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Community Health Centers; Disparities; Health Reform


Massachusetts' landmark 2006 health reform legislation sets an important precedent for national reform. Initial evaluations have demonstrated the law's success in dramatically expanding health insurance coverage and health care access, but less is known about its effects on community health centers, which serve one of every 13 residents and one in four low-income residents. This analysis evaluates the experiences of health centers with the Massachusetts reforms, using administrative data to examine finances and patient enrollment in addition to the qualitative results of in-depth interviews conducted during site visits in August 2008 and the results of a short survey of health centers.

The reforms sought to achieve near universal health insurance coverage for state residents, based on the tenet of shared responsibility for health insurance coverage among the government, individuals, employers, health care providers, and insurers. While the individual mandate that became effective in July 2007 is the best-known dimension of the plan, its success also hinges on a "pay or play" requirement for larger businesses and the establishment of a "Connector" to expand individual and small group health insurance coverage options. The state Medicaid program was expanded in July 2006, and over the next year, a new subsidized insurance program, Commonwealth Care, became available to persons with family incomes below 300 percent of the federal poverty level ($52,800 for a family of three in 2008).

The reforms have been widely credited as successful in expanding insurance coverage in Massachusetts; estimates vary, but the number of uninsured fell by about half in the year following implementation of the reforms. Some individuals are still unable to afford insurance, however. In addition, the experience in Massachusetts indicates that insurance does not guarantee access to care; a shortage of physicians has made it difficult for many to access primary care.

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