Massachusetts health care reform law lowered death rates, study finds

Providing greater access to health insurance led to a decline in deaths, according to a new study of Massachusetts' health care reform law.

Massachusetts passed comprehensive health care reform in 2006, providing a model for the Affordable Care Act -- dubbed by some as "Obamacare." In the four years after the law took effect in Massachusetts, deaths from all causes dropped nearly 3 percent compared with similar counties in states without health reform, the study found.

Researchers estimate that the Massachusetts law prevented 320 deaths a year. That works out to one life saved for every 830 people who gained insurance.

The study, published in the May 6 issue of the Annals of Internal Medicine also noted a 4.5 percent decline in deaths from preventable and treatable conditions, such as cancer, infections and heart disease.

Massachusetts differs in many ways from the nation as a whole. But in a larger expansion of coverage, "there is a very real likelihood that you're going to help people live longer," said Dr. Benjamin Sommers, assistant professor of health policy and economics at Harvard School of Public Health and the study's lead author.

Much like Obamacare, the Massachusetts health care reform law expanded Medicaid, subsidized private health plans and created an individual mandate to hold people accountable for getting health coverage. The reforms took effect in 2006 and 2007, several years before President Obama signed the Affordable Care Act into law in 2010.

Using data from the U.S. Centers for Disease Control and Prevention, Sommers and colleagues examined changes in death rates for adults, ages 20 to 64, before and after the state enacted health reform, and compared them with the experience in similar counties in states that had not enacted health reform.

The largest gains in life occurred in counties with high poverty and higher rates of uninsured adults before health care reform.

"If you think health reform is what's causing this change, that's the pattern you should see, that the people who benefit the most are lower-income and ... uninsured," Sommers said.

The study also found that more people in Massachusetts had insurance after the law was enacted. There were also fewer cost-related barriers to care, and more people saw their doctors for preventive care, according to the study. People also reported overall improvements in their health.

Glen Mays, professor of health services and systems research at the University of Kentucky in Lexington, said the study adds to a growing body of evidence showing that health care reform improves people's health.

"Interventions that can make a dent in overall death rates in the space of just a few years are few and far between, and certainly worthy of attention," Mays said.

But the drop in deaths in Massachusetts may not have been solely the result of expanded health insurance coverage in the state, he said. Lower out-of-pocket costs for preventive care and enhanced public health programs may have played a role, too.

A previously published study showed large reductions in smoking prevalence and tobacco-related health problems among people on Medicaid after Massachusetts added a comprehensive tobacco cessation benefit to the public health program as part of its health reform strategy, Mays noted.

"You can't rule out the possibility that something else is going on," agreed Christopher Conover, a research scholar at the Center for Health Policy and Inequities Research at Duke University. "But I think they've done as good a job as you can do with the data they've got in nailing it down and tying it to insurance coverage as the causal explanation."

"The conclusion that coverage expansion leads to health benefits by facilitating access is eminently reasonable," Austin Frakt, a health economist at the Veterans Affairs Boston Healthcare System, writes in an accompanying editorial in the same issue of the journal.

But at what cost to society? The study does not examine whether health reforms that save one life per 830 people are cost effective.

Based on the study, Conover offered his own rough calculation, suggesting that saving one life costs upwards of $272,000 per "quality-adjusted year of life," a measure that refers to the quality and quantity gained as a result of the health reforms.

"Is that a good way of spending valuable taxpayer dollars? I think that's a legitimate question to be asking," Conover said.