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Health and Health Care

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Who Are the Remaining Uninsured as of June 2014? (Policy Briefs/Health Policy Briefs)
Adele Shartzer, Genevieve M. Kenney, Sharon K. Long, Katherine Hempstead, Douglas A. Wissoker

It is now widely agreed that the number of nonelderly (age 18–64) uninsured adults has fallen dramatically since the Affordable Care Act’s (ACA’s) Marketplace open enrollment began. According to the June 2014 Health Reform Monitoring Survey (HRMS), the number of uninsured adults fell by an estimated 8 million between September 2013 and June 2014, with proportionately larger coverage gains among low- and middle-income adults and in states that implemented the ACA’s Medicaid expansion. However, 13.9 percent of adults still remain uninsured as of June 2014. In this brief, we use data from the June 2014 wave of the HRMS to assess the characteristics of those who remain uninsured, providing valuable information for ongoing Medicaid outreach and enrollment efforts, as well as preparations for the next open enrollment period in the Marketplaces.

Posted to Web: July 29, 2014Publication Date: July 29, 2014

Navigating the Marketplace: How Uninsured Adults Have Been Looking for Coverage (Policy Briefs/Health Policy Briefs)
Stephen Zuckerman, Michael Karpman, Fredric Blavin, Adele Shartzer

A growing body of evidence shows that the number of uninsured adults declined significantly since the Affordable Care Act’s open enrollment period started in October 2013. Although the vast majority of people turned to websites for information on the federal or state Marketplaces, many consumers used, and will likely continue to use, other sources for health insurance plan information. In this brief, we focus on adults who were uninsured for some or all of the 12 months before June 2014. We consider the share who looked for information on health plans in the Marketplaces, comparing the approaches used by those who obtained coverage with those who remained uninsured as of June 2014. Our objective is to identify which approaches to obtaining Marketplace information are more likely to be associated with gaining insurance coverage.

Posted to Web: July 29, 2014Publication Date: July 29, 2014

Insights on Instability and Children's Development: Commentaries from Practitioners, Policymakers, and Researchers (Commentary)
Gina Adams

Concern is growing about the damage that instability can do to children's healthy development. However it has emerged separately across different domains, with little focus on the pervasive and interconnected nature of the issue or on possible cross-cutting policy solutions. In November 2013, the Urban Institute convened policymakers, practitioners, and researchers to discuss the implications of instability for children's development, as well as what we know, need to learn, and need to do across research, policy, and practice. This paper contains essays from some of the meeting participants; a companion report includes the insights from the conference.

Posted to Web: July 22, 2014Publication Date: July 22, 2014

Exploring Instability and Children's Well-Being: Insights from a Dialogue among Practitioners, Policymakers and Researchers (Research Report)
Gina Adams, Lisa Dubay

Concern is growing about the damage that instability can do to children's healthy development. However it has emerged separately across different domains, with little focus on the pervasive and interconnected nature of the issue or on possible cross-cutting policy solutions. This report presents the insights gleaned from a November 2013 convening of policymakers, practitioners, and researchers about the implications of stability and instability for children's development, as well as what we know, what we need to learn, and what we need to do across research, policy, and practice. A companion report includes essays from some of the meeting participants.

Posted to Web: July 22, 2014Publication Date: July 22, 2014

Halbig v Burwell: Potential Implications for ACA Coverage and Subsidies (Policy Briefs/Health Policy Briefs)
Linda J. Blumberg, John Holahan, Matthew Buettgens

A ruling from the U.S. Court of Appeals for the D.C. Circuit on Halbig v. Burwell is imminent. The plaintiff claims a phrase in the ACA prohibits residents of states where the federal government is administering the health insurance Marketplace from receiving subsidies for purchasing insurance. With 34 states having chosen to leave administration of their Marketplaces to the federal government, a decision for the plaintiff could have broad implications. In 2016, 7.3 million people in these states are estimated to receive federal subsidies totaling $36.1 billion, ranging up to $4.8 billion in Florida and $5.6 billion in Texas.

Posted to Web: July 17, 2014Publication Date: July 17, 2014

Development of a Model for the Valuation of Work Relative Value Units: Objective Service Time Task Status Report (Press Release)
Stephen Zuckerman, Robert A. Berenson, Additional Authors

This pilot project is part of the Centers for Medicare & Medicaid Services' efforts to address potentially misvalued services in the Medicare Physician Fee Schedule. It aims to develop a validation process for the fee schedule's relative value units for physician or nonphysician practitioner work. One of the project's key elements is the development of objective time estimates based on data from several physician practices, health systems, or other entities. This status report describes that task, including selection of services to be studied, identification and engagement of data collection sites, and development of data collection protocols and tools.

Posted to Web: July 16, 2014Publication Date: June 30, 2014

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

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