title: Has Massachusetts health care reform worked for the working poor? Results from an analysis of opportunity.
abstract: OBJECTIVE
  Health care reform was introduced in Massachusetts (MA) in 2006 and serves as a model for what was subsequently introduced nationally as the Patient Protection and Affordable Care Act. The Boston Area Community Health survey collected data before (2002-2005) and after (2006-2010) introduction of the MA health insurance mandate, providing a unique opportunity to assess its effects in a large, epidemiologic cohort.
  
  
  METHODS
  We report on the apparent effects of the mandate on the same participants over time, focusing specifically on the vulnerable working poor (WP). We evaluated differences in subpopulations of interest at pre- and post-reform periods to explore whether MA health care reform resulted in an overall gain in insurance coverage.
  
  
  RESULTS
  MA health care reform was associated with net gains in health insurance coverage overall and among the subgroups studied. Our findings suggest that despite being targeted by health care reform legislation, the WP in MA continue to report lower rates of insurance coverage compared with both the nonworking poor and the not poor.
  
  
  CONCLUSIONS
  MA health care reform legislation, including the expansion of Medicaid, resulted in substantial overall gains in coverage. Disparities in insurance coverage persist among some subgroups following health care reform implementation in MA. These results have important implications for health services researchers and policy makers, particularly in light of the ongoing implementation of the Patient Protection and Affordable Care Act.
authors: New England Research Institutes, Watertown, MA. Electronic address: ltinsley@neriscience.com.
authors: Liane J
authors: LJ
authors: Tinsley
authors: New England Research Institutes, Watertown, MA.
authors: Susan A
authors: SA
authors: Hall
authors: New England Research Institutes, Watertown, MA.
authors: John B
authors: JB
authors: McKinlay
mesh_terms: D000328:Adult; D001900:Boston; D004651:Employment; D005260:Female; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000331:legislation & jurisprudence*; D008297:Male; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D011203:Poverty; D012959:Socioeconomic Factors
keywords: Health care; Health care disparities; Health care reform; Health insurance; Massachusetts; Patient Protection and Affordable Care Act