title: Support for National Health Insurance Seven Years Into Massachusetts Healthcare Reform: Views of Populations Targeted by the Reform.
abstract: Before the Affordable Care Act (ACA), many surveys showed majority support for national health insurance (NHI), also known as single payer; however, little is currently known about views of the ACA's targeted population. Massachusetts residents have had seven years of experience with state health care reform that became the model for the ACA. We surveyed 1,151 adults visiting safety-net emergency departments in Massachusetts in late 2013 on their preference for NHI or the Massachusetts reform and on their experiences with insurance. Most of the patients surveyed were low-income and non-white. The majority of patients (72.0%) preferred NHI to the Massachusetts reform. Support for NHI among those with public insurance, commercial insurance, and no insurance was 68.9%, 70.3%, and 86.3%, respectively (p < .001). Support for NHI was higher among patients dissatisfied with their insurance plan (83.3% vs. 68.9%, p = .014), who delayed medical care (81.2% vs. 69.6%, p < .001) or avoided purchasing medications due to cost (87.3% vs. 71.4%; p = .01). Majority support for NHI was observed in every demographic subgroup. Given the strong support for NHI among disadvantaged Massachusetts patients seven years after state health reform, a reappraisal of the ACA's ability to meet the needs of underserved patients is warranted.
authors.affiliation: Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Massachusetts, USA sonalisaluja@mail.harvard.edu.
authors.forename: Sonali
authors.initials: S
authors.lastname: Saluja
authors.affiliation: Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Massachusetts, USA Institute for Community Health, Cambridge, Massachusetts, USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Zallman
authors.affiliation: Department of Neurology, Cambridge Health Alliance, Harvard Medical School, Massachusetts, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Nardin
authors.affiliation: Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Massachusetts, USA.
authors.forename: David
authors.initials: D
authors.lastname: Bor
authors.affiliation: City University of New York, School of Public Health at Hunter College, New York, USA Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Massachusetts, USA.
authors.forename: Steffie
authors.initials: S
authors.lastname: Woolhandler
authors.affiliation: City University of New York, School of Public Health at Hunter College, New York, USA Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Massachusetts, USA.
authors.forename: David U
authors.initials: DU
authors.lastname: Himmelstein
authors.affiliation: Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Massachusetts, USA.
authors.forename: Danny
authors.initials: D
authors.lastname: McCormick
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration*; D006304:Health Status; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000458:organization & administration*; D007348:Insurance, Health / Q000191:economics / Q000458:organization & administration*; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009310:National Health Insurance, United States; D057240:Patient Preference; D058991:Patient Protection and Affordable Care Act / Q000458:organization & administration; D017060:Patient Satisfaction; D064876:Safety-net Providers / Q000191:economics / Q000458:organization & administration*; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult
keywords: access to care; health care reform; health insurance; underserved populations; vulnerable populations