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Sharon K. Long

Senior Fellow
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).


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Early Estimates Indicate Rapid Increase in Health Insurance Coverage under the ACA: A Promising Start (Policy Briefs/Health Policy Briefs)
Sharon K. Long, Genevieve M. Kenney, Stephen Zuckerman, Douglas A. Wissoker, Dana Goin, Katherine Hempstead, Michael Karpman, Nathaniel Anderson

By the end of March, enrollment in Marketplace plans created by the Affordable Care Act (ACA) was reported at just over 7 million and the Centers for Medicare and Medicaid Services (CMS) reported that Medicaid enrollment increased between the beginning of October 2013 and the end of February 2014. However, neither the Marketplace enrollment figures nor the CMS Medicaid report provide an accurate picture of how many uninsured people have gained coverage since open enrollment began, because both sets of enrollment figures may include newly insured people as well as those who had other sources of coverage before 2014. We use the March 2014 Health Reform Monitoring Survey (HRMS) to examine changes in health insurance coverage in early March 2014 relative to coverage over the prior year, including more disaggregated information on coverage changes and additional details on the statistical precision of the estimates.

Posted to Web: April 15, 2014Publication Date: April 15, 2014

QuickTake: Number of Uninsured Adults Falls by 5.4 Million since 2013 (Policy Briefs/Health Policy Briefs)
Sharon K. Long, Genevieve M. Kenney, Stephen Zuckerman, Douglas A. Wissoker, Dana Goin, Michael Karpman, Nathaniel Anderson

The Urban Institute's Health Reform Monitoring Survey (HRMS) has been tracking insurance coverage since the first quarter of 2013. Today, we report the first estimate of how the uninsurance rate has changed through early March 2014. These results track changes through most of the first Affordable Care Act's (ACA) open-enrollment period, which ended on March 31, 2014. Analysis of data from the March 2014 HRMS shows the uninsurance rate for nonelderly adults (age 18–64) was 15.2 percent for the nation, a drop of 2.7 percentage points since September 2013, the month before ACA open enrollment began. This represents a gain in coverage for about 5.4 million adults.

Posted to Web: April 07, 2014Publication Date: April 03, 2014

Health Care Access and Cost Barriers for Adults with Physical or Mental Health Issues: Evidence of Significant Gaps as the ACA Marketplaces Opened their Doors (Policy Briefs/Health Policy Briefs)
Dana Goin, Sharon K. Long

More than one-third of nonelderly adults in the US reported that their physical health or mental health was not good for one or more days in 2012. Physical and mental health problems translate into higher levels of health care need and higher risks for poor health outcomes if those needs are not met. Historically, such health problems have been compounded by preexisting condition exclusions employed by health insurance companies to reduce costs. While the Affordable Care Act (ACA) has eliminated this practice, barriers to care for those with high health care needs are likely to remain. In this brief we examine the health care access and affordability challenges reported by nonelderly adults in December 2013—comparing the experiences of healthy adults to those of adults reporting physical and mental health problems in order to identify whether the latter are more likely to face barriers in getting the care they need.

Posted to Web: April 04, 2014Publication Date: April 04, 2014

An Update on Health Insurance Coverage and Health Care Access, Use and Affordability in Massachusetts as of 2012 (Research Report)
Sharon K. Long, Ariel Fogel

This collection of reports provides an update on trends in health insurance coverage, health care access and use, and health care affordability in Massachusetts since fall 2006, just prior to the implementation of the state's health reform initiative. The publications also provide a more in-depth overview of the circumstances of working-age adults in 2012, as the state begins implementing the Affordable Care Act and other changes under the state's 2012 Chapter 224 cost-containment legislation. Findings show that while coverage and access to care remain strong in Massachusetts, health care costs continue to be a burden for many individuals and families.

Posted to Web: March 26, 2014Publication Date: March 16, 2014

The Expansion of Medicaid Coverage under the ACA: Implications for Health Care Access, Use, and Spending for Vulnerable Low-income Adults (Article)
Lisa Clemans-Cope, Sharon K. Long, Teresa A. Coughlin, Alshadye Yemane, Dean Resnick

The expansion of Medicaid coverage under the ACA offers the potential for significant increases in health care access, use, and spending for uninsured nonelderly adults with chronic conditions. Using pooled data from the Medical Expenditure Panel Survey, we estimate the potential effects of Medicaid, controlling for individual and local community characteristics. We project significant gains in access and use, except outpatient Emergency Department use, for uninsured adults who enroll in Medicaid coverage and have chronic and mental health conditions. Annual per capita health care spending for newly insured individuals is projected to grow from $2,677 to $6,370 in 2013 dollars, while out-of-pocket spending drops by $921.

