View Research by Author - Matthew Buettgens
Senior Research Associate
Health Policy Center
Matthew Buettgens, PhD, is a mathematician leading the development of the Urban Institute's Health Insurance Policy Simulation (HIPSM) model. The model is currently being used to provide technical assistance for health reform implementation in Massachusetts, Missouri, New York, Virginia, and Washington as well as to the federal government. His recent work includes a number of papers analyzing various aspects of national health insurance reform, both nationally and state-by-state. Topics have included the costs and savings of health reform for both federal and state governments, state-by-state analysis of changes in health insurance coverage and the remaining uninsured, the effect of reform on employers, the role of the individual mandate, the affordability of coverage under health insurance exchanges, and the implications of age rating for the affordability of coverage. Dr. Buettgens was previously a major developer of the HIRSM model?the predecessor to HIPSM?used in the design of the 2006 roadmap to universal health insurance coverage in the state of Massachusetts.
Monitoring the Impact of the Affordable Care Act on Employers: Literature Review (Research Report)
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.
In States That Don't Expand Medicaid, Who Gets New Coverage Assistance Under the ACA and Who Doesn't? (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: October 23, 2014||Publication Date: October 23, 2014|
This research provides more evidence that state officials' decisions against expansion adversely affect already disadvantaged residents. While 5.9 million adults with moderate incomes in nonexpanding states qualify for financial assistance to purchase insurance through the new marketplaces, nearly 6.3 million uninsured residents with lower incomes remain ineligible for help because the state's Medicaid program was not expanded. The median income of those ineligible for coverage assistance is less than $800 a month, compared to more than $2,000 a month for those eligible to receive subsidies.
Halbig v Burwell: Potential Implications for ACA Coverage and Subsidies (Policy Briefs/Health Policy Briefs)
|Posted to Web: October 09, 2014||Publication Date: October 09, 2014|
A ruling from the U.S. Court of Appeals for the D.C. Circuit on Halbig v. Burwell is imminent. The plaintiff claims a phrase in the ACA prohibits residents of states where the federal government is administering the health insurance Marketplace from receiving subsidies for purchasing insurance. With 34 states having chosen to leave administration of their Marketplaces to the federal government, a decision for the plaintiff could have broad implications. In 2016, 7.3 million people in these states are estimated to receive federal subsidies totaling $36.1 billion, ranging up to $4.8 billion in Florida and $5.6 billion in Texas.
The ACA and America's Cities: Fewer Uninsured and More Federal Dollars (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: July 17, 2014||Publication Date: July 17, 2014|
This report estimated the effect of the Affordable Care Act (ACA) on 14 large and diverse cities: Los Angeles, Chicago, Houston, Philadelphia, Phoenix, Indianapolis, Columbus, Charlotte, Detroit, Memphis, Seattle, Denver, Atlanta, and Miami. For each city we estimated changes in health coverage under the ACA, particularly the resulting decline in the uninsured. We also estimated the additional federal spending on health care that would flow into these cities. For cities in states that have not expanded Medicaid eligibility, we provide estimates both with and without expansion.
Measuring Medicaid/CHIP Enrollment Progress Under the Affordable Care Act (Research Report)
|Posted to Web: June 19, 2014||Publication Date: June 19, 2014|
Since the beginning of the first open enrollment period under the Affordable Care Act (ACA) on October 2013 and April 2014, Medicaid/CHIP enrollment increased by 6.0 million. This accounts for almost half of enrollment increase projected by the Urban Institute's Health Insurance Policy Simulation Model to occur by the end of 2016 when the full ACA coverage effects are expected. Progress is greater in states that expanded Medicaid but there is variation even among these states. This variation is likely due in part to differences in outreach and application assistance efforts by states and whether they used fast-track enrollment strategies.
Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States : May 2014 Update (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: June 13, 2014||Publication Date: June 13, 2014|
The authors estimate that in 2014, 56 percent of the uninsured became eligible for financial assistance with health insurance coverage through Medicaid, CHIP, or subsidized marketplace coverage. In states that expanded Medicaid eligibility, 68 percent of the uninsured became eligible for assistance, compared with only 44 percent in states that did not. Because of this difference in eligibility, the ACA is projected to reduce the number of uninsured people by 56 percent in states that expanded Medicaid, compared with only 34 percent in states that did not. The authors also provide estimates of what would happen if states that have not yet expanded Medicaid were to do so.
Why Not Just Eliminate the Employer Mandate? (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: May 28, 2014||Publication Date: May 28, 2014|
Employers of 50 or more workers are required to provide health insurance or pay a penalty. This requirement has been delayed until 2015 for employers with 100 and more workers and until 2016 for those with 50-99 workers. But there are reports of changes in employer labor practices, such as reducing the hours of part-time workers and concerns about increasing workforce above 50 workers. In this brief we argue that the employer mandate should simply be eliminated. We show that it would not reduce insurance coverage significantly, but it would eliminate the labor market distortions that have troubled employer groups and that could have negative effects on some workers. The penalties on employers do bring in some new revenues that would have to be replaced.
Measuring Marketplace Enrollment Relative to Enrollment Projections: Update (Policy Briefs/Health Policy Briefs)
|Posted to Web: May 09, 2014||Publication Date: May 09, 2014|
This brief compares Affordable Care Act Marketplace enrollment as of April 19, 2014 (the most recent state-specific data) to projected enrollment for 2014 and 2016 and estimates of the number of people eligible for subsidies. Nationally, by April 19, the Marketplaces had enrolled 115 percent of projected 2014 enrollment. Collectively, both State-Based Marketplaces (SBMs) and Federally Facilitated Marketplaces (FFMs) exceeded projected enrollment. However, there is considerable variation across the states within each group.
Measuring Marketplace Enrollment Relative to Enrollment Projections (Research Report)
|Posted to Web: May 01, 2014||Publication Date: May 01, 2014|
This brief compares Affordable Care Act Marketplace enrollment as of March 1, 2014 (the most recent state-specific data) to projected enrollment for 2014 and 2016 and estimates of the number of people eligible for subsidies. Nationally, by March 1, the Marketplaces had enrolled 61 percent of projected 2014 enrollment of subsidized and unsubsidized individuals. They had enrolled 63 percent of the subsidized population expected to enroll in 2014. Collectively, State-Based Marketplaces (SBMs) have been more successful in reaching projected enrollment than the Federally Facilitated Marketplaces (FFMs), with SBMs overall also having significantly higher rates of subsidized enrollment than FFMs.
Overlapping Eligibility and Enrollment: Human Services and Health Programs Under the Affordable Care Act (Research Report)
|Posted to Web: April 02, 2014||Publication Date: April 02, 2014|
The Affordable Care Act (ACA) has created new opportunities for health and human services programs to integrate eligibility determination, enrollment, and retention. Using two large microsimulation models—the Transfer Income Model, Version 3, and the Health Insurance Policy Simulation Model—we find considerable overlaps between expanded eligibility for health coverage and current receipt of human services benefits, particularly with Earned Income Tax Credits, the Supplemental Nutrition Assistance Program, and the Low-Income Home Energy Assistance Program. In an appendix, we identify specific data sharing strategies that seek to increase participation, lower administrative costs, and prevent errors.
|Posted to Web: February 18, 2014||Publication Date: December 01, 2013|
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