View Research by Author - Niall J. Brennan

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

Texas has a substantial low-income population, high levels of uninsurance, and many foreign-born residents, largely from Mexico. Despite low taxes, the budget passed by the legislature in Spring 2001 included several health care initiatives. These included Medicaid eligibility simplification for children, increased funding for the State Children's Health Insurance Program, higher reimbursement rates for nursing homes, and establishment of a new system of health insurance for public school teachers. The declining economy may curtail further expansions, but, so far, the state has not suffered the extreme fiscal pressures that other states are experiencing.

These reports are based on detailed case studies of safety net hospitals in Los Angeles, Houston, Boston, Detroit and Denver. Our analysis suggests that the future viability of hospitals to serve the uninsured is related to the availability of explicit or implicit financial support from local, state and federal sources and the magnitude of the uninsurance problem the facility is trying to solve. We did not find that the trend toward Medicaid managed care was an insurmountable problem for safety net hospitals. In fact, we found that the relative financial health of safety net hospitals in Denver and Boston was directly related to the aggressive approach they took toward establishing their own managed care plans. Nevertheless, despite the current financial status of individual facilities, there was widespread concern about the future. Published by the Kaiser Commission on the Medicaid and the Uninsured; 2001 April. Available at www.kff.org.

Until recently, most surveys of insurance coverage have classified people as uninsured if they have not been assigned some coverage in response to one of a series of questions about specific types of insurance. This “residual” approach to measuring uninsurance rates has not required respondents to either verify their insurance status or confirm that they are uninsured. Using the 1997 National Survey of America’s Families, this paper examines the impact of a question confirming whether or not individuals for whom no insurance coverage is reported are, in fact, uninsured. The results of our analysis suggest that a confirmation question as part of a telephone-based survey works to lower estimates of the uninsured. Staring in March 2000 and following the findings of this study, the Current Population Survey introduced a confirmation question in its health insurance sequence. (Inquiry 2000 Fall; 37(3):317-327)

This brief provides a recent look at health insurance coverage among 55- to 64-year-olds and examines the link between health insurance coverage and health care access and utilization for the low-income near elderly. This approach reveals not only how the uninsured fare relative to the insured but also how type of insurance affects beneficiary health care access and utilization.

This brief provides a snapshot of adults lacking health insurance coverage examining factors such as income level, family structure, race/ethnicity, employment, health status, and access to and utilization of health care. Findings show that younger, low-income adults, particularly blacks and Hispanics, have the highest uninsurance rates, but half of all low-income uninsured adults are white. The majority of uninsured low-income adults live in households with at least one full-time worker. Low-income uninsured adults are significantly worse off than the insured on measures of health access and health status. Uninsurance rates vary greatly among states. In general, states with low rates of employer-sponsored coverage have high uninsurance rates, although states with generous public programs can offset this effect somewhat.

This paper presents preliminary findings from the 1997 National Survey of America's Families (NSAF), a household survey providing information on over 100,000 children and non-elderly adults representing the noninstitutionalized civilian population under age 65. Focusing on health insurance coverage and several measures of access to care the authors find that children are faring better than adults in terms of health insurance coverage, primarily due to recent Medicaid expansions, the CHIP program and other state-subsidized insurance efforts. The authors also find large variations in rates of uninsurance across states with such variations generally reflecting differences in private-sector coverage. Finally, the authors show that insurance coverage differences across states and between adults and children are correlated with differences in access to care and health status.

This paper provides an overview of the health policy component of the National Survey of America’s Families (NSAF), fielded as part of the Urban Institute’s Assessing the New Federalism project. The paper is intended to provide policymakers, researchers, and potential users of public use files with an overview of NSAF’s purpose, sampling approach and questionnaire content, with a focus on issues that will be of primary interest to health care researchers. Additionally, we describe planned research using the survey and dates for public release of the NSAF data. (Inquiry 1999 Fall;36(3):353-362)

This paper examines ways to improve the Medicare Savings programs, i.e. the Qualified Medicare Beneficiaries Program (QMB) and the Specified Low Income Medicare Beneficiaries program (SLMB). These two programs offer fill-in benefits for Medicare to persons with low incomes. While some of the QMB program serves those with Medicaid, the real advantages are for beneficiaries who otherwise would not qualify for support. But participation has remained low in these programs likely because of lack of knowledge by beneficiaries and lack of enthusiasm by some states that administer QMB and SLMB. Among the options examined were efforts to increase participation by eliminating the asset limits and by federalizing the program. (Inquiry 1998 Fall; 35(3): 346-356).

A large number of children in the United States lack health insurance and may therefore have difficulty obtaining the health care services they need. The State Children's Health Insurance Program (CHIP), enacted in 1997 in response to concerns about this situation, gives grants to states to initiate and expand health insurance programs for children in low-income families. To examine health insurance coverage of children immediately prior to the implementation of CHIP, parents were asked a series of questions about their family's health insurance coverage at the time of the survey, including whether it was private or public.

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