View Research by Author - Bowen Garrett

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

Congressional proposals health care reform proposals have differed in the premium rating rules that would be applied to non-elderly adults. Some have proposed allowing premiums for the older adults to be as much as 5 times as high as those for younger adults (5:1 rating), while others would limit the highest premiums to be twice that of the lowest (2:1 rating). This analysis uses the Health Insurance Policy Simulation Model (HIPSM) to compare the financial implications of the premium rating choice (5:1, 2:1, and 1:1) for households of different ages, incomes, and sizes.

This paper used the Health Insurance Policy Simulation Model to examine the impact on insurance coverage in government, employer, and family spending in all 50 states in absence of reform. In all states employer sponsored insurance would fall, and Medicaid enrollment and the number of uninsured would increase. Employer spending would increase despite drops in coverage. Government spending for public health insurance programs and for financing of uncompensated care would increase. The results differ among states depending on the distribution of employees by firm size and wage levels, the breadth of coverage in public programs and projected population growth.

In this analysis, a health reform scenario is modeled that would expand Medicaid to an estimated 17.0 million uninsured individuals with incomes up to 133 percent of the federal poverty level (FPL), would provide subsidies to 16.3 million uninsured individuals with incomes between 133 and 399 percent of the FPL, and would require an additional 4.3 million uninsured individuals to obtain coverage through an individual mandate, though they would not be eligible for Medicaid or subsidies. The first brief contains an overview of the entire nonelderly uninsured population, and the three remaining briefs address children, parents and childless adults, respectively.

Emotions are flaring as constituents speak their minds to members of Congress home for August recess. That's to be expected, since health care is both a personal and public issue, but let's not forget to debate the basics:

Under contract to the State of New York, researchers conducted in-depth micro-simulation analyses of four types of health care reforms being considered for state implementation: a single payer public health insurance option, Assembly Member Gottfried's New York Health Plus proposal that provides an option for all New Yorkers to enroll in Family Health plus, public-private hybrid options that simplify and expand existing public programs and reform private health insurance, and a market-based option that relies on regulatory flexibility and tax credits. The cost and coverage implications of state reform options falling into these four categories are presented in this report.

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.

This report uses the Health Insurance Policy Simulation Model (HIPSM) to quantify the intermediate and longer-term implications if America’s health care system is not significantly overhauled. Under a range of economic scenarios, the analysis shows an increasing strain on business owners and their employees over the next decade if reform is not enacted. There would be a dramatic decline in the number of people insured through employers, and millions more could become uninsured. There would be large growth in Medicaid/CHIP enrollment and spending, and increased spending on uncompensated health care. Middle-income working families would be the most affected.

In 2004, 89.4 percent of uninsured children who qualified for Medicaid or the State Children's Health Insurance Program lived in families who filed federal income tax forms. This substantially exceeds the proportion of uninsured but eligible children who can be reached through many other outreach strategies. Federal lawmakers could cover uninsured children in these families by: (a) changing federal income tax forms so parents can identify their uninsured children and request coverage; (b) investing in information technology allowing data exchange between states and the Internal Revenue Service; and (c) letting states cover uninsured children if tax information shows they qualify.

This policy brief examines the relationship between increases in the unemployment rate and changes in the number of people covered by employer-sponsored health insurance, Medicaid, and the number of uninsured. The analysis projects that if the unemployment rate rises to 7 percent in 2009, Medicaid and SCHIP enrollment would increase by 2.4 million and an additional 2.6 million people would become uninsured. The impacts would increase if the unemployment rate climbs even further. The report also estimates potential state costs for Medicaid, SCHIP and the uninsured, and the potential impact of proportional statewide budget cuts on Medicaid and SCHIP funding.

This paper reviews the recent economic research on the relationship between health insurance and labor markets in the United States, with an emphasis on research that has emerged since existing major reviews and the aim of identifying the types of data that are needed for this research to progress. We focus on the conceptual and empirical challenges that researchers face in studying these relationships, the data that have allowed this research to proceed, policy-relevant questions that need further study, and the types of data that would help in obtaining better answers to these questions. Inquiry, vol. 45, number 1, Spring 2008, pp. 30-57

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