Research by Author & Topic

Publications by John Holahan on Economy

Many of Massachusetts's health reforms have brought about positive change: the number of uninsured has fallen by half, access to needed care has increased, and private insurance has not been "crowded out" by public insurance programs. But the Massachusetts initiative has also seen higher than anticipated costs. In a new analysis, John Holahan and Linda Blumberg summarize the state's accomplishments, examine the challenges, and suggest four options for addressing long-term costs. According to the authors, much of Massachusetts's high spending growth is due to the concentration in the state's hospital and insurance markets.

This Web Exclusive analyzes the changes in insurance coverage between 2000 and 2004 and finds that the six million increase in the number of uninsured all was among adults. Although both adults and children experienced a 4.6 percentage point drop in the share with employer-sponsored coverage, children were much more likely to obtain public coverage than adults. The analysis also documents that there was a shift from working in industries that historically have had high rates of employer coverage to those with low coverage rates, and from large and medium-sized firms to small firms and self-employment. (Health Affairs Web Exclusive, November 2005)

In this report we examine how ten states (Alabama, California, Colorado, Florida, Massachusetts, Michigan, New Jersey, New York, Texas, and Washington) from around the nation have responded to their budget crises in fiscal year 2004. While states vary in the depth of the budget pressures they faced, all were required to make difficult choices among spending reductions, tax increases, or other revenue measures. In general, we found states with few exceptions to be unwilling to engage in significant increases in personal or corporate income taxes or sales taxes. However, other revenue measures, e.g., cigarette and alcohol taxes, were adopted more broadly. States did continue the pattern of recent years of drawing on reserves or rainy day funds, transferring monies from dedicated trust funds and shifting spending or taxes across time periods to address current shortfalls.

In this report we examine how Michigan responded to its budget crisis in fiscal year 2004. While states vary in the depth of the budget pressures they faced, all were required to make difficult choices among spending reductions, tax increases, or other revenue measures.

In this report we examine how Washington responded to its budget crisis in fiscal year 2004. While states vary in the depth of the budget pressures they faced, all were required to make difficult choices among spending reductions, tax increases, or other revenue measures.

This brief explores the factors behind the 25% increase in Medicaid spending that occurred between fiscal years 2000 and 2002. It concludes that the spending increases have been driven by enrollment increases resulting from the loss of income and private insurance during the current economic downturn together with rising health care costs, particularly prescription drugs, which have affected the entire health care sector. Despite slower enrollment growth for the aged and disabled and for children and non-disabled adults, the aged and disabled accounted for almost 60% of the spending growth. Although current growth rates are clearly high relative to state fiscal capacity, per enrollee spending growth is below levels seen in the private health care market.

In this Health Policy Online brief, John Holahan and Alan Weil examine the changes in state and federal incentives and options that would likely take place if Medicaid is transformed from an entitlement program into a block grant. They find that such a move would discourage expansions of the program, increase incentives to contract, lock in the current inequities in federal payments across states, add only marginally to the flexibility states already have, and shift risk to the level of government less able to absorb it.

In this analysis, the authors estimate the effect of increased unemployment rates on Medicaid enrollment, the impact of increased enrollment on Medicaid expenditures, and simulate the effects that increased federal matching rates might have on state Medicaid expenditures.

[Washington Post] Although some profess to see little difference between the health care proposals of Vice President Gore and former senator Bill Bradley, the two Democratic presidential candidates do in fact offer very different answers to the key questions: Who deserves help buying insurance, who should pay for it, and how much? The plans merit careful analysis and a fair debate, which could clarify a number of choices for all American voters.

There are two Highlights for each state. The Highlights that focus on health cover Medicaid, other public insurance programs, the health care marketplace, and the role of public providers. The Highlights capture policies in place and planned in 1996 and early 1997.