NCPA - National Center for Policy Analysis

Health Care Reform and the Health Care Workforce

October 5, 2011

In 2006, Massachusetts enacted legislation to provide universal health insurance coverage that later served as a model for the national health care reform legislation passed in 2010, say Douglas O. Staiger, David I. Auerbach and Peter I. Buerhaus.

Since implementing provisions such an individual mandate and subsidies for low-income individuals, Massachusetts has achieved near-universal insurance coverage.  However, one aspect of the Massachusetts experience that has remained unexplored is the impact on the health care workforce, particularly the question of whether greater numbers of health care professionals or support personnel were needed to ensure the success of the reform in increasing access to care.  If successful reform requires a larger health care workforce, then implementation of the Affordable Care Act may increase health care costs and exacerbate expected shortages of physicians and registered nurses.

The data suggests that enactment of reform in Massachusetts was associated with more rapid growth in health care employment, primarily in administrative occupations and (perhaps) patient care support occupations rather than among physicians and nurses.

The Massachusetts experience provides lessons for national health care reform in a few ways.

  • Reform may accelerate the trend toward health care being the dominant employment sector in the economy.
  • Reform imposes administrative burdens
  • Rather than requiring greater numbers of physicians and nurses, reform may require larger numbers of people supporting the work of such health care professionals.

Source: Douglas O. Staiger, Ph.D., David I. Auerbach, Ph.D., and Peter I. Buerhaus, Ph.D., R.N., "Health Care Reform and the Health Care Workforce -- The Massachusetts Experience," New England Journal of Medicine, September 22, 2011.

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