View Research by Author - Victoria Lynch

Victoria Lynch is a Research Associate in the Health Policy Center at the Urban Institute in Washington, D.C. Her current analytical focus is simulating eligibility for Medicaid/CHIP using state-based eligibility rules, state enrollment data, and survey data from the American Community Survey (ACS). She recently co-authored a report on children's participation in Medicaid/CHIP at the national, state, and local levels.

Lynch's current survey methodological focus is on the validity of health coverage related data from the ACS and developing methods and recommendations for maximizing the ACS's utility for studying the impacts of heath reform at the state and local level. She recently co-authored a report on the impacts of using logical coverage edits to correct for misreported health insurance in the ACS and Current Population Survey (CPS).

Prior to joining the Urban Institute Lynch worked as a consultant to the Census Bureau on a variety of projects to integrate data from multiple administrative and survey sources. She was part of large scale collaboration studying discrepancies between survey estimates of enrollment in Medicaid and the number of enrollees reported in state and national enrollment data. Her focus was on modeling reporting error to study the interaction between survey design and reporting in the CPS, National Health Interview Survey (NHIS), and the Medical Expenditure Panel Survey (MEPS).

Publications

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.

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.

This brief examines variation in Medicaid/CHIP participation among children and parents. Participation continued to vary across states and subgroups of children but differences were found to be narrowing. Medicaid/CHIP participation increased nationally from 81.7 percent in 2008 to 85.8 percent in 2010, which was associated with a decline in uninsurance among eligible children. Participation rates were lower among parents in each state relative to the rates for children. States that had relatively higher/lower participation rates among children were more likely to also have relatively higher/lower participation rates among parents.

Steep declines in the uninsured population under the Affordable Care Act (ACA) will depend on high enrollment among newly Medicaid-eligible adults. We use the 2009 American Community Survey to model pre-ACA eligibility for comprehensive Medicaid coverage among nonelderly adults. We identify 4.5 million eligible but uninsured adults. We find a Medicaid participation rate of 67% for adults; the rate is 17 percentage points lower than the national Medicaid participation rate for children, and it varies substantially across socioeconomic and demographic subgroups and across states. Achieving substantial increases in coverage under the ACA will require sharp increases in Medicaid participation among adults in some states.

This brief provides new national and state-level information about the uninsured adults with incomes below 138 percent of FPL who could become eligible for Medicaid if states decide to expand Medicaid under the Affordable Care Act (ACA). At present, few states cover non-disabled, non-pregnant parents with incomes up to 138 percent of the Federal Poverty Level (FPL) and even fewer cover such adults without dependent children. This analysis shows that the approximately 15 million uninsured adults who could gain coverage under the ACA Medicaid expansion are a diverse group in terms of their age, gender and race/ethnicity.

This latest edition of our annual chartbook series for New York State features detailed information about differences in insurance coverage and uninsurance around New York State and within New York City. Overall, 12.9 percent of New Yorkers (889,000 total) under the age of 65 lacked health insurance in 2009, unchanged from the previous year despite an ongoing recession. Data for 14 separate regions across New York State, including the five boroughs of New York City and for 55 separate neighborhoods within the city itself show enormous variation in health insurance coverage across the state.

This report provides detailed demographic information on Virginia's uninsured population in 2009, including data on their income, employment status, race, ethnicity, age and citizenship, and region of residence. Between 2008 and 2009, 47,000 nonelderly adults in Virginia became newly uninsured, though there was no significant change in the number of uninsured children, due in part to increased coverage through Medicaid and CHIP. Overall, 13.2 percent of Virginians (889,000 total) under the age of 65 lacked health insurance in 2009. The majority of Virginia's uninsured are US citizens and live in working families, but most are in low-income families.

The number of children eligible for and enrolled in Medicaid and CHIP increased in recent years. As a consequence, the number of eligible but uninsured kids fell by about 340,000 between 2008 and 2009. Rates of participation in Medicaid/CHIP increased, from 82.1 to 84.8 percent nationally, with sixteen states achieving participation rates of 90 percent or higher in 2009. This report suggests that the high participation rates among children over the past few years are likely due in part to ongoing federal and state policy efforts aimed at improving enrollment and retention among children.

This paper provides national and state level estimates of Medicaid/CHIP participation rates and of the number of uninsured children who are eligible for the program based on 2008 data from the American Community Survey. The results point to a national Medicaid/CHIP participation rate of about 82 percent, with varying participation rates across states and amongst groups of children. As of 2008, an estimated 4.7 million uninsured children were eligible for Medicaid/CHIP but not enrolled, of whom about 60 percent were concentrated in 10 states.

This chart book provides national and state level estimates of uninsured rates and of the number of uninsured children based on 2008 data from the American Community Survey. The chart book documents the substantial variation in uninsured rates across states with uninsured rates among children ranging from a low of 1.7 percent in Massachusetts to a high of 20.1 percent in Nevada. The chart book also shows variation in uninsured rates across geographic areas within each state and compares the characteristics of uninsured children to those of insured children within the same state.

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