A Serendipitous Evaluation of Mandatory Health Insurance in Massachusetts

It is estimated some 49.5 million American adults under the age of 65 (28%) have no health insurance.(1) An additional 42.5 million (24%) people are underinsured - they are generally older, sicker and make greater use of the health care system.(2)

In 2006, under pressure from the federal government, Massachusetts passed a law which: (a) expanded Medicaid HMOs to cover the poor (free of charge) and near poor (with partial subsidies); and (b) established an “individual mandate,” requiring every uninsured person with incomes above the poverty level (about $10,000 annual income for an individual, $20,000 for a family of four) to purchase health insurance. This mandate is enforced through the income tax system.(3) This Massachusetts approach to universal coverage has been lauded as a national model and advanced during recent discussions of health care reform in the US.

Before mandating health insurance for the entire US population it would be prudent to enquire if the “Massachusetts Experiment” has actually worked. Has it produced the desired changes? Has it achieved universal coverage in Massachusetts? Who has gained, lost or still lacks health insurance? Has mandatory health insurance changed health care utilization? Has it increased the use of medications for major health conditions diagnosed before the introduction of the program? Finally, has it reduced health care disparities (e.g., between men and women and race/ethnic groups) known to exist prior to introduction of mandatory health insurance?

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