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Health and Health Care

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Understanding Older Drivers: An Examination of Medical Conditions, Medication Use, and Travel Behavior (Research Report)
Sandra Rosenbloom, Robert Santos

Almost 90% of people 65 and older are drivers. While older people are among the safest on the road they are more likely to use multiple medications which could interfere with driving safely. This report provides baseline information on the relationship between medical conditions, medication use, and the travel behavior of older drivers from two large national data bases: the 2009 National Household Travel Survey and the 2011 National Health and Aging Trends Study. We found that most older drivers take multiple medications and drive frequently but also self-regulate their behavior in important ways that reduce crash risk.

Posted to Web: July 15, 2014Publication Date: April 01, 2014

QuickTake: Number of Uninsured Adults Continues to Fall under the ACA: Down by 8.0 Million in June 2014 (Fact Sheet / Data at a Glance)
Sharon K. Long, Genevieve M. Kenney, Stephen Zuckerman, Douglas A. Wissoker, Adele Shartzer, Michael Karpman, Nathaniel Anderson

The Urban Institute's Health Reform Monitoring Survey (HRMS) has been tracking insurance coverage since the first quarter of 2013. This QuickTake reports on how the uninsurance rate changed through early June 2014. These results track changes in coverage following the Affordable Care Act's first open enrollment period, which ended on March 31, 2014.

Posted to Web: July 10, 2014Publication Date: July 10, 2014

In Pursuit of Health Equity: Comparing U.S. and EU Approaches to Eliminating Disparities (Policy Briefs/Timely Analysis of Health Policy Issues)
Elizabeth Docteur, Robert A. Berenson

Researchers compare and contrast the U.S. public policy approach to tackling the problem of health disparities with the European approach in this paper. They begin by providing an overview of the ways in which the issue of health disparities has been framed in American and European policy discourse. They next compare how health disparities have been addressed in policy statements produced by the U.S. Department of Health and Human Services and by the European Commission, the executive body of the European Union. In so doing, they seek to illuminate implicit choices that stand to have a bearing on the outcomes of these initiatives.

Posted to Web: June 30, 2014Publication Date: June 24, 2014

Increase in Medicaid under the ACA Reduces Uninsurance, According to Early Estimates (Policy Briefs/Health Policy Briefs)
Lisa Clemans-Cope, Michael Karpman, Adam Weiss, Nathaniel Anderson

An important strategy for increasing health insurance coverage under the Affordable Care Act (ACA) is expanded enrollment in Medicaid, which provides free or very low cost health insurance to low-income people. Over 6 million individuals enrolled in Medicaid or the Children’s Health Insurance Program between October 2013 and April 2014 despite the fact that only about half of the states have expanded Medicaid and the early problems with the federal health insurance website. This brief takes advantage of new data from the Health Reform Monitoring Survey to examine how much of the increase in Medicaid coverage is a net gain in insurance coverage rather than a shift to Medicaid from other coverage, as well as whether there are differences in the patterns of Medicaid changes across states and among different population subgroups.

Posted to Web: June 26, 2014Publication Date: June 26, 2014

Obtaining Information on Marketplace Health Plans: Websites Dominate but Key Groups Also Use Other Sources (Policy Briefs/Health Policy Briefs)
Fredric Blavin, Stephen Zuckerman, Michael Karpman

After the highly publicized troubled start, enrollment in the Affordable Care Act's health insurance Marketplaces exceeded 8 million. Despite many early problems, the vast majority of people who looked for Marketplace information had either used or tried to use a website to find it, and most had found the website they used very or somewhat easy to navigate. But not everyone used a website to obtain information on Marketplace health insurance plans. In this brief, we explore how different groups relied on many sources—website, direct assistance (e.g., call center, navigator, insurance broker, Medicaid agency office), the media, or indirect or informal channels—to find information on Marketplace plans. While Healthcare.gov and the state-based Marketplace websites are often viewed as the cornerstone of the ACA, consumers have used, and will likely continue to use, other sources of information on health insurance plans.

Posted to Web: June 24, 2014Publication Date: June 09, 2014

The ACA and America's Cities: Fewer Uninsured and More Federal Dollars (Policy Briefs/Timely Analysis of Health Policy Issues)
Matthew Buettgens, Jay Dev

This report estimated the effect of the Affordable Care Act (ACA) on 14 large and diverse cities: Los Angeles, Chicago, Houston, Philadelphia, Phoenix, Indianapolis, Columbus, Charlotte, Detroit, Memphis, Seattle, Denver, Atlanta, and Miami. For each city we estimated changes in health coverage under the ACA, particularly the resulting decline in the uninsured. We also estimated the additional federal spending on health care that would flow into these cities. For cities in states that have not expanded Medicaid eligibility, we provide estimates both with and without expansion.

Posted to Web: June 19, 2014Publication Date: June 19, 2014

Measuring Medicaid/CHIP Enrollment Progress Under the Affordable Care Act (Research Report)
Lisa Dubay, Genevieve M. Kenney, Matthew Buettgens, Jay Dev, Erik Wengle, Nathaniel Anderson

Since the beginning of the first open enrollment period under the Affordable Care Act (ACA) on October 2013 and April 2014, Medicaid/CHIP enrollment increased by 6.0 million. This accounts for almost half of enrollment increase projected by the Urban Institute's Health Insurance Policy Simulation Model to occur by the end of 2016 when the full ACA coverage effects are expected. Progress is greater in states that expanded Medicaid but there is variation even among these states. This variation is likely due in part to differences in outreach and application assistance efforts by states and whether they used fast-track enrollment strategies.

Posted to Web: June 13, 2014Publication Date: June 13, 2014

Strategies in 4 Safety-Net Hospitals to Adapt to the ACA (Research Brief)
Teresa A. Coughlin, Sharon K. Long, Rebecca Peters, Additional Authors

Safety-net hospitals have long played an essential role in the US health care system. The Affordable Care Act fundamentally changes the health care landscape and safety-net hospitals need to make major changes to compete. This report examines four safety-net hospitals to learn how they are preparing for health reform. While hospitals were employing strategies with different intensities, we found that the study hospitals had implemented an array of financial strategies focused on tapping Medicaid revenues. They also adopted delivery systems reforms, particularly ones related to developing community-based partners, and implemented changes in hospital leadership and management structure as well as efforts to better align physician incentives with hospitals and altering the culture of patient care to be more responsive to the shifting market.

Posted to Web: June 13, 2014Publication Date: June 11, 2014

Who Are the Newly Insured as of Early March 2014? (Policy Briefs/Health Policy Briefs)
Adele Shartzer, Sharon K. Long, Stephen Zuckerman

In May 2014, the US Department of Health and Human Services announced that enrollment in health plans through the health insurance Marketplaces had exceeded 8 million people. Estimates suggest that another 5 million people purchased Affordable Care Act (ACA)-compliant plans outside the Marketplace. In addition, it is estimated that total Medicaid and CHIP enrollment increased by an estimated 4.8 million people. Knowledge about the characteristics of these newly insured individuals provides an early assessment of how well the different components of the ACA are working at expanding coverage as of early March. Further, information on the health needs and health care experiences of newly insured individuals is important for understanding their likely health care demands as they gain coverage, along with their potential effect on the risk pools in private and public insurance programs.

Posted to Web: June 05, 2014Publication Date: May 22, 2014

Uncompensated Care for the Uninsured in 2013: A Detailed Examination (Research Report)
Teresa A. Coughlin, John Holahan, Kyle Caswell, Megan McGrath

Millions of uninsured people use health care services every year. We estimated providers’ uncompensated care costs in 2013 to be between $74.9 billion and $84.9 billion. We calculated that in the aggregate, at least 65 percent of providers’ uncompensated care costs were offset by government payments designated to cover the costs. Medicaid and Medicare were the largest sources of such government payments, providing $13.5 billion and $8.0 billion, respectively. Anticipating fewer uninsured people and lower levels of uncompensated care, the Affordable Care Act reduces certain Medicare and Medicaid payments. Such cuts in government funding of uncompensated care could pose challenges to some providers, particularly in states that have not adopted the Medicaid expansion or where implementation of health care reform is proceeding slowly.

Posted to Web: May 30, 2014Publication Date: May 30, 2014

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