The Massachusetts health reform, implemented in 2006 and 2007, reduced the uninsurance rate for working-age people with disabilities by nearly half. Enrollment in Medicaid and subsidized insurance accounted for most of the gain in insurance coverage. The reduction in uninsurance was greatest among younger adults. The reform also reduced cost-related problems obtaining care; however, cost remains an obstacle, particularly among young adults with disabilities. The Massachusetts outcomes demonstrate that insurance subsidies, Medicaid expansions for low-income adults, individual insurance mandates, and enrollment initiatives can lead to substantial reductions in uninsurance and cost-related problems obtaining care among working-age people with disabilities.In 2006, Massachusetts enacted legislation to provide near-universal health insurance coverage. The health reform decreased the uninsurance rate among Massachusetts children and working-age adults, improved access to health care, and reduced the burden of health care costs among working-age adults (Long and Stockley 2010;Kenney, Long, and Luque 2010; Long and Massi 2009;Tinsley et al. 2010). These positive effects of the reform are well known; however, there has been only limited study of the effects of the reform on a large (up to 18% of working-age people) and particularly vulnerable subgroup: working-age (19-64) people with disabilities (Tinsley et al. 2010).1 In this paper we examine the effects of the Massachusetts health reform on people with disabilities, a subgroup that is frequently omitted from health reform discussions and research.The Massachusetts reform includes extensive changes that potentially affect workingage adults with and without disabilities, including Medicaid expansion, a new health insurance exchange, health insurance subsidies for low-and moderate-income people, mandates that adults who can afford insurance obtain insurance, new employer requirements intended to increase employer-sponsored coverage, insurance market reforms, and enrollment initiatives.2 Whether the changes affect people with and without disabilities similarly is not known and the potential for different effects exists.John Gettens, Ph.D., is a research scientist; Monika Mitra, Ph.D., is an assistant professor of family medicine and community health; Alexis D. Henry, Sc.D., is a research associate professor of psychiatry; and Jay Himmelstein, M.D., is a professor of family medicine and community health, all at

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Health care services can play a critical role in supporting people with disabilities to work and can sometimes be the difference between working and not working for those with disabilities (Henry, Long-Bellil, Zhang, & Himmelstein, 2011). The health insurance and service delivery reforms underway in the United States will benefit persons with disabilities; however, the reforms may not fully meet the employment-related health care needs of many persons with disabilities. Increasing employment among people with disabilities is an important policy goal of federal agencies, including the Social Security Administration (SSA),

Two health care reform initiatives-patient-centered medical home (PCMH) and payment reform-in combination have the potential to increase clinical pharmacy involvement in patient care. However, the effects of these reforms on clinical pharmacy are highly uncertain. In particular, which clinical pharmacy services will be provided, how the services will be requested and delivered, and in what practice settings the services will be provided are not known. To gain insight into future clinical pharmacy service delivery in the PCMH, the authors examined current clinical pharmacy service delivery models at 4 sites in Massachusetts and assessed how the service delivery would change in PCMH settings with a payment approach of comprehensive payments to the PCMH. The findings suggest that (1) clinical pharmacy participation in the PCMH will increase at ambulatory care sites if supported by payment reform and (2) changes in addition to payment reform will be necessary to increase participation of community pharmacists. Needed changes are described.

The smoking rate among non-elderly Medicaid enrollees is more than double the rate for those privately insured; smoking-related conditions account for 15% of Medicaid expenditures. Under state health reform, Massachusetts Medicaid (MassHealth) made tobacco cessation treatment available beginning in 2006. We used surveys conducted in 2008 and 2014 to examine changes in smoking abstinence rates among MassHealth members identified as smokers and to identify factors associated with being a former smoker. Members previously identified as smokers were surveyed by mail or phone; 2008 and 2014 samples included 3,116 and 2,971 members, respectively. Surveys collected demographic and health information, asked members whether they smoked cigarettes "every day, some days or not at all', and asked questions to assess smoking intensity among current smokers. The 2014 survey included an open ended-question asking members "what helped the most" in quitting or quit attempts. We observed a significant decrease in members reporting smoking "every/ some days" of 15.5 percentage points (p < .0001) from 2008 to 2014, and a significant decrease in smokers reporting smoking "more than 10 cigarettes on days smoked" of 16.7 percentage points (p < .0001). Compared to smokers, former smokers more frequently reported health concerns, the influence of family members, and the use of e-cigarettes as helping the most in quitting. Expanded access to tobacco cessation treatment under the Affordable Care Act may have help to reduce the high smoking rates among Medicaid enrollees. Additionally, smokers' concerns about health and the influence of family and friends provide opportunities for targeted intervention and messaging about quitting.