Health Policy Center
A. Bowen Garrett, Ph.D., is an economist and senior fellow in the Health Policy Center at the Urban Institute. His research focuses extensively on health reform and health policy topics, combining rigorous empirical methods and economic thinking with an understanding of the policy landscape to better inform policymaking. He led the development Health Insurance Policy Simulation Model (HIPSM) and conducted numerous studies of the likely effects of alternative reform proposals for the Obama Administration, the state of New York, and private foundations. He has written extensively on employer-sponsored insurance, Medicaid and the uninsured, and Medicare's prospective payment systems.
Previously, Dr. Garrett was chief economist of the Center for US Health System Reform and McKinsey Advanced Health Analytics (MAHA) at McKinsey & Company (2010-2013). He is a research associate in the Info-Metrics Institute at American University and has taught quantitative methods and economic statistics at Georgetown University. He was a post-doctoral research fellow in the Robert Wood Johnson Foundation's Scholars in Health Policy Research Program at the University of California, Berkeley (1996-1998), and received his Ph.D. in economics from Columbia University in 1996.
Redistribution Under the ACA is Modest in Scope (Policy Briefs/Timely Analysis of Health Policy Issues)
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Claims that the ACA involves "the largest income transfer in American history" are exaggerated. Low- and moderate-income people receive benefits equaling 0.9 percent of GDP, a fraction of spending on Medicare, Social Security, and tax preferences for employer-sponsored insurance. The affluent contribute just 0.2 percent of GPD, with taxes limited to 2.4 percent of tax-filers, who pay an average of 0.5 percent of income. Nearly three-quarters of ACA's funding comes, not from the wealthy, but from the health care industry, through reimbursement cuts or taxes and fees. However, these contributions are offset by new revenue from people gaining health insurance.
Expectations for Health Care Quality, Access, and Costs in 2014 (Policy Briefs/Health Policy Briefs)
|Posted to Web: February 12, 2014||Publication Date: February 14, 2014|
Widespread skepticism of and public opposition to the Affordable Care Act (ACA), even among those likely to benefit from the new law, has been reported since the law was passed in 2010. In December 2013, for example, a New York Times/CBS News poll reported that uninsured people were confused about the law and worried that it would increase their health care costs. As a consequence, 6 in 10 said they had not looked into coverage and subsidy options in their state Marketplace. In contrast to general sentiment questions in other public opinion surveys, this brief examines Americans’ specific health-related expectations in order to preview potential post-reform concerns and provide insight about the trade-offs that people may make as they confront the ACA’s new provisions, focusing on how people expect the quality, access, and cost of their health care to change in 2014.
Early ACA Market Reforms: Who Has Been Affected So Far? (Policy Briefs/Health Policy Briefs)
|Posted to Web: February 07, 2014||Publication Date: February 04, 2014|
Attention to the effects of the Affordable Care Act (ACA) has largely focused on the rollout of the health insurance Marketplaces in late 2013 and the Medicaid expansions and Marketplace subsidies that took effect at the start of 2014. Yet the ACA includes many other changes and consumer protections in the private insurance market that began as early as September 2010. The goal of these early market reforms, many of which have received little attention, was to address coverage and benefit gaps in the pre-reform health insurance market. These include reforms ensuring that children with pre-existing conditions could gain stable coverage and expanded access to coverage for young adults. This brief explores whether the effects of the early market reforms have been felt on the ground by examining respondents’ reports of whether they or their families were affected by any of these early ACA provisions.
Midwifery Care at a Freestanding Birth Center: A Safe and Effective Alternative to Conventional Maternity Care (Research Report)
|Posted to Web: February 06, 2014||Publication Date: January 21, 2014|
The Family Health and Birth Center in Washington, D.C. provides accessible, culturally appropriate prenatal care and delivery services to low income women. This study of the outcomes of care at that center improves on previous research by controlling for risk selection into birth center care. We find that women who receive at least two prenatal visits from birth center midwives regardless of whether they deliver at the center or in a hospital—are less likely to have a C-section and less likely to have an induced delivery. They have fewer preterm babies and their babies have higher birth weights.
