A meta-study is research that combines results of lots of other studies. Like a meta-joke is joke about jokes ("A priest, a rabbi and a leprechaun walk into a bar. The leprechaun looks around and says, 'Saints preserve us! I'm in the wrong joke!'").
Geoffrey T. Sanzenbacher, a research economist at Boston College, published a useful compendium of research on Massachusetts health reform for their Center for Retirement Research. The meta-study looks at the impact of Massachusetts health reform on coverage, health outcomes, costs and the labor market.
The study was itself summarized by noted BC economist Alicia H. Munnell (a meta-meta study?) in a column for the Wall Street Journal today.
Munnell's summary is a great cheat-sheet on health reform in Massachusetts:
Insurance coverage. The impetus for the Massachusetts reform was to increase access to health insurance. In this goal, the reform has been largely successful. The percentage of the population age 19-64 without insurance halved between 2004 and 2012. And, in 2012, only 4.9% in Massachusetts were not covered, compared with 21.2% nationally.
The major concern of such a rapid expansion of coverage is costs. By 2009, rising health-care costs forced Massachusetts to turn its attention to this issue. This effort seems to have had some success. From 2009-2012, Massachusetts’ health-care expenditures grew at a slower rate than the state’s economy (3.1% vs. 3.7%) and at the same rate as U.S. health expenditures (3.1%).
Provision of health services. The purpose of expanding health-insurance coverage is to allow increased access to health-care services and ultimately better health. Here again the news is good. From 2006-2010, the share of non-elderly individuals with a usual source of care increased significantly, and a higher share of care recipients reported receiving good or quality care in 2012 than in 2006.
One special area of interest is emergency-room usage. On this point, the evidence in Massachusetts is mixed. A comprehensive study of all emergency room admissions found an increase in volume, but the number of low-severity visits declined slightly.
Health outcomes. Increasing insurance coverage and increasing access to health care are a means to better health. Several studies, relying on self-reported health status, have concluded that Massachusetts residents are healthier following the reform. As with any self-reported data, care must be taken in over-interpreting these results. However, mortality data appear to support the conclusion that residents are getting healthier.
Labor-market effects. One fear following the Massachusetts health reform, and reiterated on the national stage, was decreased labor supply–making it easier to get health insurance not tied to employment might cause some individuals to stop working. It was also feared that employers would cut back on employees or hours to avoid the requirement to offer health insurance, which is based on the number of full-time equivalent workers.
A comprehensive study conducted using Current Population Survey data compared Massachusetts to four other states and found that the level of employment relative to the working-age population (i.e., the employment rate) followed a generally similar pattern in all of the states after the reform. The same study found that Massachusetts did not see relative increases in the share of workers working part-time.
Regarding the provision of health insurance, another concern was that employer-sponsored insurance would be crowded out by public insurance, as employers simply dropped coverage and paid the $295 fine per employee. In fact, the percentage of employers offering coverage actually increased after the reform.
We agree completely with Munnel's summary of the summary of the summary (meta-meta-meta analysis): "Thus, a wealth of research on the reforms suggests that insurance coverage and access to health care have increased, that health outcomes appear to be improving, and that the worst fears about employment have not come to pass in Massachusetts. Costs, however, remain an issue: Although growth has slowed in recent years, Massachusetts costs still remain above the national average."
Interest in this work nationally is all about its applicability to the ACA. For us, it's that, and also why we will keep fighting to preserve the gains of Chapter 58, the 2006 reform law.