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Amanda Dennis, Kelly Blanchard, Denisse Córdova, Britt Wahlin, Jill Clark, Karen Edlund, Jennifer McIntosh and Lenore Tsikitas

Amanda Dennis, Kelly Blanchard, Denisse Córdova, Britt Wahlin, Jill Clark, Karen Edlund, Jennifer McIntosh and Lenore Tsikitas, What Happens to the Women Who Fall Through the Cracks of Health Care Reform? Lessons from Massachusetts, 38 Journal of Health Politics, Policy & Law 393 (April, 2013)

In 2006 the Commonwealth of Massachusetts passed health care reform legislation, known as Chapter 58 of the Acts of 2006, that was aimed at improving access to affordable, high-quality health care for residents. The state's groundbreaking efforts offer a unique opportunity to examine how health care reform has affected women and their access to services, specifically access to politically stigmatized services such as reproductive health care. Moreover, lessons learned about the experiences of low-income women and reproductive health care providers under Massachusetts reform provide many valuable lessons for national health care reform under the Patient Protection and Affordable Care Act (PPACA).

We focus on women's experiences with reform for a number of reasons. First, women have specific reproductive and lifelong health needs and play essential roles as managers of family health. In addition, a large body of research has documented disparities in access to insurance coverage and health care utilization between women and men (Bertakis et al. 2000). Further, compared with men, women are more likely to be unemployed or work part time and so have less access to employer-sponsored insurance; they are therefore more likely to be in need of and eligible for government-subsidized insurance plans (Patchias and Waxman 2007). It is reasonable to believe that health care reform efforts in the Commonwealth would resolve some of these challenges by expanding access to insurance and health services for uninsured low-income women; however, evidence is needed to determine if the policy change has met its intended goals.

In this article we outline how reform evolved in Massachusetts and discuss what evidence has emerged of the successes and challenges related to reform. We then share the original research conducted jointly by Ibis Reproductive Health and the Massachusetts Department of Public Health (MDPH) family planning program and analyze which populations fall through the cracks of reform and the impact of being left out of reform. We close with a discussion of the implications of our findings for national health care reform.