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Deaths fell after Massachusetts healthcare overhaul: study

By Andrew M. Seaman

NEW YORK (Reuters Health) - When Massachusetts blazed the trail of healthcare reform in 2006 by expanding coverage for the poor and requiring all residents to have health insurance, it may have done more than serve as a model for nationwide reform: it also seemed to save lives, according to a study released on Monday.

The findings, reported in the Annals of Internal Medicine, are the first to provide a detailed analysis of the effects of systematically expanding healthcare coverage. Increasing access to Medicaid, the government-run insurance program for the poor, and mandating that everyone have health insurance were the two centerpieces of Massachusetts' healthcare reform.

They are also central to President Barack Obama's 2010 Patient Protection and Affordable Care Act, and remain its most controversial elements. Half the states have refused to expand Medicaid under the law known as Obamacare, for instance, and Republican opponents of the law regularly rail against the individual mandate requiring that individuals buy insurance or pay a penalty.

The study's authors cautioned that their analysis does not prove that Massachusetts's healthcare overhaul caused the decline in deaths; all it can show is that the two are correlated.

Previous studies that examined whether expanding access to health insurance resulted in fewer deaths got mixed results.

The new study compared deaths among people aged 20 to 64 years old in Massachusetts counties before and after "Romneycare" (as the health insurance overhaul is known, since Republican politician Mitt Romney was governor when it became law) to counties in other states.

The years compared were 2001-2005 and 2007-2010.

For every 830 people who became insured as a result of Massachusetts' mandatory coverage and Medicaid expansion, they calculated, one fewer person died each year.

That represents "a 3 percent decline in the death rate in the first few years after implementation," lead author Dr Benjamin Sommers of Harvard School of Public Health in Boston told Reuters Health.

In particular, there were fewer deaths from cancer, heart disease and infections, all of which benefit from preventive and regular healthcare, said Sommers. He has served as a senior advisor to the U.S. Department of Health and Human Services, the lead Obamacare agency, and continued to serve part-time in an advisory role in 2013-2014.

"The decline in the death rate of Massachusetts was focused in those areas where you would think reform would make the biggest difference," he said.

The drop in deaths was also larger in poorer communities that had a high number of uninsured residents before 2006.

Austin Frakt, a health economist with the Department of Veterans Affairs in Jamaica Plain, Massachusetts who was not involved in the new study but wrote an editorial accompanying it, called it "one of the most relevant studies pertaining to the Affordable Care Act."

Most such studies do show that health insurance has a positive effect on death rates and health, Frakt told Reuters Health: "Those findings are out there and the findings are really robust."

Sommers cautioned that the findings may not apply nationwide. For one thing, Massachusetts has an abundance of doctors and hospitals, many of whom accept the newly insured. Under Obamacare, people whose new insurance is not accepted by many healthcare providers might have coverage on paper but not easy access to healthcare.

The Congressional Budget Office estimates that 37 million people will gain health insurance by 2018 through the Affordable Care Act.

SOURCE: http://bit.ly/SQRXAa Annals of Internal Medicine, online May 5, 2014.

(Reporting by Andrew Seaman; Editing by Genevra Pittman, Sharon Begley and Chris Reese)

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