Citation URL: http://www.urban.org/AllisonCook

Medicaid provides a strong platform on which reform efforts to expand health insurance coverage can be built as two-thirds of the nation’s uninsured are low-income. Medicaid coverage could be broadened to reach more of the low-income uninsured by eliminating categorical restrictions and establishing a national eligibility standard based on income. This paper analyzes several options for expanding Medicaid using various income eligibility thresholds for adults and children under both current and enhanced participation rates. The analysis shows coverage and cost implications of the options, as well as impacts by region and with payment rates adjusted to promote provider participation.

With the reauthorization of the State Children’s Health Insurance Program (SCHIP) under consideration in early 2009, an important question is the extent to which uninsured children could be covered under employer-sponsored insurance (ESI) through premium assistance programs. Only 440,000 uninsured children who are eligible for Medicaid or SCHIP have at least one parent with ESI coverage. Since many more uninsured children are eligible for public programs than have access to ESI through their parents, policies to increase enrollment and retention in Medicaid and SCHIP have much greater potential than premium assistance programs to close coverage gaps among children.

This comparative case study describes the organization, delivery, and content of care of three maternity care models serving low-income women at risk of poor birth outcomes in Wards 5, 6, and 7 in Washington D.C. The first model, a birth center, provides prenatal care, birth services, postpartum follow-up, and infant and child health care. The second is a safety net clinic, which provides a variety of primary health care services, as well as prenatal care services. A not-for-profit teaching and research hospital represents a third option in which prenatal and postnatal care is provided through an on-site obstetric clinic.

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.

Researchers from the Urban Institute and the State of Massachusetts explored why existing surveys generate very different estimates of the uninsurance rate in Massachusetts. The surveys they examined are the Current Population Survey (CPS), the Behavioral Risk Factor Surveillance System (BRFSS), the Massachusetts Health Insurance Survey, and the Massachusetts Health Reform Survey (MHRS). This brief described how estimates may vary because of differences in the wording of the insurance questions asked in the surveys, differences in question placement and context within the survey, differences in survey design and fielding strategies, differences in accounting for missing data and other data preparation, and differences in survey fielding time frames. The analysis concludes that there has been no single survey in Massachusetts that is clearly superior across all of these important dimensions.

The number of uninsured Americans increased by 3.4 million between 2004 and 2006, despite improving economic conditions. In the first four years of the decade, during a period of economic recession, the number increased by 6.0 million. The dominant factor in both periods was a decline in employer-sponsored insurance coverage. Although the recent decline was less than that experienced from 2000 to 2004, growth in public coverage was small, and the number of uninsured people increased by 1.0 million children and 2.4 million adults. Employer coverage declined most for self-employed or small-firm workers, in the South, and among noncitizens.

DC fares better than the nation as a whole in the share of its population that is uninsured. Lower rates of employer-sponsored coverage are more than offset by higher rates of public coverage. The District's relatively generous Medicaid eligibility standards, and the DC HealthCare Alliance, a locally funded coverage program, contribute to the high share of publicly insured residents. Although all low-income individuals are eligible for either Medicaid or the Alliance, some 66,000 residents remain uninsured. These are among the findings of this data brief on insurance status in DC by age, employment, income, family status, and health status.

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.

In July 2007, bills to reauthorize the State Children's Health Insurance Program were passed in both the House and the Senate. One question that has been raised is how well the bills target low-income children. In this brief, Genevieve Kenney and colleagues estimate that the proportion of children below 200 percent of the Federal Poverty Level (FPL) covered by the bills is 70% or higher. The share of uninsured children below 200 percent of the FPL who would gain coverage is estimated to be even higher (78 to 85 percent).

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.

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