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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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Appointment Availability after Increases in Medicaid Payments for Primary Care (Article)
Daniel Polsky, Michael Richards, Simon Basseyn, Douglas A. Wissoker, Genevieve M. Kenney, Stephen Zuckerman, Karin Rhodes

This study examines the effect of increased Medicaid reimbursements for primary care services in 2013 and 2014, a key provision of Affordable Care Act, on access to primary care. The researchers measured the availability of and waiting times for appointments for Medicaid enrollees and privately insured individuals in 10 states during two periods: from November 2012 through March 2013 and from May 2014 through July 2014. Between the two time periods, the availability of primary care appointments for Medicaid beneficiaries increased from 58.7 percent to 66.4 percent, while no changes were observed for the privately insured. During the same periods, waiting times to a scheduled new-patient appointment remained stable. These results suggest that increased Medicaid reimbursement to primary care providers was associated with improved appointment availability for Medicaid enrollees without generating longer waiting times.

Posted to Web: January 23, 2015Publication Date: January 21, 2015

Characteristics of Those Affected by a Supreme Court Finding for the Plaintiff in King v. Burwell (Policy Briefs/Timely Analysis of Health Policy Issues)
Linda J. Blumberg, Matthew Buettgens, John Holahan

Following up on our previous analysis of the implications of a Supreme Court finding for the plaintiff in the King v. Burwell, this brief describes the characteristics of those that would be affected, particularly those who would otherwise have nongroup insurance. Of the 9.3 million people estimated to lose tax credits, two-thirds would become uninsured. Most are adults who are low and middle income but not poor, most are white, non-Hispanic, and most reside in the South. Financial burdens would increase substantially for those wishing to continue buying the same coverage they would have under current implementation of the law.

Posted to Web: January 22, 2015Publication Date: January 22, 2015

Transitioning from Medicaid Expansion Programs to Medicare: Making Sure Low-Income Medicare Beneficiaries Get Financial Help (Research Brief)
Matthew Buettgens, Lynda Flowers, Jay Dev

The Affordable Care Act allows states to offer Medicaid coverage to low-income adults who would not have qualified under previous law. This population will face higher cost-sharing requirements when they transition to Medicare, although some may be eligible for traditional Medicaid benefits and/or Medicare Savings Programs (MSPs) that will reduce their costs. This report discusses how Medicare beneficiaries can qualify for traditional Medicaid and MSPs, provides new estimates of the number and characteristics of eligible individuals, and outlines policy options that would make it easier for Medicare beneficiaries to qualify for traditional Medicaid benefits and MSPs.

Posted to Web: January 21, 2015Publication Date: January 21, 2015

The Need to Reform Medicare's Payments to Skilled Nursing Facilities is as Strong as Ever (Research Report)
Carol Carter, Bowen Garrett, Douglas A. Wissoker

Well-documented shortcomings in Medicare's payment system for skilled nursing facilities (SNFs) have prompted many revisions to the system. This study finds that Medicare's payments to SNFs for therapy and non-therapy ancillary (NTA) services are the least accurate they have been since 2006. Payments are less reflective of cost differences across both stays and facilities and payments are less proportional to costs. An alternative design that would base payments on patient characteristics and establish separate payments for NTA services would increase payment accuracy and dampen the incentives to furnish excessive therapy and avoid patients with complex medical needs for financial gain.

Posted to Web: January 15, 2015Publication Date: January 15, 2015

Monitoring the Impact of Health Reform on Americans 50-64: Use of Insurance Marketplaces (Policy Briefs/Health Policy Briefs)
Gerry Smolka, Olivia Dean, Kyle Caswell, Timothy Waidmann, Adam Weiss

This paper is part of a series that looks at the experiences of 50- to 64-year-olds during the Affordable Care Act (ACA)'s first open enrollment period. An Urban Institute–AARP survey conducted in December 2013 found that approximately 9 out of 10 Americans ages 50 to 64 were aware of the new health insurance Marketplace that had been created by the ACA. The survey found that, despite widespread awareness of the Marketplace among this age group, relatively few who knew about the Marketplace were interested in using it to acquire new coverage. The survey also found that 50- to 64-year-olds' use of the Marketplace varied widely by health insurance status and income.

Posted to Web: January 13, 2015Publication Date: January 13, 2015

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