Q: What lessons can the country learn from Massachusetts as ACA implementation proceeds?
A: One study I worked on with Jonathan Gruber, PhD, of the Massachusetts Institute of Technology, showed that those who obtained coverage through the individual market- not through Medicaid, not through their employers- saw dramatic reductions in their premiums, largely because premiums were subsidized for those with incomes up to three times the poverty level.
Other research, done with Katherine Swartz, PhD, of the Harvard School of Public Health, found that Massachusetts saw the greatest declines in its uninsured, almost 20%, in people who otherwise would've been uninsured for 4 to 24 months. But after 24 months, Massachusetts looked like the rest of the country. There's still a small but significant group of longterm uninsured in Massachusetts, and it's something that we have to think about as we implement the ACA.
Q: Tell me about your latest work.
A: In research funded by the Robert Wood Johnson Foundation, we're looking at coverage expansions under the ACA and how they are going to impact access to primary care once they are implemented.
For cities with mainly "short-spell" uninsured, the utilization of primary care might just shift around in time. The new demand for care in such places is probably going to be much less than in "long-spell" places, where people are really having trouble accessing care despite the fact that they have subsidies and, potentially, Medicaid available to them.
This project is trying to drill down into a very local area to highlight areas where a lot of uninsured may be coming into the insured population with huge demands on primary care. We are relating these expansion populations to local …