Mass. Health Coverage Law Linked To Lower Mortality Rate

In this April 12, 2006, file photo, then-Gov. Mitt Romney is seen with lawmakers and staffers after signing the state's universal health coverage law at Faneuil Hall in Boston. A new report finds that the state's mortality rate has decreased almost 3 percent since the law was implemented. (AP File)

In this April 12, 2006, file photo, then-Gov. Mitt Romney is seen with lawmakers and staffers after signing the state’s universal health coverage law at Faneuil Hall in Boston. A new report finds that the state’s mortality rate has decreased almost 3 percent since the law was implemented. (AP File)

Three-hundred and twenty. It’s estimated that is the number of deaths prevented each year as a result of the 2006 Massachusetts health care law, a Harvard School of Public Health report says.

The decrease in the state’s mortality rate is the most concrete proof that Massachusetts’ health insurance mandate is improving people’s health.

When people have health insurance, they are more likely to get preventive care, go to the doctor when they become ill, and live longer. At least that was the expectation when Massachusetts passed the health coverage law back in 2006.

Now, there’s evidence of that link, in the study out Monday in the Annals of Internal Medicine.

It found that in the first four years of mandatory health insurance, the state’s death rate dropped 2.9 percent  TWEET , as compared to similar counties outside Massachusetts that did not expand health coverage.

“We already had a large body of research that showed the uninsured rate had dropped, people were able to access services, and that they felt better. This adds another important piece to that, which is that people are living longer,” said Dr. Ben Sommers, the Harvard report’s lead author.

Sommers said the most significant declines were in “things like cancer, infections, heart disease and other conditions that medical care might either prevent or treat or at least reduce the risk of death from. Meanwhile in some other causes of death that are less amenable to health care, such as car crashes, homicide, suicide, we didn’t find any statistically significant changes.”

That 2.9 percent decrease is for everyone in the state. White residents are living longer, but the biggest improvement is for blacks, Asians and Latinos, whose death rates dropped 4.6 percent.

So, as a result, is Massachusetts on a path to eliminate health disparities?

Boston Public Health Commission Director Barbara Ferrer says she’s hopeful. She says this new study builds on prior research that showed that health coverage is reducing income and racial disparities in Massachusetts.

“I would be surprised if we didn’t see a closing of the gap that could be attributed to improved coverage rates,” she said. “We have to be a little bit wary that you can’t just insure people without making sure that they have access to high-quality services, but certainly in Massachusetts we’re able to do both.”

The report’s authors say the findings are encouraging for states in the early stages of implementing the Affordable Care Act.

But Alan Weil, director of the National Academy for State Health Policy, says many opponents already knew that there would be health benefits to insuring more people through the federal law.

“But [opponents] don’t feel that the nation can afford it or that it’s an appropriate role for government,” he said. “And if that’s the basis of your opposition, I think additional evidence that it might improve people’s health is unlikely to change your overall view of the law.”

Still, Weil says, this study will draw attention because it is some of the best evidence so far that making sure people have insurance leads to better health and longer lives.

Douglas Holtz-Eakin — of the American Action Forum, a conservative advocacy group — is more critical of the report. He says the study does not prove that coverage lowers death rates.

He said the authors “don’t directly observe how people interact with the medical community,” and that they reach their conclusions “by inference and process of elimination. There’s a limit to that.”

Holtz-Eakin added: “If there’s one thing we’ve learned about health care reform, Massachusetts doesn’t look like the rest of the country. People are always skeptical expanding to the whole U.S. the findings from a Massachusetts experiment.”

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  • crescentfang

    As Mark Twain put it, “There are three kinds of lies: Lies … Damn Lies … and Statistics.” Anyone who thinks these numbers prove anything is deluding themselves. The only thing the Mass Healthcare law has done for certain is raise the cost of healthcare and the profits of the industry.

  • GentlemanCynic

    The decrease isn’t for the affordable care act. its for the mass law that passed in 2006. http://en.wikipedia.org/wiki/Massachusetts_health_care_reform.

    Mass has had mandatory health insurance since then. and in the first 4 years (2006-2010) they saw a 2.6% drop. Its not hard to understand

    • crescentfang

      That is why statistics are the lies most favored in politics. They are easy to understand and believe if you don’t understand statistics. The first rule in statistics is “correlation is not causality”. There is no way to establish cause and effect using statistics.

  • http://byrondennis.typepad.com/theabcsofmedicare/ Dennis Byron

    Really! Why do you repeat this same propaganda year after year?
    1. It would be much too soon for any effects to be seen (although surely we would hope there would be some).
    2. The state report on amendable death clearly shows that the death rate decreased twice as fast in the first half of the last decade (before the law passed) than in the second half of the decade (call Bruce Cohen at the Department of Public Health, probably the same guy you called when I first commented on this statistical trick back in 2011)

    • Martha Bebinger

      Dennis – here’s the abstract. I apologize that this link was not included in the post: http://annals.org/article.aspx?articleid=1867050. The authors compared death rates before and after the law. In the period after the law took effect (2007-2011), they compared CDC and Census county data in MA and in counties with similar demographics outside MA.

