View Research by Author - Johnny Kim

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

(Health Affairs) Declining employer-sponsored coverage from the 1970s to the mid-1990s has been attributed to a variety of factors: the shift from manufacturing to service-sector jobs, increased temporary and part-time employment, decreasing unionization, a decline in real wages, and growth in health care costs.

Based on data from the Current Population Survey, this paper compares changes in insurance coverage for the period 1994-1998 with 1989-1993. The uninsurance rate continued to rise in the 1994-1998 period, but for very different reasons than 1989-1993. The increase in employer-sponsored coverage was more than offset by declines in Medicaid and in private nongroup coverage. The movement of people into higher income brackets was responsible for the overall increase in employer-sponsored coverage. The decline of 3.3 million in Medicaid is probably related to state and federal welfare reform. The paper also looks at changes in uninsurance by race/ethnicity and family work status. (Health Affairs 2000 July/August; 19(4): 188-196).

This paper provides estimates of the cost and coverage impacts of the new State Children’s Health Insurance Program (SCHIP). The estimates reflect the many choices the states are given by the legislation: whether to use traditional Medicaid or establish separate state-run programs; how far to extend eligibility up the income distribution; and how much to use premiums. We estimated the impacts of these choices on participation by the uninsured as well as by the insured¾that is, the crowd-out effect¾and on public expenditures. We also examine the savings to families and firms that substitute SCHIP for private coverage. We conclude with estimates of the cost and coverage impacts of the actual initial choices that states have made. (Inquiry 2000 Spring; 37(1): 7-22).

Since 1991, three federal laws have sought to reform the Medicaid disproportionate share hospital (DSH) program, which is designed to provide financial support to safety net hospitals. The article provides findings from a 40-state survey about Medicaid DSH and upper payment limit programs in 1997. Results indicate that the overall size of the DSH program did not increase from 1993 to 1997, but the composition of the DSH revenues and expenditures changed substantially: A much higher share of DSH funds were being paid to local hospitals and relatively less was being retained by states. The study also revealed that large differences in states’ use of DSH still persist. Finally, the survey indicated that a growing number of states established upper payment limits programs in the late 1990s. (Health Care Financing Review 2000 Winter; 22(2):137-158).

Paper based on UI survey on the sources of state funds and the uses of DSH expenditures. Paper will also examine how states intend to respond to cuts in federal DHS payments.

This paper illustrates the considerable variation among states in Medicaid eligibility standards for the aged, blind, and disabled. Even within a single state, several income and resource standards may apply to these populations. In addition to Medicaid’s administrative structure and piecemeal evolution, variations are due to states’ choices regarding available coverage options. Many states do not take advantage of the broadest options. Financial and political considerations may limit states’ choices. Federal rules may also limit state flexibility to expand or simplify coverage in some areas, particularly medically needy programs. Still, the existing options are powerful tools available to states that want to expand or simplify coverage for the aged, blind, and disabled. The authors recommend that the federal government reconsider the link between medically needy income levels and states’ AFDC payment levels.

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