Health Care Reform and the Dynamics of Uninsurance: Lessons from Massachusetts

• Activity Number: 113
• Type: Topic Contributed
• Date/Time: Monday, August 1, 2011 : 8:30 AM to 10:20 AM
• Sponsor: Section on Health Policy Statistics
• Author(s): John Graves*+ and Katherine Swartz
• Companies: Harvard University and Harvard School of Public Health
• Keywords: Health Reform ; Health insurance ; Health Policy

Abstract

This paper provides the first dynamic look at changes in uninsurance spell durations in the wake of Massachusetts' 2006 health care reforms. Using longitudinal data from the Survey of Income and Program Participation, we utilize semi-parametric and non-parametric survival methods to estimate changes in uninsurance spell durations. We find evidence that insurance gains in Massachsuetts after 2007 were shared broadly among the short- and long-term uninsured. By contrast, we find no evidence that uninsured adults in two sets of northeastern comparison states had similar success in gaining coverage over the same time period. Non-parametric Kaplan-Meier estimates reveal that the distribution of uninsurance spells remained remarkably stable in comparison states between 2003 and 2009. In Massachusetts, we estimate a 3-month decline in the median uninsurance spell length and a decline of 11 months at the 75th percentile of spells. Our results suggest that under health insurance reforms that include an individual mandate, uninsurance becomes largely an acute event.