How Will the Affordable Care Act Affect Jobs? (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: May 09, 2013||Publication Date: April 16, 2013|
In this report, the authors examine how the Affordable Care Act (ACA) will impact labor costs and the demand for labor. They conclude that the ACA will not have noticeable effect on net levels of employment for three reasons - (1) the net new expenditures are too small relative to the overall size of the economy; (2) the negative effects on jobs of Medicare premium cuts and new taxes will be offset by the expansion of coverage through Medicaid and income related subsidies that will likely increase employment; and (3) the new law will not affect the most firms either because they already provide private insurance that meets federal standards or they are exempt from the new requirements because they employ fewer than 50 workers.
Employer-Sponsored Insurance under Health Reform: Reports of Its Demise Are Premature (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: March 21, 2011||Publication Date: March 21, 2011|
Some have argued that the Patient Protection and Affordable Care Act would erode employer-sponsored insurance (ESI) by providing incentives for employers to stop offering coverage. Others have claimed that most businesses would face increased costs as a result of reform. A new study finds that overall ESI coverage under the ACA would not differ significantly from what coverage would be without reform. The average employer contribution per person covered by ESI would decrease by nearly 8 percent for small firms and would decrease slightly for larger firms. Total employer health care spending would be 0.6 percent lower under the ACA.
Why the Individual Mandate Matters: Timely Analysis of Immediate Health Policy Issues (Policy Briefs/Health Policy Briefs)
|Posted to Web: February 01, 2011||Publication Date: January 25, 2011|
With conflicting rulings about the constitutionality of the individual mandate in the Affordable Care Act (ACA), we are left to wonder: what would the ACA look like if its individual mandate was dropped? A new report using the Urban Institute's Health Insurance Policy Simulation Model (HIPSM) shows that the number of uninsured would be cut by more than half with the mandate, but by only about 20 percent without the mandate. Uncompensated care would decline by $42.4 billion under the ACA, but only by $14.7 billion under reform without a mandate because of the large number of people remaining uninsured.
America Under the Affordable Care Act (Research Brief)
|Posted to Web: December 23, 2010||Publication Date: December 20, 2010|
Using the Urban Institute's Health Insurance Policy Simulation Model (HIPSM), the authors estimate how the Patient Protection and Affordable Care Act would affect health insurance coverage and spending on acute care for the nonelderly. They find that, for example, under the ACA, the number of nonelderly adults without health insurance would decline by 27.8 million, the cost of uncompensated care provided to the uninsured would drop by 61 percent, the Medicaid expansion would enroll 16.8 million more people, and 43.8 million would be covered through health insurance exchanges (both nongroup and SHOP).
Medicare Payment Adjustment for Inpatient Psychiatric Facilities: A Review and Potential Refinements (Research Report)
|Posted to Web: December 07, 2010||Publication Date: December 01, 2010|
In 2005, CMS implemented a prospective payment system (PPS) to pay for Medicare services provided by inpatient psychiatric facilities (IPFs). Using FY 2003 administrative data, this study independently replicates the analyses used in developing the IPF PPS. It considers alternative comorbidity classifiers and conducts the first facility-level analyses of the IPF-PPS. Payments are found to vary less than proportionately with costs at the facility level, suggesting payments may not fully reflect the higher costs of facilities that treat sicker patients. It also demonstrates how an expansion of the current set of comorbidities would more closely match payments to patient costs.
Development of Updated Models of Non-Therapy Ancillary Costs (Research Report)
|Posted to Web: November 08, 2010||Publication Date: November 08, 2010|
This memo updates models of non-therapy ancillary (NTA) costs for skilled nursing facilities (SNFs) designed to improve the accuracy of Medicare payments to SNFs. Using 2007 data for SNF stays provided by CMS, we obtain estimates that are qualitatively similar to those we obtained using 2003 data. The revised models add new variables suggested by CMS and exclude variables identified as being difficult to administer. Parsimonious models are estimated that can explain up to 22 percent of cost variation. The findings suggest that a range of options are available that would greatly improve the accuracy of Medicare payments.
|Posted to Web: November 05, 2010||Publication Date: October 15, 2010|
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