, the researchers concluded that comprehensive reform better addresses gaps in insurance coverage, access to care, and the use of care than narrower approaches. Given that national health reform incorporates many of the elements of the Massachusetts approach, the potential for significant gains in insurance coverage and access to and use of care is significant.