Massachusetts health care reform: The effect of Chapter 58 on uninsurance and on the determinants of uninsurance




Armstrong, David M.

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In this research I describe the impact of the health care reform legislation enacted in Massachusetts in 2006 (Chapter 58) on uninsurance and the determinates of uninsurance. I use logistic regression to determine whether Chapter 58 significantly reduced the odds of being uninsured. I also examine the hypothesis that uninsurance rates may have dropped because Chapter 58 caused the behavior of survey respondents to change. Chapter 58 made being uninsured illegal which may have led respondents to lie about the coverage status, refuse to participate in a survey or refuse to answer questions about insurance coverage. The use of any of these strategies could lead to uninsurance estimates that are biased downward. Finally, my research evaluates how Chapter 58 altered the relationships between uninsurance and its various determinants.

The analysis shows that Chapter 58 did significantly reduce the probability of being uninsured in Massachusetts via the health insurance exchange. The effect of the individual mandate was insignificant though limitations of the analysis may be partially responsible for this. The analysis also indicated that Chapter 58 significantly altered the relationships of occupation, low income, health status and citizenship with uninsurance. The impact of occupation, low income and health became insignificant in the post implementation model while the importance of being a non-citizen significantly increased.



health care, health insurance, health reform, massachusetts