Changes in Mortality after Massachusetts’ Health Care Reform

Benjamin D. Sommers, Harvard University and Brigham and Women's Hospital
Sharon Long, Urban Institute
Katherine Baicker, Harvard University

Massachusetts’ 2006 health reform was a model for the Affordable Care Act. It attained near-universal insurance coverage and increased access to care. We assessed whether the reform was associated with changes in all-cause mortality and mortality from causes amenable to health care. We used a differences-in-differences design, comparing mortality for adults ages 20-64 in Massachusetts from 2001-2005 (pre-reform) and 2007-2010 (post-reform) versus a propensity-score defined control group of U.S. counties. County mortality data were from the CDC’s Compressed Mortality File. Massachusetts’ reform led a significant decline in all-cause mortality compared to the control group (-2.9 percent, p=0.003; absolute decline 8.2 deaths per 100,000). Deaths from causes amenable to health care also significantly declined (-4.5 percent, p<0.001). Changes were larger in counties with lower household incomes and higher pre-reform uninsured rates. We conclude that the Massachusetts’ reform led to significant declines in mortality, concentrated in causes amenable to health care.