title: Change in health insurance coverage in Massachusetts and other New England States by perceived health status: potential impact of health reform.
abstract: OBJECTIVE
  We examined the impact of Massachusetts health reform and its public health component (enacted in 2006) on change in health insurance coverage by perceived health.
  
  
  METHODS
  We used 2003-2009 Behavioral Risk Factor Surveillance System data. We used a difference-in-differences framework to examine the experience in Massachusetts to predict the outcomes of national health care reform.
  
  
  RESULTS
  The proportion of adults aged 18 to 64 years with health insurance coverage increased more in Massachusetts than in other New England states (4.5%; 95% confidence interval [CI] = 3.5%, 5.6%). For those with higher perceived health care need (more recent mentally and physically unhealthy days and activity limitation days [ALDs]), the postreform proportion significantly exceeded prereform (P < .001). Groups with higher perceived health care need represented a disproportionate increase in health insurance coverage in Massachusetts compared with other New England states--from 4.3% (95% CI = 3.3%, 5.4%) for fewer than 14 ALDs to 9.0% (95% CI = 4.5%, 13.5%) for 14 or more ALDs.
  
  
  CONCLUSIONS
  On the basis of the Massachusetts experience, full implementation of the Affordable Care Act may increase health insurance coverage especially among populations with higher perceived health care need.
authors.affiliation: Northrop Grumman, and the Division of Behavior Surveillance, Public Health Surveillance and Informatics Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Satvinder S
authors.initials: SS
authors.lastname: Dhingra
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Zack
authors.forename: Tara W
authors.initials: TW
authors.lastname: Strine
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Druss
authors.forename: Eduardo
authors.initials: E
authors.lastname: Simoes
mesh_terms: D000293:Adolescent; D000328:Adult; D040343:Behavioral Risk Factor Surveillance System; D005260:Female; D006304:Health Status; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data* / Q000639:trends; D007348:Insurance, Health / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D008404:Massachusetts; D008603:Mental Health; D008875:Middle Aged; D009511:New England; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult