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Health and Health Care

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The Patient Protection and Affordable Care Act—health care reform—fundamentally changed health insurance and access to health care. Our researchers are unpacking the landmark law, studying the challenges of implementation, and using our Health Insurance Policy Simulation Model to estimate how its proposals will affect children, seniors, and families, as well as doctors, small businesses, and the national debt.

The Urban Institute also studies cost, coverage, and reform options for Medicare and Medicaid and analyzes trends and underlying causes of changes in health insurance coverage, access to care, and Americans’ use of health care services. Read more.

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Making Sense of Childhood Asthma: Lessons for Building a Better System of Care (Research Report)
Marla McDaniel, Susan J. Popkin, Judy Berman, Paola Barahona, Priya Saxena, Deborah Quint, Stephen J. Teach

This report highlights findings from a qualitative study about asthma care for low-income African American and Latino children ages 4-14 in Washington, DC, where nearly one in five children under age 18 has the condition. We interviewed medical providers, health administrators, policy makers and caregivers whose children had visited the IMPACT DC clinic (located in the emergency department of Children’s National Health System) about the primary barriers, challenges, and opportunities for improving asthma treatment in DC. The stakeholders each felt their school, clinic, agency, or department had a role to play in improving asthma care, and that many challenges were system-related. Three major areas where caregivers and stakeholders described system breakdowns were poor communication among caregivers, providers, and other stakeholders; inadequate access to both the quality and quantity of care needed to manage a child's asthma; and scarce long-term support to address both the social-emotional and financial burdens created by managing a chronic childhood illness.

Posted to Web: April 16, 2014Publication Date: April 16, 2014

Early Estimates Indicate Rapid Increase in Health Insurance Coverage under the ACA: A Promising Start (Policy Briefs/Health Policy Briefs)
Sharon K. Long, Genevieve M. Kenney, Stephen Zuckerman, Douglas A. Wissoker, Dana Goin, Katherine Hempstead, Michael Karpman, Nathaniel Anderson

By the end of March, enrollment in Marketplace plans created by the Affordable Care Act (ACA) was reported at just over 7 million and the Centers for Medicare and Medicaid Services (CMS) reported that Medicaid enrollment increased between the beginning of October 2013 and the end of February 2014. However, neither the Marketplace enrollment figures nor the CMS Medicaid report provide an accurate picture of how many uninsured people have gained coverage since open enrollment began, because both sets of enrollment figures may include newly insured people as well as those who had other sources of coverage before 2014. We use the March 2014 Health Reform Monitoring Survey (HRMS) to examine changes in health insurance coverage in early March 2014 relative to coverage over the prior year, including more disaggregated information on coverage changes and additional details on the statistical precision of the estimates.

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

Children's School-Related Food and Physical Activity Behaviors Are Associated with Body Mass Index (Article)
Tracy Vericker

Childhood obesity is a critical public health issue, with prevalence rates reaching nearly one in five children. Schools may be a promising public policy intervention point. The foods schools sell and the physical activity environments they foster can influence dietary behaviors and overall physical activity. Using secondary data from a nationally representative sample of children from the kindergarten class of 1998-1999 and nonexperimental methods, this study examines the associations between the food and physical activity environments in school and body mass index (BMI) for low-income boys and girls in the 8th grade during 2007. Results reveal that participating in school sports is associated with a 0.55 lower BMI score for boys. For low-income girls, eating the school breakfast is associated with a 0.70 higher BMI score and eating the school lunch is associated with a 0.65 higher BMI score. Each hour spent on homework is associated with a 0.02 higher BMI score for low-income girls. These findings suggest that schools may influence adolescent BMI and that there is room for improvement in school food and physical activity environments to promote healthier weights for low-income boys and girls.

Posted to Web: April 14, 2014Publication Date: October 28, 2013

Primary Care Access for New Patients on the Eve of Health Care Reform (Article)
Genevieve M. Kenney, Douglas A. Wissoker, Additional Authors

This study uses a simulated patient approach to assess appointment availability and wait times for new primary care appointments in late 2012/early 2013 by insurance status and state. Although most primary care physicians are accepting new patients, access varies widely across states and insurance status. Outreach programs are needed, not only to help patients enroll but also to identify practices accepting new patients within each plan's network. Tracking new patient appointment availability over time can inform policies designed to strengthen primary care capacity and enhance the effectiveness of the coverage expansions with the Patient Protection and Affordable Care Act.

Posted to Web: April 09, 2014Publication Date: April 07, 2014

As the Economy Improves, the Number of Uninsured Is Falling But Not Because of a Rebound in Employer Sponsored Insurance (Research Brief)
John Holahan, Megan McGrath

John Holahan and Megan McGrath use the Current Population Survey to provide an analysis of the changes in health insurance coverage since the 2007 recession. There has been a decline in the number of uninsured in the last two years, both among adults and children due to an increase in available public coverage. While the rate of employer sponsored insurance (ESI) has stabilized for some groups in recent years, it has not led to large gains in ESI as the economy has improved. There has, however, been an increase in ESI coverage among young adults, because of the Affordable Care Act (ACA) provisions allowing them to retain family coverage. The paper also looks at trends in coverage across race/ethnicity, region, industry, and firm size.

Posted to Web: April 09, 2014Publication Date: March 11, 2014

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