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Health and Health Care

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QuickTake: Number of Uninsured Adults Falls by 5.4 Million since 2013 (Policy Briefs/Health Policy Briefs)
Sharon K. Long, Genevieve M. Kenney, Stephen Zuckerman, Douglas A. Wissoker, Dana Goin, Michael Karpman, Nathaniel Anderson

The Urban Institute's Health Reform Monitoring Survey (HRMS) has been tracking insurance coverage since the first quarter of 2013. Today, we report the first estimate of how the uninsurance rate has changed through early March 2014. These results track changes through most of the first Affordable Care Act's (ACA) open-enrollment period, which ended on March 31, 2014. Analysis of data from the March 2014 HRMS shows the uninsurance rate for nonelderly adults (age 18–64) was 15.2 percent for the nation, a drop of 2.7 percentage points since September 2013, the month before ACA open enrollment began. This represents a gain in coverage for about 5.4 million adults.

Posted to Web: April 07, 2014Publication Date: April 03, 2014

The Availability of New Patient Appointments for Primary Care at Federally Qualified Health Centers: Findings From an Audit Study (Policy Briefs/Health Policy Briefs)
Brendan Saloner, Genevieve M. Kenney, Daniel Polsky, Karin Rhodes, Douglas A. Wissoker, Stephen Zuckerman

This brief compares the availability of primary care appointments for new patients at Federally Qualified Health Centers (FQHCs) and other non-FQHC practices using an audit study conducted in late 2012/early 2013. FQHCs were 24 percentage points more likely than non-FQHC providers to offer a new patient appointment to Medicaid callers and 39 percentage points more likely to offer an uninsured caller a visit for less than $75. The findings suggest that FQHCs are more willing than other providers to accommodate new Medicaid patients and offer low-cost appointments to uninsured patients, but that FQHC wait times are slightly longer.

Posted to Web: April 07, 2014Publication Date: April 07, 2014

Access to Care for Low-Income Medicaid and Privately Insured Adults in 2012 in the National Health Interview Survey: A Context for Findings from a New Audit Study (Policy Briefs/Health Policy Briefs)
Genevieve M. Kenney, Brendan Saloner, Nathaniel Anderson, Daniel Polsky, Karin Rhodes

This brief uses national data to provide context for a 10-state audit study which found lower availability of new patient primary care appointments but similar wait times for Medicaid as opposed to private callers. It finds that the vast majority of Medicaid adults had a usual source of care and that few reported that they had had problems finding a general provider. These findings suggest that despite the more restricted number of practices with new patient appointment availability for Medicaid patients found in the audit study, Medicaid enrollees were getting connected to primary care providers at high rates in 2012.

Posted to Web: April 07, 2014Publication Date: April 07, 2014

Health Care Access and Cost Barriers for Adults with Physical or Mental Health Issues: Evidence of Significant Gaps as the ACA Marketplaces Opened their Doors (Policy Briefs/Health Policy Briefs)
Dana Goin, Sharon K. Long

More than one-third of nonelderly adults in the US reported that their physical health or mental health was not good for one or more days in 2012. Physical and mental health problems translate into higher levels of health care need and higher risks for poor health outcomes if those needs are not met. Historically, such health problems have been compounded by preexisting condition exclusions employed by health insurance companies to reduce costs. While the Affordable Care Act (ACA) has eliminated this practice, barriers to care for those with high health care needs are likely to remain. In this brief we examine the health care access and affordability challenges reported by nonelderly adults in December 2013—comparing the experiences of healthy adults to those of adults reporting physical and mental health problems in order to identify whether the latter are more likely to face barriers in getting the care they need.

Posted to Web: April 04, 2014Publication Date: April 04, 2014

Financial Burden of Medical Spending by State and the Implications of the 2014 Medicaid Expansions (Research Report)
Kyle Caswell, Timothy Waidmann, Linda J. Blumberg

This study is the first to offer a detailed look at medical spending burden levels, defined as total family medical out-of-pocket spending as a proportion of income, for each state. It further investigates which states have greater shares of individuals with high burden levels and no Medicaid coverage, but would be Medicaid eligible under the 2014 rules of the Affordable Care Act should their state choose to participate in the expansion. This work suggests which states have the largest populations likely to benefit, in terms of lowering medical spending burden, from participating in the 2014 adult Medicaid expansions.

