HKS Case Study Examines the Impacts of Health Care Reform in Massachusetts

June 12, 2014
by Doug Gavel

The ways in which health care reform in Massachusetts have impacted public health outcomes is the focus of a Harvard Kennedy School (HKS) Case Study"Health Care Reform in Massachusetts: Impacts on Public Health” is designed to challenge readers to consider the promise and the challenges of designing and putting into practice an extensive set of public policy innovations.

"Expanding health care coverage was a positive step for public health, since it gave more Massachusetts residents continuous care and regular relationships with doctors. But progress assessments in the first few years after passage pointed out gaps," the author states in the introduction. "And when Massachusetts and the nation entered a severe economic recession in late 2007, the state had to make painful funding cuts to health programs, including many prevention and wellness initiatives."

The Case cites statistics revealing that more than 400,000 Massachusetts residents who lacked health insurance before the reforms took effect were covered less than four years after enactment of the legislation, more than 123,000 of them through the Commonwealth Care program in which no premiums are paid. The study also highlights increases in many preventative care program  post-implementation, including dentist visits, prostate and colon cancer screenings, smoking cessation, and flu vaccinations. 

But the Case also highlights the fact that more than 170,000 Massachusetts residents remained uninsured as of 2009, and even among those with insurance, approximately 25 percent of adults told pollsters that high costs remained an obstacle to obtaining health care.

The Case also addresses the impact of budget cuts on health reform efforts, specifically those imposed after the financial collapse in 2008, resulting in reductions in funding for substance abuse services, youth violence prevention, and environmental health programs, among others.

"The recession made health care reform more expensive as residents who lost their jobs turned to Commonwealth Care for coverage," the author writes. "Polls showed that the public still supported reform but was increasingly worried about how much it was costing the state."

The Case Study was authored by Jennifer Weeks under the direction of Arnold Howitt, executive director of the Ash Center for Democratic Governance and Innovation and the outgoing Faculty Chair of HKS Executive Education’s State Health Leadership Initiative, which is funded by the Robert Wood Johnson Foundation and is sponsored in conjunction with the Association of State Health Officials (ASTHO). Cases that are developed through this Initiative are subsequently used as curriculum in the Executive Education program, Leadership for New State Health Officials.

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Arn Howitt

Arnold Howitt, adjunct lecturer, executive director, Ash Center for Democratic Governance and Innovation

"The recession made health care reform more expensive as residents who lost their jobs turned to Commonwealth Care for coverage," the author writes. "Polls showed that the public still supported reform but was increasingly worried about how much it was costing the state."