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Background: The passage of the Massachusetts (MA) health care reform law (HCR) in 2006 created a microcosm for study of the impact of "near" universal coverage. Insurance coverage represents potential access to care but is also a proven predictor of care outcomes. Significant strides have been made in broadening coverage, as evidenced by the lowering of the rate of uninsured adults between the ages of 18-65 to 4.8%. However, with injuries historically accounting for approximately 25% of MA Emergency Department (ED) volume, the need remains to evaluate the impact of MA HCR on ED utilization by the largest subset of injury-related trauma patients – the "young invincibles". These patients are of ages 20-29 and have nationally been the fastest growing segment of the uninsured.
Methods: In a retrospective review of statewide aggregate level ED visit data from Oct 2002 – Sept 2010, the trend of acquisition of insurance coverage in injured patients was established during the HCR implementation.
Results: While both injured patients and those with all other diagnoses had increased rates of public insurance coverage over the time period, the rate per 1000 of uninsured decreased substantially for young invincible injury patients aged 20-24 and 25-29 from 17.5 to 4.1 and 15.2 to 4.1, respectively, in 2009-2010. A similar steep decline was not seen in the non-injured population.
Conclusion: While further correlation to HCR mandates is needed, this drastic decrease in the uninsured young invincible injured patients demonstrates the success of MA HCR in accomplishing a state level solution to an age-specific national problem.