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Massachusetts health care — wonky, with a healthy dose of reality

Today's Healthy Read: 7 Charts That Prove Obamacare Is Working (starring ... Massachusetts!)

Today's Healthy Read: 7 Charts That Prove Obamacare Is Working (starring ... Massachusetts!)

October 1, 2014

At The New Republic, Jonathan Cohn rounds up 7 charts showing the positive impact of the Affordable Care Act.  

This is a great summary of the latest findings in a number of areas. You know that coverage is increasing and uninsurance is down. But maybe you weren't aware that more people are paying less for their coverage this year compared to last year, or that employer premiums nationally went up just 3%. This piece is the perfect fact check rejoinder when someone incorrectly claims that Obamacare is increasing the deficit (it's lowering the deficit), or that insurers are abandoning the exchanges (15% more insurers participating next year). And there's lots of charts! Read it here.

To make his point that health coverage is improving overall health, Cohn uses an important study that looked at Massachusetts before and after our 2006 reform. Of course, we're always proud when the Massachusetts experience is used to inform the national debate. Here's the chart, which is somewhat difficult to interpret at first:

Chart:Massachusetts mortality declines after 2006 health reform coverage expansion (Annals of Internal Medicine)

The study is from last May, in the Annals of Internal Medicine. The lines in the chart are different measures of mortality, or death rates. The key lines to follow are the ones in the middle of the chart. This tracks premature death from causes that are “amenable to health care.” This means death rates from infections, cancers, cardiac problems, and other conditions that people should be more likely to survive with better medical care. The blue line is the death rate in Massachusetts. The black line compares us to 44 million people in 513 similar counties in other states adjusted to match Massachusetts in age, income, and other factors.

You can see how the blue line (our death rate) goes down a fair amount after health reform is implemented (the vertical blue box). That's health reform, saving hundreds of lives in Massachusetts.

The conclusion? Here's how the study authors put it: "Health reform in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care." They found that "reform in Massachusetts was associated with a significant decrease in all-cause mortality compared with the control group (−2.9%; P = 0.003, or an absolute decrease of 8.2 deaths per 100 000 adults). Deaths from causes amenable to health care also significantly decreased (−4.5%; P < 0.001). Changes were larger in counties with lower household incomes and higher prereform uninsured rates." One death was saved each year for every 830 people enrolled in coverage. The decline in mortality was nearly twice as large for minorities as it was for whites.

The researchers are confident that the study's findings are driven by the expansion in coverage due to health reform. For example, they did not find a decrease in death rate among people over age 65, who were covered by Medicare both before and after implementation of reform.

Cohn wrote a good summary of the study, here, and the NY Times covered it here.

  -Brian Rosman