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.
Measuring Marketplace Enrollment Relative to Enrollment Projections (Research Report)
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.
Tax Preparers Could Help Most Uninsured Get Covered (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: February 18, 2014||Publication Date: December 01, 2013|
More than 74% of uninsured consumers who qualify for ACA health coverage file federal income tax returns. This includes over 90% of consumers under age 35 who qualify for subsidies in health insurance marketplaces. Most low-income taxpayers use tax preparers, including 64.6% of EITC claimants, more than 78% of whom file by March 31, the final day of open enrollment. State and federal officials and private leaders concerned about ACA enrollment should seriously explore partnering with commercial and nonprofit tax preparers to reach the eligible uninsured and move towards a healthy, balanced risk pool.
Will Those With Cancelled Insurance Policies Be Better Off in ACA Marketplaces? (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: February 18, 2014||Publication Date: February 18, 2014|
In recent months, there has been considerable focus on cancellations of nongroup health insurance policies. It is difficult to directly obtain data on premiums that individuals were paying prior to the ACA, but we can provide data on the premium cost to enrollees for the lowest cost bronze plans and the second lowest cost silver plans by age and income group in each state. We conclude that it would be difficult for the majority of individuals, particularly those qualifying for subsidies, to obtain coverage for a lower premium than those available in the Marketplaces today. Unsubsidized individuals, particularly those in older age groups, are more likely to face higher premiums.
Using Past Income Data to Verify Current Medicaid Eligibility (Research Report)
|Posted to Web: January 24, 2014||Publication Date: January 23, 2014|
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.
|Posted to Web: July 26, 2013||Publication Date: July 17, 2013|
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