title: Insurance expansion in Massachusetts did not reduce access among previously insured Medicare patients.
abstract: Critics of Massachusetts's health reform, a model for the Affordable Care Act, have argued that insurance expansion probably had a negative spillover effect leading to worse outcomes among already insured patients, such as vulnerable Medicare patients. Using Medicare data from 2004 to 2009, we examined trends in preventable hospitalizations for conditions such as uncontrolled hypertension and diabetes--markers of access to effective primary care--in Massachusetts compared to control states. We found that after Massachusetts's health reform, preventable hospitalization rates for Medicare patients actually decreased more in Massachusetts than in control states (a reduction of 101 admissions per 100,000 patients per quarter compared to a reduction of 83 admissions). Therefore, we found no evidence that Massachusetts's insurance expansion had a deleterious spillover effect on preventable hospitalizations among the previously insured. Our findings should offer some reassurance that it is possible to expand access to uninsured Americans without negatively affecting important clinical outcomes for those who are already insured.
authors: Harvard Medical School, Boston, Massachusetts, USA. kjoynt@partners.org
authors: Karen E
authors: KE
authors: Joynt
authors: David
authors: D
authors: Chan
authors: E John
authors: EJ
authors: Orav
authors: Ashish K
authors: AK
authors: Jha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology; D005260:Female; D018166:Health Care Reform / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000517:prevention & control / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008404:Massachusetts; D017057:Medically Uninsured; D058991:Patient Protection and Affordable Care Act; D013221:State Health Plans / Q000706:statistics & numerical data*; D017664:Uncompensated Care / Q000706:statistics & numerical data*; D014481:United States