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Uninsured/Uncompensated Care

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Estimates of Coverage Changes for Children Enrolled in Separate Children's Health Insurance Programs in the Absence of Additional Federal CHIP Funding-Key Findings and Methodology: Report to the Medicaid and CHIP Payment and Access Commission (Research Report)
Lisa Dubay, Matthew Buettgens, Genevieve M. Kenney

The Medicaid and CHIP Payment and Access Commission (MACPAC) commissioned the Urban Institute to updates its model to consider the alternative health insurance options that would be available to children enrolled in separate CHIP programs were separate CHIP coverage to be discontinued. Chapter 1, “Sources of Coverage for Children if CHIP Funding Is Exhausted,” of the March 2015 MACPAC report to Congress presents key findings from our simulation modeling. This report provides additional detail on the methodology used to develop the estimates and includes supplemental tables that support the estimates included in chapter 1 of the March 2015 MACPAC report.

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

Nonfederal Surveys Fill a Gap in Data on ACA (Research Report)
Michael Karpman, Sharon K. Long, Michael Huntress

Though federal government surveys are essential for understanding the effect of the Affordable Care Act (ACA) on health insurance coverage and health care, the time lag between data collection and release means little information has been available as major provisions of the law have been implemented in 2014 and early 2015. This brief compares the design and content of seven surveys conducted by private research organizations that are providing timely data on ACA implementation issues and challenges.

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

Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions: Final Annual Report - Year Two (Research Report)
Brenda C. Spillman, Elizabeth Richardson, Anna C. Spencer, Eva H. Allen

This second report on the long-term evaluation of Medicaid health homes, provides an overview of the program and evaluation, describes programs in 11 states, and summarizes cross-cutting qualitative findings. The Urban Institute is conducting the five-year evaluation for the DHHS Assistant Secretary of Planning and Evaluation. Health homes, created in the Affordable Care Act, is an optional benefit for high-need, high-cost beneficiaries with chronic physical conditions or serious mental illness. Distinctive model features are the focus on comprehensive management of clinical and nonclinical services for persons with specific conditions, the variety of providers who may be health homes, and the elevated emphasis on integrating physical and behavioral/mental health care and linking enrollees to social services and other community supports.

Posted to Web: March 06, 2015Publication Date: March 06, 2015

Death Rates for US Women Ages 15 to 54: Some Unexpected Trends (Research Report)
Nan Astone, Steven Martin, Laudan Y. Aron

Recent trends in death rates among US women ages 15 to 54 reveal that rates among non-Hispanic whites are rising for many causes of death. These rising causes include accidental poisoning (linked to the epidemic of prescription opioids), suicide, and obesity- and smoking-related diseases. Specific changes in behavior might reduce some of these death rates, but the range of rising causes of death among white women suggests a need for a broader perspective on the social determinants of health. Unhealthy behaviors often arise and persist within certain social and economic contexts, and such behaviors resist improvement or are replaced by other unhealthy behaviors unless those contexts change.

Posted to Web: March 05, 2015Publication Date: March 05, 2015

The Implications of King v. Burwell: Highlights from Three Analyses of the Consequences of Eliminating ACA Tax Credits in 34 States (Policy Briefs)
Linda J. Blumberg, Matthew Buettgens, John Holahan

This one page summary highlights finding from three recent analyses of the implications of a Supreme Court finding for the plaintiffs in King v. Burwell. The Supreme Court will hear arguments in the case on March 4, 2015.

Posted to Web: March 02, 2015Publication Date: March 02, 2015

Special Enrollment Periods in 2014: A Study of Select States (Research Report)
Jane B. Wishner, Sandy Ahn, Kevin Lucia, Sarah Gadsden

Analysis of Marketplace enrollment has focused primarily on the initial 2014 open enrollment period. But as the second open enrollment period ends—and as open enrollment periods shorten in future years—special enrollment periods (SEPs) will warrant increasing attention. This paper analyzes the legal framework, limited enrollment data, and first year special enrollment experiences in five State-Based Marketplaces (SBMs) and finds that Marketplace systems and consumer outreach and enrollment efforts did not yet match the significant potential for SEP enrollment. The paper identifies several themes that may help policymakers improve SEP enrollment systems in 2015 and beyond.

Posted to Web: February 25, 2015Publication Date: February 25, 2015

Response to the Heritage Foundation's Criticisms of the Urban Institute's King v. Burwell Analyses (Research Brief)
Linda J. Blumberg, Matthew Buettgens, John Holahan

In January and February 2015, Urban Institute researchers released three papers analyzing the implications of a Supreme Court ruling for the plaintiffs in King v. Burwell. A finding for the plaintiffs would eliminate the premium tax credits and cost-sharing reductions currently being provided under the Affordable Care Act in the states where the federal government is playing a role in operating the new nongroup insurance marketplaces established under the law. The Heritage Foundation criticized the validity of some of these estimates, as well as related analyses released by other researchers. Here the UI researchers respond to each of these criticisms.

Posted to Web: February 24, 2015Publication Date: February 24, 2015

Certificates of Public Advantage: Can They Address Provider Market Power? (Research Report)
Randall R. Bovbjerg, Robert A. Berenson

Heath care costs too much, largely because American medical providers command high prices. Waves of mergers have consolidated markets for care and created market power for remaining providers. Antitrust has done too little to prevent the merger frenzy, and policy makers badly need additional tools. This case study highlights one underappreciated alternative, a Certificate of Public Advantage. COPAs are unusual, but one has for nearly two decades overseen the behavior and costs of a merged hospital system in western North Carolina. We detail the accomplishments and shortcomings of this quasi-regulatory public oversight, which is more targeted than full-scale rate regulation.

Posted to Web: February 18, 2015Publication Date: February 18, 2015

Maternal Depression Associated with Less Healthy Dietary Behaviors in Young Children (Research Report)
Tracy Vericker

Maternal depression threatens the well-being of millions of children in the United States and may increase the risk of child obesity. Poor eating habits may be the link between those two conditions. This research brief suggests that young children with mothers reporting depressive symptoms consume more unhealthy foods and beverages and fewer healthy foods and beverages than children with mothers who do not report depressive symptoms.

Posted to Web: February 17, 2015Publication Date: February 17, 2015

Health Care Spending by Those Becoming Uninsured if the Supreme Court Finds for the Plaintiff in King v. Burwell Would Fall by at Least 35 Percent (Research Report)
Matthew Buettgens, John Holahan, Linda J. Blumberg, Hannah Recht

If King v. Burwell is decided in favor of the plaintiff, additional coverage resulting from the ACA’s premium tax credits would be reversed, and some of those purchasing nongroup insurance fully with their own funds would become uninsured due to large increases in premiums. Consequently, spending on medical care would decline in the affected states. This analysis estimates the effect of such a change on hospital, physician, prescription drug and all other spending, noting how much of the continued spending would be self-paid by the uninsured and how much would rely upon historic rates of uncompensated care funding persisting.

Posted to Web: February 12, 2015Publication Date: February 12, 2015

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