View Research by Author - Frank C. Ullman

Publications

In recent years, New Jersey has substantially expanded its role in health financing. Public coverage has increased, especially for low- and moderate-income children, and so has public oversight of private coverage. This is a marked shift from the prior era of active public retrenchment and downsizing. During the early to mid-1990s, the state had been implementing hospital deregulation, major reductions in support for hospital uncompensated care, cuts in hospital and nursing home rates, and mandatory Medicaid managed care for cash-assistance beneficiaries. Such downsizing had been prompted both by economic downturn and a shift in political philosophy as Republicans assumed control of the governorship and both houses of the legislature in the early 1990s.

To contain Medicaid costs during the late 1990s, Michigan shifted from a fee-for-service system to a system dominated by HMOs. While Medicaid cost increases have moderated under managed care, state officials worry about growth in pharmaceutical expenditures. These currently absorb 15 percent of the Medicaid budget and are increasing more rapidly than any other Medicaid service. In 1998, Michigan received approval for a Medicaid waiver to establish a statewide Medicaid managed care program for long-term recipients of mental health, substance abuse, and developmental disability services. The Department of Community Health contracts with local or regional Community Mental Health Service Programs (CMHSPs) to manage and provide Medicaid mental health, substance abuse, and developmental disability services and supports under a prepaid, shared-risk arrangement.

Major expansions of public coverage for low-income people have dominated Massachusetts's health policy since the mid-1990s. The state in 1997 expanded Medicaid enrollment by almost a third. The expansions, along with high rates of employer-sponsored insurance, have dramatically reduced uninsurance.

Mississippi suffers from the dual problem of a large poor population with significant health care needs and a small state budget with which to meet these needs. An important policy issue is the maximization of federal dollars available to support the state's health programs. Mississippi's Medicaid match rate is the most favorable in the nation, and Medicaid is viewed as a potential revenue generator for the state. Despite recent progress, however, rapidly increasing budgetary pressures have made any program expansions unlikely for the near future and may threaten earlier gains in eligibility and enrollment.

This study analyzed associations between income eligibility criteria under SCHIP and state characteristics, finding that higher proportions of uninsured children, higher state per capita income, and lower pre-SCHIP eligibility thresholds were statistically associated with larger increases in eligibility thresholds. These findings suggest that states with previously low levels of coverage may be “catching up” to those with historically more generous programs. (American Journal of Public Health 2001 September; 91(9): 1449-1451).

National policy makers focus on insurance coverage from a national perspective—expanding it (or not) or re-engineering it (or not), noted this article on gaps in insurance and emerging options in safety-net systems. Interest in promoting insurance for all has for the moment waned, though the number of uninsured Americans has generally increased for over a decade. The ultimate backstop for uninsured access is the local safety net, dominated by hospitals and clinics with a mission to serve the underserved. Federal policy mandates limited hospital access to emergency hospital care, but only indirectly influences general provision of care. General safety net access is left for local provision of care and, usually, local funding. Insurance policy, public and private, is pressuring the hospital-based safety net through payment cuts and managed care shifts in patterns of delivery. Some localities are experimenting with new organizational arrangements. Their experience suggests some policy options for the twenty-first century. The safety net ought to get more policy attention at higher levels of government. (Journal of Legal Medicine 2001 April; 22(2): 247-262).

Three-quarters of low-income children and 60 percent of all children without health insurance live in families that participate in the National School Lunch Program, the Food Stamp program, the Special Supplemental Program for Women, Infants and Children (WIC), and the Unemployment Compensation Program. The research is based on the 1997 National Survey America's Families and includes state-specific information for 13 states.

This report examines spending on SCHIP programs relative to federal allotments to states in the early years following the enactment of SCHIP and discusses the pros and cons of different options for reallocating unspent SCHIP funds.

Researchers studied the impact of public hospital closures or conversions in Milwaukee, Boston, Tampa, Philadelphia, and San Diego. The good news is that some localities seem to have invented a better way to deliver and finance care for the poor at an affordable price. The bad news is that it is at best a struggle to maintain funding for indigent care in the absence of a public hospital. The authors conclude that a robust local safety net needs non-local funding, and safety net policies need to be made at local and higher levels of government.

This paper examines changes in states' average income eligibility thresholds for children, pre- and post-CHIP. The report finds that states with the lowest level of coverage prior to CHIP have expanded income eligibility thresholds the most. States with a higher proportion of low-income uninsured children have increased their income eligibility thresholds to a greater degree than states with smaller percentages of uninsured children. States with higher per capita personal income have raised eligibility thresholds more than states with lower per capita income. States that experienced the greatest increase in federal matching rates expanded eligibility the most. And, states in the Northeast have increased eligibility more than states in other regions of the country.

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