State Health Reform

VII. Key Issues: Regulation & Reform >> C. Health Reform >> State Health Reform (last updated 4.25.17)


  • is staffed by policy experts who believe that economic incentives, combined with personal authority, will enhance the political, economic, and physical health of our states and our citizens. is a collaborative effort of the groups that belong to the State Policy Network (SPN). SPN is the national service organization of America’s free-market, state-focused policy organizations. They watch developments in the states, and make recommendations for public policy, including health care policy. The site provides links to each individual state with news about health reform initiatives in each.


  • A Resource on California Health Care Reform. CHCF and the Center for Governmental Studies created as a one-stop site to learn about the 2007 reform proposals on the table, compare and analyze features of the proposals, and weigh in on the policy debate. The site offers comprehensive analysis, discussion, and news about the 2007 health care reform debate in California.


  • Indiana: Health Care Reform Amidst Colliding Values. In May 2007, Indiana enacted comprehensive health reform in the form of the Indiana Check-Up Plan and its centerpiece, the Healthy Indiana Plan (HIP). After intense negotiations, the Centers for Medicare and Medicaid Services granted Indiana the 1115b waiver required for the plan to go into effect in December 2007. HIP is the first Medicaid expansion in the nation to be modeled in the spirit of a high deductible health plan (HDHP)/ health savings account (HSA).



The Blue Cross Blue Shield of Massachusetts Foundation has an online resource dedicated to Massachusetts health reform: Users can navigate through sections devoted to the following topics:

  • The Massachusetts Law and its History
  • Health Reform Implementation
  • Health Reform Results
  • Financing Massachusetts Reform
  • Health Reform 2.0: Cost and Quality
  • Lessons from the Massachusetts Experience
  • How National Reform Affects Massachusetts
  • Other Resources

Impact Studies

  • Blumberg LJ, Holahan J, Weil A, et al. “Toward Universal Coverage in Massachusetts.” Inquiry, 43(2): 102–21, June 2006.
  • Kolstad, Jonathan T., Amanda E. Kowalski. The Impact of Health Care Reform On Hospital and Preventive Care: Evidence from Massachusetts. NBER Working Paper No. 16012. Issued in May 2010. Using the Current Population Survey, we find that the reform increased insurance coverage among the general Massachusetts population. Our main source of data is a nationally-representative sample of approximately 20% of hospitals in the United States. Among the population of hospital discharges in Massachusetts, the reform decreased uninsurance by 36% relative to its initial level. We also find that the reform affected utilization patterns by decreasing length of stay and the number of inpatient admissions originating from the emergency room. Using new measures of preventive care, we find some evidence that hospitalizations for preventable conditions were reduced. The reform affected nearly all age, gender, income, and race categories. We also examine costs on the hospital level and find that hospital cost growth did not increase after the reform in Massachusetts relative to other states.
  • Long SK, Stockley K and Nordahl KW. “Coverage, Access, and Affordability under Health Reform: Learning from the Massachusetts Model.” Inquiry, 49(4): 303–16, Winter 2012/2013.
  • Boston Globe (January 24, 2008). Cost of Health Initiative Up $400M. “The biggest driver of the cost increase is projected growth in the number of people signing up for state-subsidized insurance, which now far exceeds earlier estimates. State and federal taxpayers are expected to bear nearly all of the additional cost…In April 2006, the state estimated that about 400,000 residents were uninsured. Census estimates of the uninsured were far higher – about 650,000 – and many independent observers suggest that the truth lies somewhere in between. Officials had projected that about 140,000 would enroll in the new state-financed insurance plan, called Commonwealth Care, which provides full or partial subsidies. But by the end of last month, 169,000 people had signed up for Commonwealth Care, and the state is now estimating enrollment will reach 225,000 by June 2009, the close of the next fiscal year. More than 70,000 have obtained Medicaid coverage since the law passed expanding eligibility, and the cost for covering those additional people, plus rate increases for hospitals, doctors, and others, is projected to grow significantly above this year’s spending.”
  • Survival Rates in Trauma Patients Following Health Care Reform in Massachusetts. “Our finding that HCR (health care reform) was associated with a transient increase in excess deaths was unexpected…Two other groups have recently reported worse outcomes in Massachusetts following HCR. Albert et al studied patients who underwent invasive cardiovascular procedures before and after Massachusetts HCR and found an increase in hospital-adjusted odds of death following HCR among less-educated patients. Lasser et al found that hospital readmission rates increased in Massachusetts compared with New Jersey and New York following HCR…Our finding that mortality rates increased for trauma patients following HCR is perhaps the most unsettling result to date but likely stems from the same root cause: administratively encouraging insurance coverage fails to address, and may even undermine, the fundamental structural changes required to improve health care outcomes.” (JAMA Surgery, 5.6.15)
  • Arguable: With Successes Like that, Who Needs Failure? “It has been 11 years since former Governor Mitt Romney signed into law the health-care overhaul that later became the model for the ACA. The chief architect of Romneycare was MIT’s Jonathan Gruber, who later played a key role in drafting Obamacare and famously said that there was zero difference between the two laws. (In Gruber’s elegant formulation: ‘It’s the same f—ing bill.’)… Behold the Massachusetts health-care triumph: Government set out to control the health-care and health insurance markets through an ever-more-intricate web of mandates, subsidies, regulations, and price controls, and achieved near-universal health coverage. What that means in practice is that patients in Massachusetts not only pay a lot more money for insurance and medical care than they used to, but they also wait far longer to see a new doctor than they used to.” (Boston Globe, 3.28.17)


New York

  • Linda J. Blumberg, Bowen Garrett, Matthew Buettgens, Lisa Clemans-Cope, John Holahan, Aaron Lucas, Paul Masi, Baoping Shang. Achieving Quality, Affordable Health Insurance for All New Yorkers: An Analysis of Reform Options. Urban Institute, July 17, 2009. [Summary (html)] [Full Text (pdf)]



  • Edmund F. Haislmaier. State Health Reform: The Significance of Utah Health Insurance Reforms. Heritage Foundation WebMemo #2569, July 29, 2009. [Full Text (html)]


  • Kaiser Health NewsStates.

Leave a Reply

Your email address will not be published. Required fields are marked *