Health Policy Center
Sharon Long, a senior fellow in the Health Policy Center at the Urban Institute, is an applied economist with over 25 years of experience conducting timely research on health care issues, including work addressing state and national health reform. Dr. Long was recently awarded AcademyHealth's 2012 Health Services Research Impact Award for her research evaluating the impacts of health reform in Massachusetts. While Dr. Long has spent most of her career at the Urban Institute, she was a Professor in the School of Public Health at the University of Minnesota from 2010 to 2012, where she worked with states on health reform issues as a senior economist at the State Health Access Data Assistance Center (SHADAC).
Physicians May Need More Than Higher Reimbursements To Expand Medicaid Participation: Findings From Washington State (Article)
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The expansion of Medicaid eligibility under the Affordable Care Act is expected to put considerable pressure on the capacity of the primary care workforce to meet the needs of the Medicaid population beginning in 2014. This paper reports on a 2011 survey and focus group sessions with Washington State primary care physicians. Findings suggest that increases in Medicaid reimbursement rates would be welcomed by doctors but that other strategies that reduced the costs of caring for Medicaid patients would be even more effective in expanding physician willingness to see Medicaid patients.
Health Status, Risk Factors, and Medical Conditions Among Persons Enrolled in Medicaid vs Uninsured Low-Income Adults Potentially Eligible for Medicaid Under the Affordable Care Act (Research Brief)
|Posted to Web: September 09, 2013||Publication Date: September 09, 2013|
Under the Affordable Care Act (ACA), states can extend Medicaid eligibility to more low-income adults, but little is known about the health care needs and health risks of these individuals. In this study, Kenney, Long and colleagues, Sandra Decker and Deliana Kostova from the National Center for Health Statistics, use data from the National Health and Nutrition Examination Survey and find that compared with adults currently enrolled in Medicaid, uninsured low-income adults potentially eligible to enroll in Medicaid under the ACA have a lower prevalence of many chronic conditions but that the uninsured adults with these chronic conditions are less likely to be aware that they have them and less likely to have the condition under control. The rates of undiagnosed and uncontrolled chronic health problems indicate that millions of low-income uninsured adults are currently at risk of premature mortality and other significant health issues. These findings provide new evidence of the potential health benefits associated with the Medicaid expansion under the ACA.
What Difference Does Medicaid Make? Assessing Cost Effectiveness, Access, and Financial Protection under Medicaid for Low-Income Adults (Research Report)
|Posted to Web: July 03, 2013||Publication Date: June 23, 2013|
Information on the role of Medicaid is once again taking center stage as federal and state policymakers debate how to address budget deficits and states consider next steps in extending coverage to their low-income populations. Using the Medicaid Expenditure Panel Survey, Urban researchers examine the use and cost of health care among low-income nonelderly adults who are covered by Medicaid relative to their expected service use and costs if they instead had employer-sponsored insurance coverage or were uninsured. Consistent with previous work, the analysis demonstrates that Medicaid provides access to health care services comparable to that of ESI but at significantly lower costs. Also, compared to ESI coverage direct out-of-pocket spending for health care services would be three times higher if Medicaid beneficiaries were instead covered by ESI. The analysis also confirms the better access and financial protection Medicaid beneficiaries have over their uninsured counterparts.
Developing Subannual Estimates of Health Insurance Coverage from the American Community Survey: Challenges and Promising Next Steps (Research Report)
|Posted to Web: May 22, 2013||Publication Date: May 03, 2013|
Following the introduction of a question on health insurance coverage in 2008, the American Community Survey (ACS) has increasingly been used as a source for state-level health insurance estimates. This reflects a number of key advantages of the ACS, including a survey design that supports state representative estimates for all states and the large size of its sample. As a result, the ACS yields relatively precise state-level estimates of annual health insurance coverage. This paper explores the feasibility of expanding the value of the ACS for tracking health insurance coverage by generating subannual estimates.
