Health Reform in Massachusetts: Reducing the Uninsured and Keeping it That Way

Comprehensive health reform in Massachusetts, enacted in April 2006 on a platform of shared responsibility, has reduced the number of uninsured by half in the first two years of implementation, bringing the uninsured rate to less than 5.7%. The experience of the first two of three years of full implementation lends lessons to other states as they struggle with the politics and policy of expanding access to health insurance coverage. Employer coverage is holding steady at rates above the national average. The state and federal governments have maintained their investments through funding of the state's Medicaid 1115 Waiver. And, implementation of the first year of the first-ever individual mandate for health insurance shows early signs of effectiveness and success in reducing rates of uninsurance by requiring individuals to obtain insurance with an affordability contingency. The moving parts of the health reform package continue to move effectively in a combination of state-subsidized coverage, unsubsidized products for the middle-income and young adults, and expanded Medicaid and SCHIP eligibility. The reform's successes and challenges as it enters its third, and final, year of full implementation will be highlighted with a particular focus on the individual mandate.