Health Reform in Massachusetts:
Impacts on Coverage for Children
Genevieve
G
i
Kenney
K
Sharon Long
Adela Luque
Sunday, June 27, 2010
AcademyHealth Annual Research Meeting
Boston MA
Boston,
Funded by the Robert Wood Johnson Foundation and The SHARE Project
URBAN INSTITUTE
Road Map
• Research Questions
• Data and Methods
• Key Findings
• Implications
I li i
• Conclusions
URBAN INSTITUTE
Key Research Questions
• What impact did Massachusetts Health Reform
h
have
on uninsurance
i
rates off children?
hild ?
• What were impacts in on type of coverage for
children?
• H
How did health
h l h reform
f
affect
ff coverage off lowerl
and higher-income children and those newly
eligible
li ibl for
f MassHealth?
M H l h?
URBAN INSTITUTE
Massachusetts Health Reform
• Enacted comprehensive health reform in April 2006: new
subsidized health insurance program for low
low-income
income
parents; insurance market reforms and an insurance
exchange; new requirements on employers; an individual
mandate
d t on coverage for
f adults
d lt
• Affected coverage of children both directly through their
expanded eligibility for subsidized coverage and indirectly
through their parent’s insurance coverage
– MassHealth expanded coverage to children with family incomes
b t
between
200 and
d 300 percentt FPL
– Strong Outreach and Enrollment Efforts
URBAN INSTITUTE
Data
• Annual Social and Economic Supplement to the Current Population
Survey (CPS) from 2005-2009
– Data cover 2004-2008
• Nationally representative survey that provides data on health insurance
coverage, labor force characteristics, household composition,
demographic and geographic characteristics
• The analysis sample includes children ages 0-18 in MA and
comparison states
• Coverage Categories: Uninsurance; Public (MassHealth) and
Nongroup/other together and separately; Employer-sponsored
Coverage
URBAN INSTITUTE
Methods
• Models include child, family, and parent control variables
• Linear probability models estimated for low (less than 300 percent
FPL) and higher-income children (greater than 300 percent FPL)
– Estimates for subcategories <200 and 200-300 percent FPL
• Difference-in-differences estimates for pre-post models with a
comparison group
– Comparison group: higher income children in NE states or children in
comparable
bl states not making
ki coverage changes
h
for
f parents (i.e.,
(i MN andd
WA)
– Pre-period defined as 2004-06; Post-period defined as 07/08
• Sensitivity analyses conducted to assess robustness of estimates
URBAN INSTITUTE
Changes in
Ch
i Insurance
I
Coverage
C
for
f Children
Child
in
i
MA, Overall and by Family Income
Pre-reform
period
Post-reform
period
Difference
Uninsured
4 6%
4.6%
1 8%
1.8%
-2.8**
2 8**
Public and
nongroup
21.7%
26.7%
5.0*
Employersponsored
73.7%
71.5%
-2.2
Uninsurance by Family Income
Lowerincome
8.2%
3.0%
-5.2**
Higherincome
1.8%
0.9%
-0.9
* p<0.10,
p<0 10 ** p<0.05
p<0 05
URBAN INSTITUTE
Source: ASEC to the CPS, 2005
2005-2009
2009
Difference in Differences Estimates
Difference-in-Differences
Impacts of Health Reform on Children’s Insurance Coverage
in MA, Overall and by Family Income
Uninsured
Public
Nongroup
Employersponsored
* p<0.10, ** p<0.05
URBAN INSTITUTE
All
Lower-income
Higher-income
-2.7**
-5.2**
-1.0
3.2
7.7*
-0.8
-2 8*
-2.8
-3 4*
-3.4
-2 3
-2.3
2.3
0.8
4.1*
Source: ASEC to the CPS, 2005-2009
Difference in Differences Estimates
Difference-in-Differences
Effects of Health Reform on Lower-Income Children’s
Insurance Coverage in MA, by Eligibility for MassHealth
Eligible for
MassHealth
before reform
Newly Eligible
for MassHealth
under reform
Uninsured
-5.1*
-6.4**
Public
10.4*
3.9
Nongroup
-3.6*
-2.2
p y
Employersponsored
-1.7
17
46
4.6
* p<0.10, ** p<0.05
URBAN INSTITUTE
Source: ASEC to the CPS, 2005-2009
Sensitivity Analysis
• Obtained similar findings using alternative
comparison groups (e.g.,
(e g children in MN and WA)
• Also obtained similar findings excluding 2006, a
transition year
year, excluding non-citizen
non citizen children,
children
and using a propensity score approach to
reweighting the comparison group
• Robust findings,
findings but still reliant on nonnon
experimental design….
URBAN INSTITUTE
Conclusions
• Health Reform in MA cut uninsurance rate in half
f kid
for
kids:
– Just 1.8 percent of all kids and 3.0 percent of lowi
income
children
hild
are uninsured
i
d
• No apparent substitution of Public Coverage for
ESI
• Access to care likely increased for children due to
reductions in uninsurance and non-group coverage
URBAN INSTITUTE
Implications for
Federal Health Reform
• National health reform law contains many of the
same elements as Massachusetts health reform
• Majority of uninsured children nationwide are
eligible for Medicaid/CHIP but not enrolled
– Experience
p
in MA suggests
gg
that increasing
g take-up
p of
public coverage is possible even when uninsured rates
among eligible children are already high
– Policy changes that address enrollment/retention
barriers and coverage gaps for parents may be critical
URBAN INSTITUTE
Genevieve Kenney
Senior Fellow
Health Policy Center
Urban Institute
(202) 261-5568
JKenney@urban.org
www.urban.org
URBAN INSTITUTE