Research by Author & Topic

Publications by Sharon K. Long on Medicaid

Massachusetts began an ambitious push toward near universal health insurance coverage in 2006. This policy brief provides an update of the impacts of health reform in Massachusetts on insurance coverage as of Fall 2008 for working-age adults, the primary target population of the reform initiative, along with an update on support for health reform in the state. Findings demonstrate that the state has achieved its goal of near universal health insurance coverage and that state residents continue to show strong support for health reform, even in the face of increasing program costs and the recession that began in December 2007. Given the success of the coverage expansion, Massachusetts policymakers are turning to the next phase of health reform - reigning in health care costs.

Urban Institute researcher Sharon Long answers five questions about Massachusetts's landmark health reform experiment, which aims for near-universal coverage and improved access to affordable health care. In 2006, lawmakers passed a bill that required most adults to get health insurance, expanded Medicaid, provided subsidies for lower-income adults, created a health insurance exchange where residents can buy plans easily, and required employers to offer coverage or pay a fee. Early success has made the state a model for nationwide reform.

Massachusetts continues to move forward on comprehensive health reform, with improvements in coverage, access to care and the affordability of care in the state. This policy brief provides a supplement to a recent Health Affairs article on health reform in Massachusetts, examining geographic and racial/ethnic differences in access to care and affordability of care across the commonwealth in Fall 2008.

The Urban Institute, along with its subcontractor, International Communications Research, conducted the 2008 Massachusetts Health Insurance Survey (HIS) for the Massachusetts Division of Health Care Finance and Policy to obtain information on health insurance coverage and access to and use of health care for the non-institutionalized population in Massachusetts. This report provides information about the methods used to collect and analyze the 2008 HIS data.

The Urban Institute, along with its subcontractor, International Communications Research, conducted the 2008 Massachusetts Health Insurance Survey (HIS) for the Massachusetts Division of Health Care Finance and Policy to obtain information on health insurance coverage and access to and use of health care for the non-institutionalized population in Massachusetts. This report summarizes the results of that new survey, including the finding that more than more than 97 percent of Massachusetts residents have health insurance, with only 2.6 percent of state residents remaining uninsured.

We know that health insurance coverage rose dramatically in the past year in Massachusetts. This study examines what the effect has been on specific populations, finding that the greatest gains in insurance coverage were reported by lower-income adults, younger adults and those in minority groups. Further, the reductions in uninsurance tended to be largest for subgroups that started out with higher levels of uninsurance.

Although health insurance coverage rose dramatically in the past year in Massachusetts, some questioned whether health reforms simply moved people from being uninsured to underinsured. This study explores whether requiring individuals to have health insurance has forced some people, particularly those with modest incomes, into plans that offer little financial protection. The findings suggest, however, that health reform in Massachusetts is both providing new coverage for many of those who were previously uninsured and improving the quality of coverage for those with insurance coverage.

In April 2006, Massachusetts enacted a health care reform bill that seeks to move the state to (almost) universal coverage through a combination of Medicaid expansions, subsidized private health insurance coverage, and insurance reforms. As part of an evaluation of the impacts of the state's reform effort, we conducted surveys of adults aged 18 to 64 years old in Massachusetts in Fall 2006 and Fall 2007. This document provides an overview of the survey approach and the two survey instruments.

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.

This study uses survey data linked with claims data to examine the consequences of unmet need for future health care use for a sample of disabled Medicaid beneficiaries. The findings show that self-reported unmet need is a strong predictor of future health care use for disabled Medicaid beneficiaries, including a greater reliance on emergency rooms and hospital care for conditions that potentially could be handled in less expensive settings. Addressing the barriers to care that underlie unmet need could generate cost savings to Medicaid and provide better health outcomes for program beneficiaries. (Inquiry, 42, 4, Winter 2005/2006. pp. 413-420)