When former Governor Mitt Romney signed Massachusetts' health care reform in 2006, it was a major step in providing near-universal health insurance to the citizens of the state and became commonly known as "Romneycare."

Six years later, when Romney decided to run for the White House as the Republican presidential nominee, he had a hard time distancing himself from Obamacare since it was essentially "Romneycare" at the national level.

There are a number of similarities between the two programs, from insurance exchanges to individual insurance purchases to providing subsidies to people who can't afford it, but the incurring costs of these landmark laws needed more scrutiny.

That's when the American Heart Association decided to evaluate further when they embarked on a study weighing hospital and care costs of Massachusetts' health care system. The statewide examination found that the law did not result in any accretion of hospital use or higher costs

The findings were presented at the AMA's Quality of Care and Outcomes Research 2013 Scientific Sessions in Baltimore, Maryland.

"In light of the Affordable Healthcare Act, we wanted to validate concerns that insurance reform would lead to dramatic increases in healthcare use and costs," said Amresh Hanchate, Ph.D., lead author of the study and an economist at the VA Boston Healthcare System and assistant professor at Boston University School of Medicine. "We were surprised to find little impact on healthcare use."

The study gathered information from 2004 to 2010 on more than 2.6 million patients between the ages 18 and 64 who were discharged from 66 short-term acute care hospitals in the state.

Before the health care reform, quarterly admissions for each hospital between 2004 and 2006 was 1,502. Afterwards, from 2008 to 2010, the average admissions were 1,557, which was a 3.6 percent increase compared to a 3.3 percent increase in the comparison states.

"Changes we saw in Massachusetts are very similar to those we saw in New Jersey, New York and Pennsylvania - states without reform," Hanchate added.

In addition, researchers found that the total number of days for inpatient care increased by 0.94 percent, while comparison states only rose 0.8 percent.

With regard to hospital charges, costs per quarter increased by 1.1 more in Massachusetts compared to the other states, and hospital use increased 2.8 percent for the newly insured African-Americans and 4.5 percent Hispanics.

"These results are more applicable for states similar to Massachusetts in terms of the current health care system and government policy," Hanchate said. "Because states vary a lot, it's hard to say how this would compare for the rest of the country."

According to the Kaiser Family Foundation, who did a study of Romneycare six years after its implementation, residents are receiving more preventive care amenities. Particularly, low-income families have gotten more access to health care services from safety net providers. However, affordability remains an issue. For instance, health spending per capita is 15 percent higher than the national average, and Massachusetts still has one of the highest individual market premiums in the national, despite recent lags in premium growth.

Another concern, according to Ashish K. Jha, physician and health policy researcher at Harvard School of Public Health, is the increased strain on current primary care physicians to treat the newly insured residents of Massachusetts. When the state's health care system, officially known as "An Act Providing Access to Affordable, Quality, Accountable Health Care," took over, nearly 300,000 became newly insured.

"As these folks rushed in to see primary care physicians, all the empty spots filled up," Jha pointed out on his blog, An Ounce of Evidence. "The primary care offices got overwhelmed, and access for everyone else was diminished." This concern is also a national problem. A recent study has shown that population growth and aging could increase visits to doctor's office to 565 million by 2025, compared to 462 million in 2008. The study also said insurance expansion would entail more than 8,000 additional primary care physicians, which is a three percent increase in their field.

Regarding the Massachusetts health system, the Kaiser Foundation also added that, "While much of the Affordable Care Act was modeled on Massachusetts reform, the state must still make significant changes before 2014 in order to fully comply with the new provisions. Given the parallels between Massachusetts' health reform and federal reform, the state's experience can provide valuable insights into the future of ACA implementation."

Study co-authors: Karen E. Lasser, M.D., M.P.H.; Danny McCormick, M.D., M.P.H.; Nancy R. Kressin, Ph.D.; and Chen Feng, M.A.