Health reform in Massachusetts cut the uninsurance rate among children in half

Health Affairs

Volumn 29, Issue 6, 2010, Pages 1242-1247

  Kenney, Genevieve M ^a   Long, Sharon K ^a   Luque, Adela ^a  

^a URBAN INSTITUTE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CHILD; HEALTH CARE POLICY; HUMAN; LOWEST INCOME GROUP; MEDICAID; NATIONAL HEALTH INSURANCE; UNITED STATES; HEALTH INSURANCE; LEGAL ASPECT; ORGANIZATION AND MANAGEMENT; PATIENT; POVERTY; STATISTICS;

CHILD; ELIGIBILITY DETERMINATION; HEALTH CARE REFORM; HUMANS; INSURANCE, HEALTH; MASSACHUSETTS; MEDICAID; MEDICALLY UNINSURED; POVERTY; UNITED STATES;

EID: 77956908715     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2010.0314     Document Type: Article

References (25)

1. Turner J, Boudreaux M, Lynch V. A preliminary evaluation of health insurance coverage in the 2008 American Community Survey [Internet]. Washington (DC): U.S. Census Bureau; 2009 Sep 22 [cited 2010 Apr 12]. Available from: http://www.census.gov/hhes/www/hlthins/2008ACS-healthins.pdf. This paper used data for children ages 0-17, whereas the Census Bureau's analysis used data for children ages 0-18.
2. Long SK. On the road to universal coverage: impacts of reform in Massachusetts at one year. Health Aff (Millwood). 2008;27(4):w270-84.
3. Long SK, Stockley K, Yemane A. Another look at the impacts of health reform in Massachusetts: evidence using new data and a stronger model. Am Econ Rev: Papers & Proceedings. 2009;99(2):508-11.
4. We are aware of only one study that has looked at the impacts of health reform on children. Yelowitz A, Cannon MF. The Massachusetts health plan: much pain, little gain [Internet]. Washington (DC): Cato Institute; 2010 Jan 19 [cited 2010 Apr 12]. Available from: http://www.cato.org/pub-display.php?pub-id= 11115
5. The Appendix is available by clicking on the Appendix link in the box to the right of the article online.
6. For a more detailed summary of the changes introduced under health reform in Massachusetts, see McDonough JE, Rosman B, Phelps F, Shannon M. The third wave of Massachusetts health care access reform. Health Aff (Millwood). 2006;25(6):w420-31.
7. Long SK. Who gained the most under health reform in Massachusetts? [Internet]. Washington (DC): Urban Institute; 2008 Oct 15 [cited 2010 Apr 12]. Available from: http://www.urban.org/url.cfm?ID=411770
8. Dubay L, Kenney G. Expanding public health insurance to parents: effects on children's coverage under Medicaid. Health Serv Res. 2003;38(5):1283-302.
9. Hudson JL, Selden TM, Banthin JS. The impact of SCHIP on insurance coverage of children. Inquiry. 2005;42(3):232-54.
10. Kenney G, Cook A, Dubay L. Progress enrolling children in Medicaid/CHIP: who is left and what are the prospects for covering more children? [Internet]. Washington (DC): Urban Institute; 2009 Dec 14 [cited 2010 Apr 12]. Available from: http://www.urban.org/health-policy/url.cfm?ID=411981
11. Wooldridge J. What's new in econometrics? Lecture 10: difference-in-differences estimation [Internet]. Cambridge (MA): National Bureau of Economic Research Summer Institute; 2007 [cited 2010 Apr 12]. Available from: http://www.nber.org/WNE/Slides7-31-07/slides-10-diffindiffs.pdf
12. Davern M, Rodin H, Call KT, Blewett LA. Are the Current Population Survey uninsurance estimates too high? An examination of imputation. Health Serv Res. 2007;42(5):2038-55.
13. Our regression-based impact estimates were virtually the same whether we used this new weight or the original Current Population Survey weight. We note, however, that annual point estimates of the uninsured may vary depending on the weight used.
14. It is not clear where parents would have classified children enrolled in the state-funded Children's Medical Security Plan prior to reform. To the extent that parents reported such coverage as Medicaid, our analysis will not reflect shifts from that plan into MassHealth.
15. Call KT, Davidson G, Sommers AS, Feldman R, Farseth P, Rockwood T. Uncovering the missing Medicaid cases and assessing their bias for estimates of the uninsured. Inquiry. 2001-2;38(4):396-408.
16. In the Current Population Survey, individuals are classified as uninsured only if they report having no coverage at any point over the prior calendar year. However, the uninsurance rate in the Current Population Survey aligns more closely to point-in-time estimates than fullyear estimates. See DeNavas-Walt C, Proctor BD, Smith J. Income, poverty, and health insurance coverage in the United States: 2006 [Internet]. Current Population Reports no. P60-233. Washington (DC): U.S. Census Bureau; 2007 [cited 2010 Apr 12]. Available from: http://www.census.gov/prod/2007pubs/p60-233.pdf
17. Heberlein M, Guyer J, Horner D. Weathering the storm: states move forward on child and family health coverage despite tough economic climate [Internet]. Washington (DC): Georgetown University Center for Children and Families; 2009 [cited 2010 Apr 12]. Available from: http://ccf.georgetown.edu/index/weathering- the-storm
18. Kaiser Commission on Medicaid and the Uninsured. A 50 state update on eligibility rules, enrollment and renewal procedures, and cost-sharing practices in Medicaid and SCHIP. Washington (DC): Kaiser Family Foundation; 2004 Jan-2009 Jan. This annual publication is repeated once a year, representing data from 2003-8.
19. Long SK, Stockley K. Health reform in Massachusetts: an update on insurance coverage and support for reform as of fall 2008 [Internet]. Washington (DC): Urban Institute; 2009 Sep 1 [cited 2010 Apr 12]. Available from: http://www.urban.org/url.cfm?ID=411958
20. Rubin DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med. 1997;127(8 pt 2):757-63.
21. For this study, we defined family as the child's health insurance unit (HIU), which corresponds to the child, his or her parents or guardians, and his or her siblings under age nineteen.
22. Because these estimates were based on our analytical sample and adjusted survey weights, they are not strictly comparable to those in published tables using Current Population Survey data (such as those in the Kaiser Family Foundation's StateHealthFacts.org site), but the pattern of change is consistent with what has been reported elsewhere.
23. An example of the regression output from the difference-in-differences analysis is provided in Appendix A.4; see Note 5.
24. Our findings are not directly comparable to those reported by the only other study that has looked at the impacts of health reform on children in Massachusetts (Yelowitz and Cannon, Note 4). That study provided little discussion of data and methods, but it appears that there are a number of methodological issues that raise concerns about its findings. For a discussion of those issues, see Long SK. A comment on "The Massachusetts health plan: much pain, little gain" [Internet]. Washington (DC): Urban Institute; 2010 Feb 2 [cited 2010 Apr 12]. Available from: http://www.urban.org/url.cfm?ID= 901318
25. Urban Institute tabulations of data from the 2009 American Community Survey.