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Documenting Success:
Health Reform in Massachusetts and the Nation

By Nancy Wagman, September 12, 2017

For more than a decade, Massachusetts has made a commitment to expanding health care, and the success of our initiatives to expand health insurance coverage is clear. Massachusetts continues to lead the nation in providing almost universal health insurance coverage to its residents (see chart).

bar graph: Massachusetts continues to lead the nation in health care coverage

The state’s health insurance coverage rate in 2016 was 97.5 percent, a statistically significant increase from 97.2 percent in 2015. The gap between Massachusetts’ “nearly-universal” health care coverage and fully “universal” health care coverage gets smaller and smaller. In 2016 (the most recent year for which data are available), the U.S. Census Bureau estimates that only 2.5 percent—171,000 people—in Massachusetts did not have health insurance coverage. This rate has been falling over the past several years (see chart).

line graph: Uninsured rates in Massachusetts continue to drop

Health reform at the national level has led to significant increases in health insurance coverage rates across the nation. In fact, close to 17.9 million more people nationally in 2016 have health insurance compared to 2013, before the key provisions of national health reform had started to take effect. In particular, many states that have taken advantage of the federal funding available to expand their Medicaid coverage have seen dramatic increases in health care coverage from 2013 to 2016—by more than nine percentage points in some states (see chart).

bar graph: Largest increases in health coverage since 2013 concentrated in states that have expanded Medicaid

Reforms in Massachusetts and nationally have brought greater access to health care for thousands of people across the Commonwealth, and these reforms represent an important financial partnership between the federal and state governments. Federal funding supports a significant share of the costs of health insurance for close to two million people in the Commonwealth.

The state’s health insurance coverage rates for children in Massachusetts also demonstrate the effectiveness of Massachusetts’ health reform efforts. Ninety-nine percent of children under age 19 in Massachusetts now have health insurance—just shy of universal coverage. Nationally, health insurance coverage rates for children continue to rise as well, from 92.5 percent of children under 19 in 2013 to 95.3 percent in 2016 (see chart).

line graph: Children's health coverage continues to climb

Fortunately, thanks in large part to national health reform, and to funding from such programs as the federal Children’s Health Insurance Program (CHIP), other states are finally catching up to Massachusetts’ impressive health insurance rates for children. Vermont covers 98.5 percent of its children under 19, and Rhode Island covers 97.8 percent.

How the Census Bureau Measures Health Insurance

The data above are from the American Community Survey. The Census Bureau today released 2016 data today from two major surveys that measure health insurance coverage: the Current Population Survey (CPS) and the American Community Survey (ACS). These two surveys measure health insurance coverage in slightly different ways, and can have slightly different results.

The CPS has been measuring unemployment statistics for decades, and began asking about health insurance coverage in 1987. This survey provides important information about long-term historic trends. However, the Census Bureau changed the health insurance questions in 2013, so the health insurance information prior to that year is not directly comparable to information since then. Since 2008, the Census Bureau also included questions about health insurance in the ACS. The ACS uses a much larger sample size than the CPS, so health insurance statistics are available from the ACS for states, counties, and even smaller geographic regions.

The two surveys also measure health insurance coverage in slightly different ways. The Census Bureau conducts the CPS in the spring, and asks respondents if they had health insurance at any time during the previous calendar year. “Uninsured” in the CPS means not having any type of health insurance at any point during the prior year. In contrast, the Census Bureau conducts the ACS continuously over the course of the year, and asks respondents if they are covered by any of the types of listed health insurance (public, private, etc.) at the time of the survey. “Uninsured” in the ACS means not having health insurance at the time of the survey.