Association for Public Policy Analysis & Management

This paper is the first study to examine the impact of the 2006 Massachusetts health reform on infant health. Despite some recent improvements, key markers of infant health in the U.S. continue to lag behind other industrialized countries. Poor health at birth is not only exceedingly expensive to treat, but it has been shown to be an important determinant of long-term morbidity, cognitive impairment and poor economic attainment. Policymakers have long sought to improve the health and survival of infants by improving access to medical care through health insurance expansions. However, an expansion of the Medicaid program in the 1980’s yielded only modest returns to birthweight and mortality. A clear shortcoming of previous public health insurance expansions was the conditioning of eligibility on pregnancy, which some studies suggest led to delays in entering prenatal and/or pre-conception care. Thus, it remains unclear if health insurance expansions are simply ineffective or if the policy design features of health insurance expansion can be leveraged to improve infant outcomes. 

The 2006 Massachusetts reform substantially reduced the uninsured rate, increased access to care, reduced financial hardships and improved child and adult health. Importantly, health insurance was expanded regardless of pregnancy status, and take-up was strongly encouraged through an individual mandate and an extensive outreach campaign. We use restricted data from the Detailed Natality Files to examine the impact of reform on birth weight. Our empirical approach uses a difference-in-differences design, implemented with multivariable regression that compares changes in outcomes in Massachusetts to corresponding changes in a set of control states drawn from the same geographic region. We observe 2.1 million singleton births from 2001 through 2013.  Preliminary results suggest negatively signed, but small and non-significant effects of reform on the incidence of low birthweight (coefficient estimate= -0.006; p=0.43). The null effect is precise enough to rule out impacts larger than a 4% decline in the incidence of low birthweight. Similar effects are found across race and ethnic categories. Additional analyses will examine infant mortality and investigate if the effects of reform varied across counties that had low versus high pre-reform insured rates.

Our findings have important policy implications given the similarity of Massachusetts reform and the Affordable Care Act. Particularly, our preliminary results suggest that expanding health insurance coverage to near universal levels, as was accomplished in Massachusetts, may not improve persistently high rates of low birthweight in the U.S.