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.
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)
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.
Why the ACA's Limits on Age-Rating Will Not Cause "Rate Shock": Distributional Implications of Limited Age Bands in Nongroup Health Insurance (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: March 20, 2013||Publication Date: March 20, 2013|
Insurers are calling attention to a potential "rate shock" that will push young adults out of the nongroup insurance market under the ACA due to limitations on premium differences by age. We compare the impact of the ACA's 3:1 rate band to a "looser" 5:1 alternative. Loosening the bands would have very little impact on out-of-pocket rates paid by the youngest purchasers once subsidies are taken into account. Also, the majority of young adults currently purchasing nongroup coverage will also be financially protected by the exchange subsidies, the ACA's Medicaid expansion, and the expansion of dependent coverage to young adults.
Uninsured New Yorkers After Full Implementation of the Affordable Care Act: Source of Health Insurance Coverage by Individual Characteristics and Sub-State Geographic Area (Research Report)
|Posted to Web: March 04, 2013||Publication Date: March 04, 2013|
The Urban Institute developed a New York state-specific version of its Health Insurance Reform Simulation Model (HIPSM) to support to the state in its effort to assess the implications of the implementation of the Affordable Care Act (ACA). Initial findings from this work were made available in March of 2012.The tables presented here provide sub-state analyses, focusing on those without insurance coverage of any kind prior to reform. We show the share of uninsured expected to gain coverage under the ACA, and include the distribution of characteristics for those anticipated to gain insurance of each type whenever sample sizes allow.
After the Supreme Court Decision: The Implications of Expanding Medicaid for Uninsured Low-Income Midlife Adults (Research Report)
|Posted to Web: February 15, 2013||Publication Date: February 15, 2013|
The Affordable Care Act required states to expand their Medicaid programs to cover more low-income people, including mid-life adults. However, a recent U.S. Supreme Court decision, while upholding the rest of the health reform law, effectively turned the mandate into a state option. This brief examines the Court's decision and how uninsured midlife adults in states that take up this option could benefit.
Medicaid in Alaska Under the ACA (Research Report)
|Posted to Web: February 12, 2013||Publication Date: February 12, 2013|
The authors simulate the effect of the Affordable Care Act (ACA) in Alaska, both with and without the Medicaid expansion. The ACA would reduce the uninsured rate in Alaska from 21% without the ACA to 10% under the ACA with the expansion, or 15% without the expansion. The Medicaid expansion would increase enrollment 30% by 2020, while state Medicaid spending on the nonelderly would only increase 3.7%. The report includes a sensitivity analysis of Medicaid take-up rates and detailed characteristics of new enrollees by sub-state region.
Access to Employer-Sponsored Insurance and Subsidy Eligibility in Health Benefits Exchanges: Two Data-Based Approaches (Research Report)
|Posted to Web: February 01, 2013||Publication Date: February 01, 2013|
Consumers offered employer-sponsored insurance (ESI) can be ineligible for subsidies in health insurance exchanges (HIX). Until better ESI data become available, HHS proposes using post-enrollment audits, rather than pre-enrollment verification for this eligibility requirement. Using the Health Insurance Policy Simulation Model (HIPSM), we find that more than 70 percent of eligible consumers work for firms that do not sponsor ESI. HIXes could thus avoid the need to audit them by developing databases that show which employers sponsor ESI. Alternatively, HIXes could target non-ESI recipients for audits based on HIPSM results that show their relative likelihood of being offered ESI.
Small Firm Self-Insurance Under the ACA: Minimum Stop Loss Attachment Points and Adverse Selection in the Fully Insured Small Group Market (Research Report)
|Posted to Web: December 13, 2012||Publication Date: December 13, 2012|
The Affordable Care Act changes the small group insurance market substantially, but most of these changes do not apply to self-insured group plans. This exemption provides an opening for small employers with healthier workers to avoid broader sharing of health care risk, isolating higher-cost groups in the fully insured market. We simulate employer decisions under the ACA for a range of stop loss insurance plans, which mediate financial risk, and find that if low-risk stop loss policies are allowed, fully insured small group premiums could be higher by up to 25%. Regulation of stop loss could prevent such adverse selection.
|Posted to Web: December 07, 2012||Publication Date: December 07, 2012|
Return to list of authors