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.
Using Past Income Data to Verify Current Medicaid Eligibility (Research Report)
Using data from the 2008 Survey of Income and Program Participation, we find that information about past income and employment that is available to state Medicaid programs can potentially verify (a) initial financial eligibility for between 55 and 79 percent of eligible applicants and (b) renewed eligibility for between 60 and 71 percent of eligible enrollees. Verifying eligibility based on data matches, rather than documentation from consumers, could lower administrative costs; cut paperwork burdens for consumers, thereby increasing participation levels among those who qualify for help; and prevent eligibility errors.
Administrative Renewal, Accuracy of Redetermination Outcomes, and Administrative Costs (Research Report)
|Posted to Web: October 14, 2013||Publication Date: October 14, 2013|
When a Medicaid beneficiary approaches the end of a 12-month enrollment period, coverage should be "administratively renewed," according to ACA a regulation, if "reliable information" shows the beneficiary remains eligible. The beneficiary is sent a notice explaining the basis for renewal and the legal duty to make needed corrections. If none are forthcoming, coverage continues. We find that using administrative renewal should lower the number of mistaken outcomes if it is used with beneficiaries known to have an 80 percent or greater likelihood of eligibility. However, administrative renewal will change most mistakes from incorrect terminations to incorrect renewals.
Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States (Research Report)
|Posted to Web: October 14, 2013||Publication Date: October 14, 2013|
This report examines how many of the uninsured in each state would be eligible for health coverage assistance programs - i.e. Medicaid, the Children's Health Insurance Program and subsidized private coverage through the new health insurance marketplaces - under the Affordable Care Act. The report also estimates the anticipated decrease in the uninsured population under the ACA in each state. Finally, the report examines the share of those remaining uninsured under the ACA in each state who would be eligible for, but not enrolled in, assistance programs.
No Wrong Door: Improving Health Equity and the Health Coverage Consumer Experience in Connecticut (Policy Briefs)
|Posted to Web: October 10, 2013||Publication Date: October 10, 2013|
"No Wrong Door" (NWD) is a system that allows consumers to apply for health insurance through different agencies, and then seamlessly routes them to the program for which they qualify. We find that over the course of a year under the Affordable Care Act, NWD would prevent 36,000 Connecticut residents from losing health insurance coverage for at least part of the year. Connecticut's leaders have committed to full implementation of NWD by the end of 2015. If this commitment is fulfilled, significant gains will result for both state government and residents. However, monitoring implementation in the transition period is critical.
State and Local Coverage Changes Under Full Implementation of the Affordable Care Act (Research Report)
|Posted to Web: September 06, 2013||Publication Date: September 01, 2013|
The Affordable Care Act (ACA) includes many new policies intended to reduce the number of people without health insurance. This brief highlights new state and sub-state estimates of how the number and composition of individuals enrolled in Medicaid/CHIP would change with full implementation of the ACA, including the Medicaid expansion. These estimates provide more detail on the projected coverage changes under the ACA at the state level than in prior research and provide guidance on the areas that are likely to experience the largest declines in the uninsured and where the residual uninsured are likely to be concentrated.
The Cost of Not Expanding Medicaid (Research Report)
|Posted to Web: August 02, 2013||Publication Date: July 31, 2013|
As states make decisions about whether to implement the Medicaid expansion under the Affordable Care Act, this new analysis highlights the implications of these decisions for coverage, state finances, and providers. The results show that the decisions by as many as 27 states not to adopt the Medicaid expansion will leave 6.4 million people who could have been eligible for Medicaid uninsured. States that do not expand Medicaid will forego significant federal funding, which could have had a positive impact on state economies and general revenues. Moreover, hospitals in these states will receive substantially less revenue than they would have had the state expanded coverage while they will still have to serve a large uninsured population. These findings present a strong economic case for Medicaid expansion.
It's No Contest: The ACA's Employer Mandate Has Far Less Effect on Coverage and Costs Than the Individual Mandate (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: July 26, 2013||Publication Date: July 17, 2013|
The Obama administration announced a 1-year delay in imposition of penalties for large employers who do not offer affordable coverage to their full-time workers under the Affordable Care Act (ACA). The announcement led to some suggesting that the employer penalties amounted to a key component of the ACA, and others stating that it was "unfair" to delay employer penalties but to leave the penalty on individuals in place. However, our analysis shows that the ACA can achieve all its major objectives without the employer mandate. Conversely, the individual mandate is a central component of the law and its coverage expansion.
Documentation on the Urban Institute's American Community Survey Health Insurance Policy Simulation Model (ACS-HIPSM) (Research Report)
|Posted to Web: July 15, 2013||Publication Date: July 15, 2013|
The model documented here builds off of the Urban Institute's base HIPSM, which uses the Current Population Survey (CPS) as its core data set, matched to several other data sets including the Medical Expenditure Panel Survey-Household Component (MEPS-HC), to predict changes in national health insurance coverage and spending under ACA using a micro-simulation modeling approach. To create HIPSM-ACS, we apply the core behavioral estimates coming from base HIPSM to ACS records (using a series HIPSM-estimated imputation models) to exploit the much larger sample size for more precise estimates at the state and sub-state level.
Expanding Medicaid in Ohio: Analysis of Likely Effects (Research Report)
|Posted to Web: June 13, 2013||Publication Date: June 13, 2013|
Adding Medicaid expansion to the remainder of the Patient Protection and Affordable Care Act (ACA) would increase Ohio’s Medicaid costs between $2.4 and $2.5 billion during FY 2014 to 2022. The state could reduce $1.5 billion in spending on medically needy adults, inpatient prison costs, and other services to the poor uninsured. Expansion would yield $2.7 and $2.8 billion in new revenue, including premium taxes, general revenue from economic activity generated by increased federal Medicaid dollars, and prescription drug rebates. Altogether, expansion would generate between $1.8 and $1.9 billion in net state budget gains while covering more than 400,000 uninsured.
The Financial Benefit to Hospitals from State Expansion of Medicaid (Research Report)
|Posted to Web: March 21, 2013||Publication Date: March 21, 2013|
State decisions to expand Medicaid have important implications for hospitals. There are a number of provisions in the Affordable Care Act that will reduce hospital payments - lower rates of Medicare reimbursement and cut backs in Medicare and Medicaid disproportionate share hospital payments. On the other hand, hospitals stand to gain considerably from the added insurance coverage because of the Medicaid expansion. Fewer uninsured will mean higher revenues to hospitals. However, some newly covered Medicaid patients will have formally been privately insured. For these patients, Medicaid will typically pay less than private insurance. On balance, we show that for each $1.0 in private revenue that the Medicaid expansion eliminates, hospitals Medicaid revenue increases by $2.59.
|Posted to Web: March 20, 2013||Publication Date: March 20, 2013|
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