Research by Author & Topic

Publications by John Holahan on Medicaid

Emotions are flaring as constituents speak their minds to members of Congress home for August recess. That's to be expected, since health care is both a personal and public issue, but let's not forget to debate the basics:

In this paper and brief, the authors discuss alternative ways that health reform could be financed. They analyze different options including several proposals for delivery system reforms and for reduction in Medicare and Medicaid payments. They estimate the cost savings that could occur due to the introduction of a public plan option. Finally, they explore a range of revenue options. The key message of the paper is that health reform can be paid for, but it is best to obtain funds from a large number of measures to spread the burden broadly.

This report uses the Health Insurance Policy Simulation Model (HIPSM) to quantify the intermediate and longer-term implications if America’s health care system is not significantly overhauled. Under a range of economic scenarios, the analysis shows an increasing strain on business owners and their employees over the next decade if reform is not enacted. There would be a dramatic decline in the number of people insured through employers, and millions more could become uninsured. There would be large growth in Medicaid/CHIP enrollment and spending, and increased spending on uncompensated health care. Middle-income working families would be the most affected.

In this Press-Enterprise (Riverside, California) commentary, John Holahan explains that Medicaid has done a good job of keeping costs under control and that its increase in spending is caused by the swelling number of enrollees, particularly in a weak economy. The 7 million people eligible for both Medicaid and Medicare are not dealt with in a cost-effective way, though, and transferring responsibility for them to the federal government would pave the way for health reform.

The commentary responds to a recent report from the Centers for Medicare and Medicaid Services (CMS) on future Medicaid spending growth. Medicaid spending growth will in fact be high but not probably as high as the CMS actuaries have forecast (7.9% per year). The evidence on Medicaid spending growth suggests that spending per enrollee in the Medicaid program has been held down to levels consistent with the medical care CPI and increases in GDP. The main cost driver has been enrollment growth - hard to address when the number of uninsured is rising. Further spending restraint could come from more efficient care for Medicaid's dual eligibles.

On August 28, 2007, the Census Bureau reported that the number of nonelderly uninsured had increased by 2.1 million in 2006. Of the 2.1 million non-elderly uninsured, 1.4 million were adults and 710,000 were children (age 18 and under). In this paper we show that children experienced declines in employer-sponsored coverage at all income levels. The largest growth in uninsured children (48%) occurred among those in middle-income families (between 200 and 399% of poverty) because there was no increase in Medicaid and SCHIP to offset the decline in employer sponsored coverage.

About 2.5 million New Yorkers were uninsured in 2005, and medical providers that serve them incurred some $2.8 billion in uncompensated care. Two separate analyses in this report agreed on this estimate, one using provider cost reports and the other household survey data. Budgetary and other sources showed that state, local, and federal governments supplied about $3.5 billion in revenues that offset these costs, through a complex mix of programs. If these uninsured people had all had insurance for the full year, their projected medical spending would have been higher by about $4.1 billion. Any insurance expansion program would incur these and additional costs as well.

This paper profiles cost changes in Missouri's Medicaid program between 2001 and 2005. Missouri’s Medicaid expenditures increased by almost 50 percent (from $4.2 billion to $6.3 billion), predominately due to increases in enrollment, as well as changes in case mix. This report analyzes the growth in Medicaid spending using data provided by the Missouri Department of Social Services on expenditure by eligibility group and service category.

A major increase in coverage for the uninsured in Missouri can only be achieved with significant governmental financial intervention. This report discusses the issues surrounding employer and individual subsidies. Background data on the uninsured in Missouri and national data on the employer offer and take-up rates are provided. The paper describes how employer and individual and family subsidies could be structured and discusses the challenges with each approach. Included are recommended strategies for expanding coverage in Missouri.

This in-depth report compares and reviews linkages among costs, access, and utilization of health care services for individuals covered by Medicaid with those covered by private insurance, and those who have no health insurance. The report examines the evidence on whether the growth in Medicaid spending is greater then what has been observed in the private sector. It then considers how well Medicaid works at providing health care to program beneficiaries, relative to both the care Medicaid beneficiaries would have received if uninsured and the care they would have received with private insurance.