Reaching the Remaining Uninsured in Massachusetts: Challenges and Opportunities (Research Report)
|Posted to Web: April 17, 2013||Publication Date: April 17, 2013|
While Massachusetts has the lowest uninsurance rate in the nation following its 2006 health reform initiative, some residents of the state continue to go without health insurance coverage. This study focuses on those lacking health insurance coverage in the state, considering the potential impacts of the changes being introduced under the Affordable Care Act.
Coverage, Access, and Affordability under Health Reform: Learning from the Massachusetts Model (Research Report)
|Posted to Web: March 21, 2013||Publication Date: March 21, 2013|
While the impacts of the Affordable Care Act will vary across the states given their different circumstances, Massachusetts' 2006 reform initiative, the template for national reform, provides a preview of the potential gains in insurance coverage, access to and use of care, and health care affordability for the rest of the nation. Under reform, uninsurance in Massachusetts dropped by more than 50%, due, in part, to an increase in employer-sponsored coverage. Gains in health care access and affordability were widespread, including a 28% decline in unmet need for doctor care and a 38% decline in high out-of-pocket costs.
Will the Affordable Care Act Be a Job Killer? (Policy Briefs/Health Policy Briefs)
|Posted to Web: February 26, 2013||Publication Date: February 26, 2013|
The question of whether the Affordable Care Act (ACA) will lead to job loss was revisited in the first presidential debate. This brief summarizes what would be expected based on economic theory and the evidence under health reform in Massachusetts, the template for the ACA. Employment trends in Massachusetts closely mirrored those of the rest of the nation in the periods before and after reform, while gross domestic product grew at a faster rate than in the rest of the nation after reform. The evidence suggests that the ACA will have little effect on employment and may support stronger economic growth.
How Five Leading Safety-Net Hospitals Are Preparing For The Challenges And Opportunities Of Health Care Reform (Research Report)
|Posted to Web: October 22, 2012||Publication Date: October 22, 2012|
Safety-net hospitals will continue to play a critical role in the US health care system, as they will need to care for the more than twenty-three million people who are estimated to remain uninsured after the Affordable Care Act is implemented. Yet such hospitals will probably have less federal and state support for uncompensated care. At the same time, safety-net hospitals will need to reposition themselves in the marketplace to compete effectively for newly insured people who will have a choice of providers. We examine how five leading safety-net hospitals have begun preparing for reform. Building upon strong organizational attributes such as health information technology and system integration, the study hospitals' preparations include improving the efficiency and quality of care delivery, retaining current and attracting new patients, and expanding the medical home model.
National Findings on Access to Health Care and Service Use for Non-elderly Adults Enrolled in Medicaid (Research Report)
|Posted to Web: August 31, 2012||Publication Date: August 31, 2012|
This report to the Medicaid and CHIP Payment and Access Commission (MAPCAC) was prepared to support MACPAC’s June 2012 Report to the Congress on Medicaid and CHIP. The report presents national findings on access to care for non-elderly Medicaid adults using measures from two national household surveys—the National Health Interview Survey (NHIS) and the Household Component of the Medical Expenditure Panel Survey (MEPS). These estimates give a national picture of how access to care for non-elderly adults enrolled in Medicaid compares to that of adults with ESI and uninsured adults, building on prior reports and analyses.
Will Health Reform Lead to Job Loss? Evidence from Massachusetts Says No. (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: June 22, 2012||Publication Date: June 22, 2012|
In 2006, Massachusetts enacted an ambitious health care reform bill that greatly expanded insurance coverage in the state. This brief explores whether the State's reform initiative led to a dampening of employment and, thus, economic growth. Employment trends in Massachusetts immediately after health reform was implemented and over the period of the recession closely mirrored those of comparison states that had similar employment patterns to Massachusetts prior to health reform. The evidence suggests that Massachusetts has achieved its goal of near-universal health insurance coverage under its 2006 health reform initiative, with no indication of negative job consequences.
|Posted to Web: June 07, 2012||Publication Date: June 07, 2012|
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