The Massachusetts Experience – Reform and the Workforce

One of the most revealing impacts of health care reform on the workforce is the “Massachusetts Experience.” With implementation of the 2006 Massachusetts Health Care Reform Plan, including insurance subsidies for low-income individuals, pay-or-play requirements for employers and a state insurance exchange, the effect upon the health workforce was yet to be seen. The unanswered question was whether greater numbers of health care professionals were needed to ensure a successful reform with increasing access to care.

A study conducted by Douglas O. Staiger, PhD, and reported in the September 2011 issue of The New England Journal of Medicine, points out that “from January 2001 to December 2005, employment per capita grew by just over 8 percent in both Massachusetts and rest of the country. Subsequently, health care employment grew faster in Massachusetts, increasing by 9.5 percent from December 2005 through September 2010, while the rate of growth in the rest of the country was 5.5 percent. Most of the divergence in employment growth between Massachusetts and the rest of the country occurred in 2006 and 2007, when the Massachusetts reforms were being phased in. Had health care employment in Massachusetts grown at the same rate as in the rest of the country, approximately 18,000 fewer people would have been employed in health care by 2010.”

This study suggests there is a direct association between the implementation of the state’s health care reform plan and increase health care employment, especially in areas of administration and patient care support. The increase was not as dramatic among physicians and nurses. Further analysis suggests the impact to Massachusetts health care reform had other factors different from other states including “the numbers of physicians and nurses per capita in Massachusetts were already among the highest in the country, and this ample workforce may have facilitated absorption of large numbers of newly insured people without compromising access.” The entire article can be found here.

Another study can be found in the Baker Institute Policy Report for March 2012. This report detailed workforce programs, impacts of the Affordable Care Act (ACA) and workforce shortages. Accordingly, expanding the health workforce is one way to take full advantage of the ACA’s focus on preventive care.