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State Strategies: Massachusetts’ Health Reforms


“In 2006, Massachusetts passed comprehensive health care reform designed to provide near-universal health insurance coverage for state residents” (Keiser Family Foundation, 2012, p. 1). Such a step was needed to promote shared responsibility and react to existing issues of rising costs. The existing Medicaid program that operated at that time was expiring, which would have resulted in financial problems for the population.

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A lot of people were at risk of losing their Medicaid coverage. Reforms connected with them individually purchased insurance failed, as the number of people who resorted to them decreased significantly. The price of insurance was rising rather fast, which prevented the representatives of the general public from purchasing it, especially those that resorted to a small group market managed. In addition to that, emergency rooms were always full of people, which led to the misuse of resources. Finally, employers tend to avoid including health insurance in the framework of employee benefits.


A three-legged stool model was approached when implementing reforms, as it lies based on the state legislation. Firstly, the non-group private health insurance was considered. This law prevented price discrimination, ensured insurance, and prevented medical underwriting. An online insurance exchange was also developed. Secondly, unraveling was avoided.

To prevent biases and inequality, all individuals over age 18 were made to buy insurance. Otherwise, they had to pay the penalty. Thirdly, government subsidies were provided for people with low income to afford insurance. Similarly, Mitt Romney attracted attention to the issue connected to insurance in 2003 already. He identified opportunities and advertised them to the public the next year. In 2005, separate reform bills passed so that eventually the law was adopted (Shapiro, 2015). Based on these reforms, federal health reform was developed in 2010 to expand coverage.

Funding Structure

Massachusetts’ health reforms are funded in different ways. Of course, a particular amount of money is provided by the government. It consists of those funds that are gathered from the representatives of the general public through taxes. However, the number of people served in this way increased while governmental expenditures remained the same. As a result, the program got almost $1,5 billion from the state in 2012. In addition to that, the waiver became a primary source of finances, and almost $27 billion were obtained over 3 years (Keiser Family Foundation, 2012).


Due to Massachusetts’ health reforms, the number of uninsured people decreased greatly, especially during the first year after their implementation. Thus, while 10.9% of the population had no insurance in 2006, only 5.5% lacked it in 2007. This level remained rather low until 2010 (6.3%) when the state’s unemployment rate almost doubled. The coverage was distributed differently so that a private group and employer-sponsored insurance was almost 80% in 2011. MassHealth dealt with 16%.

The rest resorted to Commonwealth Care, Commonwealth Choice, and individual coverage. Comparing with 2006, more people had a usual source of care and visited a doctor in 2010 (Keiser Family Foundation, 2012). Both coverage rates and physician payment levels increased, which proves that these reforms had positive outcomes for the state even though they did not eliminate this issue.

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I hope this information was helpful. Please let me know if there is something you want to clarify.


Keiser Family Foundation. (2012). Massachusetts health care reform: Six years later.

Shapiro, A. (2015). Did Massachusetts health-care reform affect prices?

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