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Evaluating the Massachusetts Health Care Reform

There are a number of reasons the Affordable Care Act (ACA) is unprecedented in its scope and reach. The law aims to introduce the largest expansion in insurance coverage in the nation's history, to redistribute billions of dollars to make health insurance more affordable, to overhaul the regulation of insurance markets, and to introduce system reforms that transform the delivery of health care in the United States. Yet another unprecedented feature of the ACA is that it is perhaps the only massive expansion of our nation's safety net which was directly piloted before passage. The state of Massachusetts passed a health care reform in 2006 which was the explicit model for the coverage and insurance market reform portions of the ACA. By the time that the ACA was passed in March 2010, there were nearly 4 years of experience with a similar law that could be studied to predict the ACA's impacts.

The Massachusetts law is not identical to the ACA for a number of reasons. First and most important, it applies only in Massachusetts, which is different from the nation as a whole in a variety of ways. Second, the subsidies provided to many low-income families in Massachusetts were significantly more generous than those offered under the ACA. Third, employers play a much larger role in financing the ACA than they did with the Massachusetts law. However, in the main, the basic structure of the ACA was pioneered in the Bay State.

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