States expanding Medicaid eligibility under the ACA can substantially expedite Medicaid enrollment and retention for SNAP participants, 97 percent of whom will qualify for Medicaid, according to this study. Even in states where SNAP provides broad-based categorical eligibility that extends SNAP’s gross income limits to at least 185 percent of the federal poverty level, 94 percent of SNAP recipients will qualify for Medicaid. Data showing SNAP receipt can thus verify Medicaid applicants’ financial eligibility, allow administrative renewal for Medicaid beneficiaries, and facilitate Medicaid enrollment for numerous eligible consumers when expanded coverage begins in early 2014.
The Heritage Foundation has repeatedly and misleadingly claimed that Urban Institute research shows most states would experience budget problems if they implemented the ACA's Medicaid expansion. In fact, every comprehensive fiscal analysis done at the state level has concluded that expansion would yield net state budget gains, with revenues and savings that exceed increased state costs. All states must pay for national health reform but only those that expand Medicaid will receive large, offsetting allotments of federal Medicaid dollars, with resulting economic activity, jobs, and state revenue. Solid research shows that Medicaid expansion saves lives and improves access to care.
The Family Health and Birth Center in Washington, D.C. provides accessible, culturally appropriate prenatal care and delivery services to low income women. This study of the outcomes of care at that center improves on previous research by controlling for risk selection into birth center care. We find that women who receive at least two prenatal visits from birth center midwives regardless of whether they deliver at the center or in a hospital—are less likely to have a C-section and less likely to have an induced delivery. They have fewer preterm babies and their babies have higher birth weights.
The exclusion of employer-sponsored health insurance premiums and medical benefits reduced federal tax revenues by $268 billion in 2011 alone-by far the largest federal tax expenditure. Moreover, the exclusion disproportionately subsidizes those with higher incomes. In this brief, we provide estimates of the revenue potential and distributional consequences of limiting the exclusion from income and payroll taxes at the 75th percentile of 2013 premiums, indexing by GDP. The policy would produce $264.0 billion in new tax revenues over the coming decade while preserving 93 percent of the tax subsidies available under the current policy.
National health expenditures have grown at record-low rates for the past three years. The recession has been cited as an important driver of recent trends leading many to wonder if slower spending growth will continue as the economy recovers. We review the trends in health spending growth over the last decade and show that growth began to slow well before the most recent recession. We also consider trends in incomes and insurance coverage and suggest that declines in real incomes and a shift towards less generous insurance arrangements have slowed the growth in provider revenues and forced cost containment efforts. The question remains, however, as to whether the changes that slowed health spending growth over the last decade will be maintained or extended as the economy recovers and the Affordable Care Act expands health insurance coverage.
This report presents data on changes in Medicaid's enrollment and spending between federal fiscal year 2007 and federal fiscal year 2011, a period which includes the worst economic downturn in the United States since the Great Depression of the 1930s. The paper also examines what factors drove Medicaid spending over the period, and concludes that overall spending growth from 2007 to 2011 was driven largely by the enrollment growth that resulted from many people losing jobs and income during the recession. However, on a per enrollee basis, Medicaid spending has grown more slowly than other sectors of the health system.
Maternal depression can have severe and lasting consequences for both a mother and her child. This brief uses the National Survey of Drug Use and Health to estimate the prevalence, severity, and treatment of major depression among low-income mothers with young children (ages 0-5). We find that one out of eleven low-income mothers with young children had a major depressive episode in the past year, and nearly one-third did not report receiving any treatment. While uninsured low-income mothers had much lower treatment rates than insured low-income mothers, rates were comparable across treatment providers, suggesting that Medicaid fills an important gap.
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.
Policy experts predict that small employers, especially those with younger and healthier employees, will increasingly establish “self-funded” health plans, leaving the traditional fully insured market to obtain lower premiums and avoid market reforms under the Affordable
Care Act. Through interviews with stakeholders in 10 study states, this paper describes factors that may in¬fluence whether and how extensively this change occurs. It also shows that states have minimal data on this potentially growing market, but they would be well served to improve their monitoring efforts so they can identify any increases in small group self-funding and resulting adverse selection, and respond appropriately.
Work Support Strategies (WSS) is a multiyear, multi-state initiative to implement reforms that help eligible low-income families get and keep a full package of work support benefits, including Medicaid, nutrition assistance (SNAP), and child care assistance. This report summarizes the lessons learned from the nine planning grant states (Colorado, Idaho, Illinois, Kentucky, New Mexico, North Carolina, Oregon, Rhode Island, South Carolina), just one year into a four-year project. The report includes what the states did, how they overcame challenges, and how the planning year changed their strategies and capacities for the future.
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