Case #1995.0

Health Care Reform in Massachusetts: Impacts on Public Health

Publication Date: April 24, 2014
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In 2006, with healthcare costs and the number of uninsured rising, Massachusetts passed landmark legislation that aimed to provide health insurance to everyone in the state. A product of bipartisan collaboration between a legislature dominated by Democrats and a Republican governor, the law contained several major innovations, including: mandates requiring residents to purchase health insurance and businesses to contribute toward employees health care costs; programs to offer subsidized health insurance plans to low-income residents and to help wealthier individuals and small businesses buy coverage from private providers; and an expansion of the state's Medicaid program to cover more children in low-income families. This case explores some of the initial successes of the law's implementation, but also describes a number of challenges associated with it, not least of which was that within a year of the law's passage, Massachusetts, along with the rest of the nation, would endure a severe and protracted recession. Worsening economic conditions not only led to worries about the cost of expanding healthcare coverage, but also had serious implications for wellness initiatives and public health programs, which faced dramatic budget cuts. Exploring both the policy innovations of the law and the negative consequences of a poor economy, the case raises a number of points about the potential benefits of near-universal healthcare while highlighting some officials' concerns that an overemphasis on expanding coverage could detract from other investments in public health programming.

Learning Objective:
In exploring the implementation of the 2006 Massachusetts law that aimed to provide health insurance to all state residents, this case prompts readers to consider the promise and the challenges of designing and putting into practice an extensive set of public policy innovations. It asks readers to reflect on the benefits of expanding healthcare as well as on the efforts potential implications for traditional public health programming.

Other Details

Case Author:
Jennifer Weeks
Faculty Lead:
Arnold Howitt
Pages (incl. exhibits):
United States
Funding Source:
Robert Wood Johnson Foundation and the Association of State and Territorial Health Officials