      As usual, I look forward to your insights.

      • http://byrondennis.typepad.com/theabcsofmedicare/ Dennis Byron

        Yes, Martha, I had already read the abstract and ran into the the typical academic you-are-a-stupid-and-ignorant-peasant pay wall.

        The issue is that I can’t tell what they are even measuring without the actual report. The abstract doesn’t tell you what the Department of Public Health has told us for years: the amendable death rate in Massachusetts went down twice as fast before the RomneyCare law was passed than it went down after. Insurance likely has no effect one way or the other (unless the 2000-2005 drop is due to the 1997 Massachusetts so-called “reform,” which no one is claiming).

        But even if insurance has an effect, it is too early to tell. A year or two of preventive care after a lifetime of not going to a doctor could not have dropped the amenable death rate in such a short period. And a doctor’s visit in any other scenario — a year without insurance, e.g. — would be even less relevant. Remember, this new Medicaid coverage only affected less than 5% of the Massachusetts population – NET – but the academics are measuring the whole population. (It’s like the claim that coverage for these same 300,000 people – NET – out of 6.500,000 somehow reduced bankruptcy among the 6,500,000. Pure craziness.)

        But I love this wording in the abstract:

        “Nonrandomized design subject to unmeasured confounders. Massachusetts results may not generalize to other states.”

        And then they apparently base their whole argument by comparing to other states.

        • Martha Bebinger

          Dennis – I’ll get you a copy of the report.

          I understand your larger points. But I also know people who received possibly life saving treatment for cancer, cardiac and other serious illnesses in those first few years of getting insurance. So my very limited anecdotal experience fits the findings.

          That said, I will call DPH and ask Bruce or someone there to see if they can reconcile this study with their numbers. They are different data sets, yes? Thanks again.

          • http://byrondennis.typepad.com/theabcsofmedicare/ Dennis Byron

            See my answers below but, again, this is just a nice mental exercise for me to test my old brain for dementia (per another blog post on the site yesterday). The real issue is that there is no way that any effects — if there are any and I hope there are — could show up statistically in a few years. It would take a generation to measure what these Democratic Party ideologues are trying to measure based on comparing a few years of data they themselves say should not be compared using what they themselves call a “quasi-experimental” statistical trick.

            1. Thanks but no need to get me the report. I have back doors :) despite my complaint that U.S.-taxpayer funded information is hidden from U.S. taxpayers by goo goo academics (was it even peer-reviewed?). Also see point 2 below; the numbers are reconciled. Apparently Harvard doesn’t disagree that the amenable death rate in Massachusetts decreased faster 2001-2005 before the law was passed than 2007-2010 after the law was passed.

            2. Forbes has actually published a graph which appears be taken from the Harvard report (or its data) and it shows exactly the same thing as the Massachusetts Department of Health (DPH) Morbidity report as noted in point 1. In fact, in addition, Forbes (and apparently Harvard) shows — as does the DPH — that the death rate actually went up in 2008, the first really effective year of RomneyCare. As I said Harvard apparently doesn’t disagree but instead bases its theory (which Harvard states in fine print “cannot directly link mortality changes to persons gaining insurance coverage;” Harvard also says“our quasi experimental approach cannot definitively demonstrate a causal relationship underlying the association between the Massachusetts reform and the state’s declining mortality relative to other states. It is possible that the post-reform reduction in mortality in Massachusetts was due to other factors that differentially affected Massachusetts, such as the recession”) on county comparisons.

            3. Without seeing the report it appears the difference in the data sets (although the trend lines are the same) is that Massachusetts’ DPH numbers are based on absolutely every death in Massachusetts and Harvard’s are based on some “quasi-experimental” statistical blah blah blah

            4. Another difference seems to be the county orientation. While DPH has such data, no one looks at it much in Massachusetts for reasons you understand. But it brings up an interesting point: Does Harvard compare Suffolk County, MA (probably no U.S. county has more doctors and leading hospitals per capita) with Wayne County, MI and Clay County, MO, with which it is probably demographically and economically similar? That would not really be an apples to apples comparison.

            5. If you talk to Mr. Cohen, ask him why there has been no Morbidity Report from DPH the last few years?

  • Cat

    If suicide is casually referred to as being “less amenable to health care” we still have some very serious problems with mental health coverage and care.

    • http://www.wbur.org/people/martha-bebinger Martha Bebinger

      Important point Cat – thanks for posting.

    • Martha Bebinger

      Important point Cat – thanks!