Posted to Web: February 25, 2014Publication Date: May 01, 2013

Most Adults Are Not Aware of Health Reform's Coverage Provisions (Policy Briefs/Health Policy Briefs)
Sharon K. Long, Dana Goin

The Affordable Care Act (ACA) includes many changes to the health care system—some implemented as early as 2010 (e.g., allowing children to stay on a parent's health insurance plan until age 26), others to be implemented much later. Of particular relevance to the coverage provisions of the law are the rollout of the Marketplaces, which began in October 2013 with coverage starting in January 2014; the Medicaid expansion taking effect in January 2014 in those states that choose to expand eligibility; and the mandate on individuals to buy insurance beginning in 2014. This brief focuses on knowledge of the ACA coverage provisions among nonelderly adults overall and among those most likely to be affected by the different provisions of the law.

Posted to Web: February 24, 2014Publication Date: February 06, 2014

The Health Reform Monitoring Survey: Addressing Data Gaps To Provide Timely Insights Into The Affordable Care Act (Article)
Sharon K. Long, Genevieve M. Kenney, Stephen Zuckerman, Dana Goin, Douglas A. Wissoker, Fredric Blavin, Linda J. Blumberg, Lisa Clemans-Cope, John Holahan, Katherine Hempstead

The Health Reform Monitoring Survey (HRMS) was launched in 2013 as a mechanism to obtain timely information on the ACA during the period before federal survey data will be available. The HRMS provides quarterly data on insurance coverage, access to health care, and health care affordability, along with changing topics of relevance to current policy and program issues. For example, data from summer 2013 show that more than 60 percent of those targeted by the health insurance exchanges struggle with understanding key health insurance concepts, raising concerns about their ability to evaluate trade-offs when choosing coverage.

Posted to Web: February 11, 2014Publication Date: December 01, 2013

Factors Influencing Health Plan Choice among the Marketplace Target Population on the Eve of Health Reform (Policy Briefs/Health Policy Briefs)
Linda J. Blumberg, Sharon K. Long, Genevieve M. Kenney, Dana Goin

At present, little is known about the plan preferences of those most likely to enroll in the new Marketplace—people with incomes above 138 percent of the federal poverty level (FPL) who are currently either uninsured or purchasing nongroup insurance coverage. This brief examines what factors matter when these adults choose a new health insurance plan and what trade-offs they are willing to make in order to pay a lower premium for that coverage.

Posted to Web: February 06, 2014Publication Date: January 01, 2014

Uninsured Adults Eligible for Medicaid and Health Insurance Literacy (Policy Briefs/Health Policy Briefs)
Genevieve M. Kenney, Michael Karpman, Sharon K. Long

A key question is how successful enrollment efforts under the ACA will be at reaching uninsured adults who will become newly eligible for Medicaid. Historically, enrollment in Medicaid coverage has been lower for adults than for children, with substantial variation across states. Approximately two-thirds of nonelderly adults without private coverage who currently qualify for Medicaid are enrolled. This brief explores prior experiences with Medicaid among low-income, uninsured adults targeted by Medicaid under the ACA and assesses this population's understanding of basic health insurance terms and the sources of information they would use for making health insurance decisions.

Posted to Web: February 06, 2014Publication Date: January 01, 2014

Public Understanding of Basic Health Insurance Concepts on the Eve of Health Reform (Policy Briefs/Health Policy Briefs)
Linda J. Blumberg, Sharon K. Long, Genevieve M. Kenney, Dana Goin

A central objective of the Affordable Care Act (ACA) is to reduce the number of Americans without health insurance. Providing the opportunity to purchase private insurance through the new health insurance Marketplaces is one of the major ways in which this goal is to be achieved. The people most likely to enroll in Marketplace-based coverage—those the ACA Marketplaces are specifically designed to help—are nonelderly adults with incomes above the national Medicaid-eligibility cutoff (138 percent of the federal poverty level) who are currently uninsured or are purchasing individual coverage. The new Marketplaces will offer a multitude of choices with differing costs and benefits, although all will include coverage within ACA-defined categories of essential health benefits. This brief focuses on how well the target population understands the concepts they will confront as they make their insurance choices.

Posted to Web: February 06, 2014Publication Date: January 01, 2014

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