Support for National Health Insurance Seven Years Into Massachusetts Healthcare Reform: Views of Populations Targeted by the Reform

Int J Health Serv. 2016;46(1):185-200. doi: 10.1177/0020731415615314. Epub 2015 Nov 3.


Before the Affordable Care Act (ACA), many surveys showed majority support for national health insurance (NHI), also known as single payer; however, little is currently known about views of the ACA's targeted population. Massachusetts residents have had seven years of experience with state health care reform that became the model for the ACA. We surveyed 1,151 adults visiting safety-net emergency departments in Massachusetts in late 2013 on their preference for NHI or the Massachusetts reform and on their experiences with insurance. Most of the patients surveyed were low-income and non-white. The majority of patients (72.0%) preferred NHI to the Massachusetts reform. Support for NHI among those with public insurance, commercial insurance, and no insurance was 68.9%, 70.3%, and 86.3%, respectively (p < .001). Support for NHI was higher among patients dissatisfied with their insurance plan (83.3% vs. 68.9%, p = .014), who delayed medical care (81.2% vs. 69.6%, p < .001) or avoided purchasing medications due to cost (87.3% vs. 71.4%; p = .01). Majority support for NHI was observed in every demographic subgroup. Given the strong support for NHI among disadvantaged Massachusetts patients seven years after state health reform, a reappraisal of the ACA's ability to meet the needs of underserved patients is warranted.

Keywords: access to care; health care reform; health insurance; underserved populations; vulnerable populations.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Health Care Reform / economics
  • Health Care Reform / organization & administration*
  • Health Status
  • Humans
  • Insurance Coverage / economics
  • Insurance Coverage / organization & administration*
  • Insurance, Health / economics
  • Insurance, Health / organization & administration*
  • Male
  • Massachusetts
  • Middle Aged
  • National Health Insurance, United States
  • Patient Preference*
  • Patient Protection and Affordable Care Act / organization & administration
  • Patient Satisfaction
  • Safety-net Providers / economics
  • Safety-net Providers / organization & administration*
  • Socioeconomic Factors
  • United States
  • Young Adult