New Study Provides Peek Into Future of “Obamacare”

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A groundbreaking study of how the Massachusetts Healthcare Reform act has affected the state’s working poor may shed light on how the federal Affordable Care Act (dubbed “Obamacare”) may fare. Conducted by New England Research Institutes (NERI), the study was published in the January 17 online edition of the Annals of Epidemiology.

The new study found that the 2006 Massachusetts healthcare legislation has substantially increased healthcare coverage for state residents, and particularly for the “working poor.” In a study of roughly 3,050 community-dwelling adults in the Boston area, nearly 97% of participants interviewed after the law’s rollout reported having some kind of health insurance, compared to 87% interviewed pre-reform. Among the working poor (defined as working for pay, whether full or part-time, but earning less than 200% of the federal poverty threshold), the number of people reporting that they had no health insurance at the beginning of the study was cut in half (from about 27% pre-reform to about 13%).

“If what has happened with Massachusetts healthcare reform indicates what will occur nationwide with the Affordable Care Act, it will be a historic legislative achievement—expanding quality insurance to millions of Americans with unmet medical needs,” says John McKinlay, NERI senior vice president and an author on the new study. “But because of persistent healthcare inequalities, the ACA is obviously a work in progress.”

Despite the expanded healthcare coverage, however, gaps remain, and there are disparities in the type of healthcare insurance that is used. For example, more than half of the working poor in the study are employed in service, construction, or repair jobs, compared to only 17% of those classified as “not-poor.” Jobs in these industries are often part-time or seasonal in nature, and therefore the Massachusetts employer-mandated health insurance coverage may not apply. In addition, gains in insurance coverage among the working poor were overwhelmingly via public insurance programs, specifically Medicaid/MassHealth. Less than half of working poor reported private insurance coverage, compared to greater than 80% private coverage among the “not-poor.” Such trends highlight continuing needs for improvements in the Massachusetts health reform laws, and may signal the need for future adjustments to the nationwide-legislation.