Research by Author & Topic

Publications by Stephen Zuckerman on Medicaid

New data on health insurance coverage from the American Community Survey show extensive variation in rates of private and public coverage and uninsurance across congressional districts in the United States. Rates of private coverage are lowest in districts that have higher poverty rates which tend to be concentrated in the South and West and uninsurance remains most serious in districts with low rates of private coverage. This analysis identifies the districts in which residents would have the most to gain from health reforms that are designed to increase health insurance coverage toward a higher and more uniform national standard.

This article examines experiences under Medicaid and the State Children's Health Insurance Program (SCHIP), drawing on surveys of over 3,000 enrollees in California and North Carolina in 2002. In both States, Medicaid enrollees were less likely than SCHIP enrollees to have parents who were covered by employer-sponsored insurance (ESI). With the exception of dental care and provider perceptions, access experiences were fairly comparable across the two programs, despite differences in the characteristics of the children served by the two programs. Relative to being uninsured, Medicaid enrollment was found to improve access to care along a number of different dimensions, controlling for other factors. Furthermore, this study emphasizes the need for continued evaluation of access to care for both programs.

Using state survey data, researchers examined Medicaid supplemental payments, including disproportionate share hospital and upper payment limit payments in 2005 and changes in these payments between 2001 and 2005. The researchers found that states increased their use of general funds in financing Medicaid DSH payments while expanding the size and scope of other supplemental payments considerably. Although the federal government has made some headway in reforming state Medicaid financing in recent years, the paper concludes that problems persist and more work remains.

One of the more prominent concerns in the SCHIP reauthorization debate is that many children enrolling in the program could have been insured through their parents' employers. However, concern about parents dropping employer coverage to enroll their children in SCHIP typically ignores the affordability of that coverage. We show that families' spending burden is, on average, lower under public insurance than under employer-sponsored insurance (ESI), especially for the lowest-income families. For families in which children are covered by Medicaid or SCHIP, out-of-pocket spending is, on average, 4 to 5 percent of their income. However, for families in which children have ESI for a full year, the out-of-pocket spending burden is higher, ranging from 12.9 percent of income for families below 150 percent of the federal poverty level (FPL) to 6.1 percent for families between 250-400 percent of FPL.

This study, funded by the Maine Health Access Foundation, presented alternative estimates of the costs of health care that uninsured Maine residents receive and determined how much public revenue was available to offset those costs. Using data from health care providers, the study estimated that the costs of caring for the uninsured in Maine were $138 million in 2005, with hospitals and Veterans' Affairs facilities identified as the largest providers. Estimates based on household survey data from the Medical Expenditure Panel Survey showed that uncompensated care costs for the uninsured were only $81 million in 2005. The report discusses possible reasons for the large discrepancy between these two sources. Our review of federal and state funding sources in 2005 suggests there were roughly $110 million available to offset these costs of caring for the uninsured.

The Maine Health Care Access Foundation funded this profile of Maine health insurance coverage. According to data from the Current Population Survey, 124,000 Maine residents did not have health insurance during the 2004–2005 period. The majority (84%) of uninsured people were adults. Just over half of Maine residents who were uninsured came from low-income families residents. Low-income young adults (ages 19–34) were particularly at risk for being uninsured, and one-quarter lacked coverage. Over 86,000 of Maine's uninsured people were workers. Forty-seven percent of this uninsured group were low-income, over half (55%) were employed by firms with fewer than 25 workers, and just over two-thirds worked in industries with low rates of job-based health coverage. Over two-thirds (67%) of Maine's uninsured people came from families with one or more full-time worker, while another 19 percent are from families with a part-time worker.

This data brief documents the decline in health coverage from employer-sponsored insurance (ESI) for low-income adults and children between 2000 and 2004 and how this varied across states. During this period, uninsurance rates for low-income children fell by more than 2 percentage points, because Medicaid and SCHIP coverage expanded to offset the reduction in ESI. Without public programs serving as the same coverage safety net, uninsurance rates for low-income adults increased nearly 3 percentage points in the same period. The data brief shows that public coverage offset the reduction in ESI for children in states with large and moderate reductions in ESI.

This study examines trends in insurance coverage by geographic area and by subgroups such as age, ethnicity, income, and firm size. It also analyzes differences in the types of insurance that people have in large cities compared to rural communities and small cities throughout Missouri.

This paper explores the key features of four essential federal-state-local programs that have offered supports to low-income families and individuals in the aftermath of Hurricane Katrina -- housing, unemployment compensation, Medicaid, and Temporary Assistance for Needy Families. It argues that the complexity of their structures and limited scale have inhibited their ability to respond effectively and quickly to the needs created by Hurricane Katrina. It recommends that national policymakers develop a set of disaster relief mechanisms better suited to address the large-scale cross-jurisdictional migration, diminished state fiscal capacity, increased demand for assistance, and other challenges that major disasters present.

Hurricane Katrina destroyed much of the New Orleans health care system. The devastation was especially profound for the low-income uninsured, most of whom depend heavily on a handful of providers. Focusing on the low-income population, this essay examines some of the early responses to the many health care issues that surfaced in Katrina's wake, and discusses emerging issues that both private and public decisionmakers will face. One potential strategy for rebuilding is a health care safety net based on a continuum of care to low-income residents, integrating a network of community clinics with a new but smaller Charity Hospital.