Disentangling the Effects of Health Reform in Massachusetts: How Important Are the Special Provisions for Young Adults?

Massachusetts enacted a comprehensive health care reform bill in 2006 that has moved the state to near universal health insurance coverage. In 2008, uninsurance in Massachusetts was at 4.1 percent, well below the national average of 15.1 percent and below the rate of 6.7 percent in the next lowest state—Hawaii (Joanna Turner, Michel Boudreaux, and Victoria Lynch 2009). The Massachusetts law included expanded eligibility for public coverage, subsidized insurance coverage, an insurance purchase exchange, market reforms, expanded coverage options for young adults, requirements for employers, and, most controversial, an individual mandate that requires all adults who have access to affordable coverage to obtain health insurance (John E. McDonough et al. 2008). Although estimates to date have focused on the overall effect of the Massachusetts health reform package (e.g., Sharon K. Long, Karen Stockley, and Alshadye Yemane 2009), there is substantial policy interest in determining the effects of the different components of the reform effort. In this paper, we focus on disentangling the effects of the special provisions implemented in Massachusetts to expand coverage to young adults. Compared to older adults, young adults are much less likely to be insured, reflecting their access to fewer coverage options and, when coverage options are available, lower probability Disentangling the Effects of Health Reform in Massachusetts: How Important Are the Special Provisions for Young Adults?