title: The impacts of state health reform initiatives on adults in New York and Massachusetts.
abstract: OBJECTIVE
  To analyze the effects of health reform efforts in two large states--New York and Massachusetts.
  
  
  METHODS
  National Health Interview Survey (NHIS) data from 1999 to 2008.
  
  
  METHODS
  We take advantage of the "natural experiments" that occurred in New York and Massachusetts to compare health insurance coverage and health care access and use for adults before and after the implementation of the health policy changes. To control for underlying trends not related to the reform initiatives, we subtract changes in the outcomes over the same time period for comparison groups of adults who were not affected by the policy changes using a differences-in-differences framework. The analyses are conducted using multiple comparison groups and different time periods as a check on the robustness of the findings.
  
  
  METHODS
  Nonelderly adults ages 19-64 in the NHIS.
  
  
  RESULTS
  We find evidence of the success of the initiatives in New York and Massachusetts at expanding insurance coverage, with the greatest gains reported by the initiative that was broadest in scope--the Massachusetts push toward universal coverage. There is no evidence of improvements in access to care in New York, reflecting the small gains in coverage under that state's reform effort and the narrow focus of the initiative. In contrast, there were significant gains in access to care in Massachusetts, where the impact on insurance coverage was greater and a more comprehensive set of reforms were implemented to improve access to a full array of health care services. The estimated gains in coverage and access to care reported here for Massachusetts were achieved in the early period under health reform, before the state's reform initiative was fully implemented.
  
  
  CONCLUSIONS
  Comprehensive reform initiatives are more successful at addressing gaps in coverage and access to care than are narrower efforts, highlighting the potential gains under national health reform. Tracking the implications of national health reform will be challenging, as sample sizes and content in existing national surveys are not currently sufficient for in-depth evaluations of the impacts of reform within many states.
authors.affiliation: University of Minnesota, SHADAC, Minneapolis, MN 55414, USA. slong@umn.edu
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Long
authors.forename: Karen
authors.initials: K
authors.lastname: Stockley
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015438:Health Behavior; D006264:Health Benefit Plans, Employee / Q000706:statistics & numerical data; D018166:Health Care Reform / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008404:Massachusetts; D008603:Mental Health; D008875:Middle Aged; D009518:New York; D012959:Socioeconomic Factors; D013221:State Health Plans / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*