Posted to Web: April 03, 2014Publication Date: April 03, 2014

Measuring Marketplace Enrollment Relative to Enrollment Projections (Research Report)
Linda J. Blumberg, Genevieve M. Kenney, Matthew Buettgens, John Holahan, Nathaniel Anderson, Hannah Recht, Stephen Zuckerman

This brief compares Affordable Care Act Marketplace enrollment as of March 1, 2014 (the most recent state-specific data) to projected enrollment for 2014 and 2016 and estimates of the number of people eligible for subsidies. Nationally, by March 1, the Marketplaces had enrolled 61 percent of projected 2014 enrollment of subsidized and unsubsidized individuals. They had enrolled 63 percent of the subsidized population expected to enroll in 2014. Collectively, State-Based Marketplaces (SBMs) have been more successful in reaching projected enrollment than the Federally Facilitated Marketplaces (FFMs), with SBMs overall also having significantly higher rates of subsidized enrollment than FFMs.

Posted to Web: April 02, 2014Publication Date: April 02, 2014

Who among the Uninsured Do Not Plan to Look for Health Insurance in the ACA Marketplaces? (Policy Briefs/Health Policy Briefs)
Bowen Garrett, Lisa Clemans-Cope, Katherine Hempstead, Nathaniel Anderson

New enrollment figures for both state and federal health insurance Marketplaces created by the Affordable Care Act (ACA) show that participation picked up steam after a slow start. Previous research suggests that the initial low levels of Marketplace enrollment were driven as much by gaps in awareness of the ACA's coverage provisions as by the widely publicized problems with the federal website. For example, only about one-third of adults had heard some or a lot about the Marketplaces on the eve of the Marketplace rollout. By December 2013, about one-fifth of uninsured adults had looked at that time and another third planned to look. Additional research finds that many uninsured are not looking for coverage in the Marketplaces because they are unaware that financial help is available there.

Posted to Web: April 01, 2014Publication Date: March 21, 2014

The Urban Institute Health Policy Center's Medicaid/CHIP Eligibility Simulation Model (Methodology Report)
Jennifer M. Haley, Victoria Lynch, Genevieve M. Kenney

The Urban Institute Health Policy Center's Medicaid/CHIP Eligibility Simulation Model is a microsimulation that uses rules about Medicaid/CHIP eligibility to approximate adults' and children's eligibility for Medicaid and CHIP. It has been used to simulate eligibility in the 50 states and Washington DC for the years 2008-2012 (before the Affordable Care Act [ACA] was implemented) and 2014 (simulating the new coverage provisions of the ACA). It has also been used to simulate eligibility in Puerto Rico in 2011 and enrollment under hypothetical statehood. It relies on the American Community Survey (ACS) and the Puerto Rico Community Survey (PRCS).

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

Integrating Community Health Workers into a Reformed Health Care System (Research Report)
Randall R. Bovbjerg, Lauren Eyster, Barbara A. Ormond, Theresa Anderson, Elizabeth Richardson

Community health workers (CHWs) can help to achieve the goals of the Affordable Care Act—better health, better care, and lower costs. CHWs are typically laypeople whose close connections with a community enable them to win trust and improve health and health services for those they serve. However, challenges with financing structures, workforce training, and service organization can hinder the expansion of the CHW workforce. This paper highlights the roles played by CHWs, assesses evidence of their achievements, describes the increasing opportunities for them under health care reform, and considers productive next steps for growing the CHW workforce.

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

Opportunities for Community Health Workers in the Era of Health Reform (Research Report)
Randall R. Bovbjerg, Lauren Eyster, Barbara A. Ormond, Theresa Anderson, Elizabeth Richardson

Health reform has created a watershed moment for community health workers (CHWs). Both coverage expansions and a new focus on creating value in health care offer new opportunities for CHWs. This paper assesses existing impediments to and enablers of the expansion of CHW employment. It catalogues how the ACA and other health reform efforts affect prospects for sustainable employment for CHWs. It also looks at workforce issues, insurance enrollment needs, affordability and accessibility of services, and changes in approaches to public health and prevention. The paper concludes by highlighting particular promising opportunities for CHWs in both public and private sectors.

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

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