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Health reform expanded coverage without "churn"


Researchers find Massachusetts’ health reform law increased coverage

without increasing “churn”; led to more women following up on cancer screenings


BOSTON  - (Feb 5) A paper published today in the Journal for Health Care for the Poor and Underserved showed that the after the expansion of health insurance coverage under Massachusetts’ 2006 health reform law, more women who used community health centers in Boston gained both private and publicly-funded health coverage without an increase in “churning” or switching plans. A related paper showed that women who had abnormal mammograms were significantly more likely to seek timely follow-up diagnostic care if they were continuously insured. In both papers, researchers analyzed data from 1,946 women who had abnormal breast or cervical cancer screenings at six community health centers before and after the health reform law took effect.

The first paper, The Impact of Health Insurance Reform on Insurance Instability, examined the frequency of switches in insurance coverage as measures of long-term insurance instability as well as the rate of insurance coverage overall. The overall rate of women without insurance in the sample dropped from 39 percent in the pre-reform period to 29 percent post-reform. At the time of abnormal breast cancer screening exam in the pre-reform period, 42 percent of subjects were uninsured, compared with 35 percent uninsured in the post-reform period. Among women with cervical cancer screening abnormalities, the proportion uninsured (36 percent) was reduced by half to 18 percent. The study also found that there was not a significant change in the frequency with which the women’s insured status changed pre- or post-reform.

“Our findings suggest that the insurance reform had its intended effect of increasing the proportion of women with consistent health insurance and did not demonstrate that insurance coverage became more unstable,” said Karen Freund, MD, MPH, of the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, and Professor of Medicine, Tufts University School of Medicine and lead author of the studies. “Interestingly, our data show very little transition from private insurers to the subsidized plans, indicating that employers did not drop their employee coverage – something that was feared when Massachusetts introduced its own health care exchange,” she said.

The second study using the same data, The Impact of Insurance Coverage during Insurance Reform on Diagnostic Resolution of Cancer Screening Abnormalities, looked at whether insurance coverage was associated with more timely resolution of an abnormal mammogram or cervical cancer screening.  Researchers found that for women with breast screening abnormalities, those who had continuous insurance coverage were more likely to get follow-up diagnostic exams after an abnormal mammogram than women who had no insurance or lost their insurance coverage.  That same disparity was not seen in the population of women with abnormal cervical cancer screenings, a difference that could be due to the fact that follow-up care for abnormal pap smears occurred at the community health center even when insurance had lapsed, often by the health center using Title X federal family planning funds.  Women with abnormal breast screening must seek out care at outside the health center, usually at hospitals that required insurance coverage for registration and care.

“These data provide evidence that stability of health insurance coverage with insurance reform nationally may improve timely care after abnormal cancer screening in historically underserved women,” Freund said. “For future research, it would be useful to look at how insured status impacts treatment for chronic disease. It will also be important to study whether we see the same patterns or different patterns as national insurance reform is implemented, particularly in states that accepted increased Medicaid enrollment and those that did not.”

Funding sources for this research included: National Institute on Minority Health and Health Disparities award number RC1MD004582, National Cancer Institute award number U01CA116892, and the American Cancer Society—Harry and Elsa Jiler Clinical Research Professorship.

In addition to Tufts Medical Center, researchers from Boston University, Boston Medical Center, the Lahey Clinic, Brigham and Women’s Hospital, Harvard Medical School and Massachusetts General Hospital were authors of these studies.


Media contact: Julie Jette



About Tufts Medical Center and Floating Hospital for Children

Tufts Medical Center is an exceptional, not-for-profit, 415-bed academic medical center that is home to both a full-service hospital for adults and Floating Hospital for Children. Conveniently located in downtown Boston, the Medical Center is the principal teaching hospital for Tufts University School of Medicine. Floating Hospital for Children is the full-service children's hospital of Tufts Medical Center and the principal pediatric teaching hospital of Tufts University School of Medicine. Tufts Medical Center is affiliated with the New England Quality Care Alliance, a network of more than 1,800 physicians throughout Eastern Massachusetts. For more information, please visit