Does universal coverage improve health? The Massachusetts experience

Charles J. Courtemanche, Daniela Zapata

Research output: Contribution to journalArticlepeer-review

109 Scopus citations


In 2006, Massachusetts passed health care reform legislation designed to achieve nearly universal coverage through a combination of insurance market reforms, mandates, and subsidies that later served as the model for national reform. Using data from the Behavioral Risk Factor Surveillance System, we provide evidence that health care reform in Massachusetts led to better overall self-assessed health. Various robustness checks and placebo tests support a causal interpretation of the results. We also document improvements in several determinants of overall health: physical health, mental health, functional limitations, joint disorders, and body mass index. Next, we show that the effects on overall health were strongest among those with low incomes, nonwhites, near-elderly adults, and women. Finally, we use the reform to instrument for health insurance and estimate a sizeable impact of coverage on health.

Original languageEnglish
Pages (from-to)36-69
Number of pages34
JournalJournal of Policy Analysis and Management
Issue number1
StatePublished - Dec 2014

ASJC Scopus subject areas

  • General Business, Management and Accounting
  • Sociology and Political Science
  • Public Administration


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