This is an appendix to the brief, Year-to-Year Variation in Small-Group Health Insurance Premiums: Double-Digit Annual Increases Have Been Common Over the Past Decade. The brief can be found at http://www.urban.org/url.cfm?ID=413235
In anticipation of next year's premium announcements and given some information already made public, concerns have surfaced about the potential for double-digit percent increases in nongroup and small-group health insurance premiums. This analysis shows that, although average annual increases in small-group premiums over the past 13 years averaged roughly 5.5 percent, double-digit average premium increases are common for states and large metropolitan areas. Large increases in one year are frequently followed by much smaller increases, or even decreases. This may be especially true as insurers and purchasers navigate the ACA's new insurance environment, moving toward a more stable equilibrium.
This environmental scan report compiles and assesses the available literature from the last 5 years on preventive health care services for child beneficiaries (including adolescents) in Medicaid and the Children's Health Insurance Program (CHIP). It addresses preventive service utilization patterns and barriers, cost and health outcomes associated with prevention, and activities designed to improve preventive service rates and outcomes. This report is intended to help inform the development and dissemination of resources for states to use in their efforts to increase the utilization of recommended preventive services by Medicaid and CHIP beneficiaries.
This environmental scan report compiles and assesses the available literature from the last 5 years on preventive health care services for adult beneficiaries in Medicaid. It addresses preventive service utilization patterns and barriers, cost and health outcomes associated with prevention, and activities designed to improve preventive service rates and outcomes. This report is intended to help inform the development and dissemination of resources for states to use in their efforts to increase the utilization of recommended preventive services by Medicaid and CHIP beneficiaries.
Compared to usual obstetrical care, care by midwives at a birth center could reduce costs to the Medicaid program. This article examines whether such care reduces Medicaid costs for low income women using results from a prior study of maternal and infant outcomes at the Family Health and Birth Center in Washington, D.C. Costs to Medicaid are derived from birth center data and from national sources. Birth center care could save an average of $1,163 per birth. Policy makers should consider a larger role for midwives and birth centers in maternity care for low-risk pregnant women with Medicaid.
Behavioral economics, which analyzes how behavior sometimes departs from the rational calculation of self-interest, can help Medicaid programs use targeted enrollment strategies more effectively by eliminating apparently modest procedural requirements, which can greatly reduce participation levels. It can also help health coverage applicants receive SNAP, even though demonstrating eligibility for health subsidies and choosing a health plan can tax many consumers' cognitive resources, making it hard to process information about SNAP. For example, health applicants could be given the option to have the state's food agency contact them later to complete a SNAP application by phone.
Human services programs can benefit from 90 percent federal funding for information technology investments that are complete by the end of 2015 and that: 1) build a service that helps both Medicaid and human services; or 2) build an interface that helps Medicaid use human services records to verify eligibility or "fast track" enrollment. Once the Affordable Care Act is fully phased in, Medicaid will be the country's most widely-used need-based program. Human services programs can use Medicaid records to streamline eligibility determination, despite limits on information sharing and differences between Medicaid and human services program rules, including household definitions.
Beginning in June 2013, the Urban Institute's Health Reform Monitoring Survey (HRMS), which was designed to provide early feedback on implementation of the Affordable Care Act (ACA), has been tracking changes in health insurance coverage and other outcomes for children under the ACA. In contrast to adults, uninsured rates for children had been declining in the decade before the ACA's passage, largely because of the expansion of public coverage (Medicaid and the Children's Health Insurance Program) which is substantially generous and draws high participation among children. Estimates derived from HRMS children's supplement suggest that uninsured rates for children had not changed by June 2014 from their pre-ACA levels, though there are reasons to expect that children's coverage will grow in future years.
In this brief, we use data from the June 2014 Health Reform Monitoring Survey (HRMS) to examine changes in health insurance coverage for parents since September 2013. The HRMS was designed to provide early feedback on ACA implementation to complement the more robust assessments that will be possible when the federal surveys release their estimates of changes in health insurance coverage later in 2014 and in 2015. We find that the uninsurance rate declined by 14.4 percent for parents nationally between September 2013 and June 2014 and by 33.3 percent for parents in states that expanded Medicaid. As the ACA moves forward, it will be important to assess (1) whether these coverage gains translate into improvements in access to care, health status, and financial well-being for parents and (2) the extent of positive spillover effects on parents' children.
The Urban Institute's Health Reform Monitoring Survey has been tracking health insurance coverage, including employer-sponsored insurance coverage (ESI), since the first quarter of 2013. This QuickTake reports on nonelderly (ages 18–64) workers' ESI in June 2014. In June 2014, most workers were insured and, among those who were insured, most had ESI. When asked to assess their ESI, workers were generally satisfied with available health care services, choice of doctors and other providers, and the quality of the care available under their ESI plan. However, satisfaction levels are much lower for the financial aspects of coverage, with workers more concerned about premiums, co-payments, and their potential financial risk from high medical bills.