Working Paper: NBER ID: w17893
Authors: Charles J. Courtemanche; Daniela Zapata
Abstract: In 2006, Massachusetts passed health care reform legislation designed to achieve nearly universal coverage through a combination of insurance market reforms, mandates, and subsidies that later served as the model for national reform. Using data from the Behavioral Risk Factor Surveillance System, we provide evidence that health care reform in Massachusetts led to better overall self-assessed health. Various robustness checks and placebo tests support a causal interpretation of the results. We also document improvements in several determinants of overall health: physical health, mental health, functional limitations, joint disorders, and body mass index. Next, we show that the effects on overall health were strongest among those with low incomes, non-whites, near-elderly adults, and women. Finally, we use the reform to instrument for health insurance and estimate a sizeable impact of coverage on health.
Keywords: health care reform; universal coverage; health outcomes; Massachusetts
JEL Codes: I12; I13; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| health insurance coverage (I13) | health outcomes (I14) |
| Massachusetts health care reform (I13) | self-assessed health improvement (I14) |
| self-assessed health improvement (I14) | probability of rating health as excellent or very good (I10) |
| Massachusetts health care reform (I13) | health insurance coverage (I13) |
| Massachusetts health care reform (I13) | improvements in physical health (I19) |
| Massachusetts health care reform (I13) | improvements in mental health (I19) |
| Massachusetts health care reform (I13) | improvements in functional limitations (I14) |
| Massachusetts health care reform (I13) | improvements in joint disorders (I12) |
| Massachusetts health care reform (I13) | improvements in body mass index (BMI) (I14) |