The Impact of Massachusetts Healthcare Reform on Weight- and Exercise-Related Health Behaviors Among Low-Income Individuals

Between 1960 and 2012, the adult obesity rate climbed from 13% to 35% (Flegal et al., 1998; Ogden et al., 2014). As health professionals and researchers seek to curb this rise in obesity, we note that recent research found that BMI fell slightly for all MA residents following MA health care reform. Specifically, Courtemanche and Zapata (2014) find that BMI fell by 0.04 standard deviations, or approximately 1 percent, among all MA residents. Although at first this may seem to be a modest impact, a small decline in obesity could result in large reductions in medical costs. Estimates suggest that obesity increases annual medical costs by $2,741 per person, totaling over $200 billion per year (Cawley and Meyerhoefer, 2012). Understanding whether these declines in BMI are correlated with reductions in obesity, and which groups experienced the reductions in BMI, will help health professionals and policymakers understand how to target efforts to reduce obesity. In this paper, we take a closer look at the impact of MA health care reform on BMI, obesity, and related outcomes.

With Behavioral Risk Factor Surveillance System (BRFSS) data from 2000 through 2010, we employ a difference-in-differences approach to examine which groups experience reductions in BMI, and whether there is a corresponding reduction in obesity. Preliminary results show that the reductions in BMI are driven by the low-income individuals who were most directly targeted by subsidies and public health insurance expansions (i.e., under 300 percent of the federal poverty level). Further, preliminary work also suggests that these changes in BMI correspond with a reduction in the likelihood an individual is obese or overweight. We will then examine whether these reductions in BMI and obesity are associated with health improvements on diabetes-related outcomes such as whether a respondent has been told he or she has diabetes, is taking insulin or a pill, and has seen a health professional for diabetes.

We will also examine potential mechanisms for this reduction in BMI and obesity, such as increased exercise. Preliminary evidence suggests that low-income adults in Massachusetts are more likely to exercise following MA health reform, and this increase is driven by moderate, not vigorous, exercise. 

References:

Cawley, John and Chad Meyerhoefer. 2012. “The medical care costs of obesity: An instrumental variables approach.” Journal of Health Economics, 31: 219-230.

Courtemanche, Charles J.  and Daniela Zapata. 2014. “Does Universal Coverage Improve Health? The Massachusetts Experience.” Journal of Policy Analysis and Management, 33(1): 36-39.

Flegal, K., Carroll, M., Kuczmarski, R., and Johnson, C. 1998. “Overweight and Obesity in the United States: Prevalence and Trends, 1960-1994,” International Journal of Obesity, 22, 39-47.

Ogden, C.L., Carroll, M.D., Kit, B.K., and Flegal, K.M. 2014. “Prevalence of Childhood and Adult Obesity in the United States, 2011-2012,” Journal of the American Medical Association, 311(8): 806-814.