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.
The Need to Reform Medicare's Payments to Skilled Nursing Facilities is as Strong as Ever (Research Report)
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Well-documented shortcomings in Medicare's payment system for skilled nursing facilities (SNFs) have prompted many revisions to the system. This study finds that Medicare's payments to SNFs for therapy and non-therapy ancillary (NTA) services are the least accurate they have been since 2006. Payments are less reflective of cost differences across both stays and facilities and payments are less proportional to costs. An alternative design that would base payments on patient characteristics and establish separate payments for NTA services would increase payment accuracy and dampen the incentives to furnish excessive therapy and avoid patients with complex medical needs for financial gain.
Monitoring the Impact of the Affordable Care Act on Employers: Literature Review (Research Report)
|Posted to Web: January 15, 2015||Publication Date: January 15, 2015|
In this report, we analyze recent trends in the employer health insurance market and the anticipated effects of the Affordable Care Act on employers, with a particular focus on small firms with fewer than 50 workers. We first present a detailed picture of the employer market by identifying preexisting trends in key outcomes that could be incorrectly attributed to the Affordable Care Act. We also analyze the literature to identify economic factors that are important in current employer and employee decisions regarding health coverage.
Potential Medicaid Cost Savings from Maternity Care Based at a Freestanding Birth Center (Article)
|Posted to Web: October 23, 2014||Publication Date: October 23, 2014|
Compared to usual obstetrical care, care by midwives at a birth center could reduce costs to the Medicaid program. This article examines whether such care reduces Medicaid costs for low income women using results from a prior study of maternal and infant outcomes at the Family Health and Birth Center in Washington, D.C. Costs to Medicaid are derived from birth center data and from national sources. Birth center care could save an average of $1,163 per birth. Policy makers should consider a larger role for midwives and birth centers in maternity care for low-risk pregnant women with Medicaid.
Little Evidence of the ACA Increasing Part-Time Work So Far (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: September 17, 2014||Publication Date: September 09, 2014|
This brief examines whether the Affordable Care Act (ACA) has increased part-time work using recent Current Population Survey data. We find a small increase in part-time work in 2014 beyond what would be expected at this point in the economic recovery, attributable to an increase in involuntary part-time work. The increase is not specific to part-time work as defined by the ACA (less than 30 hours per week). Moreover, job transition patterns suggest that the increase in part-time work in 2014 is more likely due to a slow recovery of full-time jobs following the Great Recession than the ACA.
The Best Evidence Suggests the Effects of the ACA on Employment Will Be Small (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: September 03, 2014||Publication Date: September 03, 2014|
A recent report by the CBO concluded that the ACA could reduce the number of people working, almost entirely because workers would choose to work less due to incentives in the law. This report places the ACA and its employment effects in the context of other social programs. It assesses the evidence on likely employment effects from four recent and directly relevant studies. The best evidence to date suggests the employment effects of the ACA are likely to be small, and that the CBO estimate may be toward the high end of the range of potential ACA effects on employment.
Who among the Uninsured Do Not Plan to Look for Health Insurance in the ACA Marketplaces? (Policy Briefs/Health Policy Briefs)
|Posted to Web: April 29, 2014||Publication Date: April 29, 2014|
New enrollment figures for both state and federal health insurance Marketplaces created by the Affordable Care Act (ACA) show that participation picked up steam after a slow start. Previous research suggests that the initial low levels of Marketplace enrollment were driven as much by gaps in awareness of the ACA's coverage provisions as by the widely publicized problems with the federal website. For example, only about one-third of adults had heard some or a lot about the Marketplaces on the eve of the Marketplace rollout. By December 2013, about one-fifth of uninsured adults had looked at that time and another third planned to look. Additional research finds that many uninsured are not looking for coverage in the Marketplaces because they are unaware that financial help is available there.
Redistribution Under the ACA is Modest in Scope (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: April 01, 2014||Publication Date: March 21, 2014|
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.
|Posted to Web: May 09, 2013||Publication Date: April 16, 2013|
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