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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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.
Older youth face many challenges including continuing health care as they approach adulthood. The Affordable Care Act will provide new coverage for young adults. This 10 state study provides new data on Medicaid health costs for youth turning age 18. On average, boys are more expensive than girls at this age. Three groups are particularly high cost, disabled youth enrolled in Supplemental Security Income, foster care youth, and those with behavioral health problems. These three groups account for less than 20 percent of all youth that age, but over half the cost of the program.
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.
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