Massachusetts Health Care Reform and the Working Poor Interview with:
Liane J. Tinsley, MPH
Associate Research Scientist
Department of Epidemiology
New England Research Institutes, Inc.
Watertown, MA 02472 What are the main findings of the study?

Answer: For this study, we analyzed health insurance data from a cohort of community-dwelling individuals between the ages of 30-79 at baseline, in Boston, MA. Massachusetts health care reform legislation, including the expansion of Medicaid, resulted in substantial overall gains in coverage in our study population. Despite being targeted by the law, the working poor (those currently working for pay, either part- or full-time and earning less than 200% of the US federal poverty threshold for household size) continued to report lower rates of insurance coverage following reform (13.3% without insurance), compared to the both non-working poor (4.7% without insurance) and the not poor (5.0% without insurance). Were any of the findings unexpected?

Answer: Gains in insurance coverage among the working poor came overwhelmingly via public channels (e.g. Medicaid), while less than half of working poor reported private insurance coverage following reform. This was despite the fact that one of the main goals of the law was to tie private insurance coverage to employment (such as the employer mandate to provide health benefits to fulltime employees). This aspect of the law does not appear to have provided substantial benefits to the working poor in this study population. This may be related to occupational differences among subgroups: many of the study’s participants reported working in service or construction and repair occupations, jobs which are often part-time or seasonal in nature, and to which the employer mandate may not apply. What should clinicians and patients take away from your report?

Answer: Despite overall gains in insurance coverage following healthcare reform, disparities persisted among the working poor, who represent a growing sector of the U.S. population. What recommendations do you have for future research as a result of this study?

Answer: Our findings may have implications for the 2014 rollout of the federal Patient Protection and Affordable Care Act (ACA), which is modeled on the MA health reform experiment. We believe our findings may be relevant for predicting the potential future success of the ACA among similar populations.


Has Massachusetts health care reform worked for the working poor? Results from an analysis of opportunity
Liane J. Tinsley, MPH Susan A. Hall, PhD, John B. McKinlay, PhD
Annals of Epidemiology Volume 24, Issue 4, April 2014, Pages 312–318


Last Updated on March 12, 2014 by Marie Benz MD FAAD