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Uninsured/Uncompensated Care

 
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Exploring Instability and Children's Well-Being: Insights from a Dialogue among Practitioners, Policymakers and Researchers (Research Report)
Gina Adams, Lisa Dubay

Concern is growing about the damage that instability can do to children's healthy development. However it has emerged separately across different domains, with little focus on the pervasive and interconnected nature of the issue or on possible cross-cutting policy solutions. This report presents the insights gleaned from a November 2013 convening of policymakers, practitioners, and researchers about the implications of stability and instability for children's development, as well as what we know, what we need to learn, and what we need to do across research, policy, and practice. A companion report includes essays from some of the meeting participants.

Posted to Web: July 22, 2014Publication Date: July 22, 2014

Halbig v Burwell: Potential Implications for ACA Coverage and Subsidies (Policy Briefs/Health Policy Briefs)
Linda J. Blumberg, John Holahan, Matthew Buettgens

A ruling from the U.S. Court of Appeals for the D.C. Circuit on Halbig v. Burwell is imminent. The plaintiff claims a phrase in the ACA prohibits residents of states where the federal government is administering the health insurance Marketplace from receiving subsidies for purchasing insurance. With 34 states having chosen to leave administration of their Marketplaces to the federal government, a decision for the plaintiff could have broad implications. In 2016, 7.3 million people in these states are estimated to receive federal subsidies totaling $36.1 billion, ranging up to $4.8 billion in Florida and $5.6 billion in Texas.

Posted to Web: July 17, 2014Publication Date: July 17, 2014

Development of a Model for the Valuation of Work Relative Value Units: Objective Service Time Task Status Report (Press Release)
Stephen Zuckerman, Robert A. Berenson, Additional Authors

This pilot project is part of the Centers for Medicare & Medicaid Services' efforts to address potentially misvalued services in the Medicare Physician Fee Schedule. It aims to develop a validation process for the fee schedule's relative value units for physician or nonphysician practitioner work. One of the project's key elements is the development of objective time estimates based on data from several physician practices, health systems, or other entities. This status report describes that task, including selection of services to be studied, identification and engagement of data collection sites, and development of data collection protocols and tools.

Posted to Web: July 16, 2014Publication Date: June 30, 2014

Understanding Older Drivers: An Examination of Medical Conditions, Medication Use, and Travel Behavior (Research Report)
Sandra Rosenbloom, Robert Santos

Almost 90% of people 65 and older are drivers. While older people are among the safest on the road they are more likely to use multiple medications which could interfere with driving safely. This report provides baseline information on the relationship between medical conditions, medication use, and the travel behavior of older drivers from two large national data bases: the 2009 National Household Travel Survey and the 2011 National Health and Aging Trends Study. We found that most older drivers take multiple medications and drive frequently but also self-regulate their behavior in important ways that reduce crash risk.

Posted to Web: July 15, 2014Publication Date: April 01, 2014

QuickTake: Number of Uninsured Adults Continues to Fall under the ACA: Down by 8.0 Million in June 2014 (Fact Sheet / Data at a Glance)
Sharon K. Long, Genevieve M. Kenney, Stephen Zuckerman, Douglas A. Wissoker, Adele Shartzer, Michael Karpman, Nathaniel Anderson

The Urban Institute's Health Reform Monitoring Survey (HRMS) has been tracking insurance coverage since the first quarter of 2013. This QuickTake reports on how the uninsurance rate changed through early June 2014. These results track changes in coverage following the Affordable Care Act's first open enrollment period, which ended on March 31, 2014.

Posted to Web: July 10, 2014Publication Date: July 10, 2014

In Pursuit of Health Equity: Comparing U.S. and EU Approaches to Eliminating Disparities (Policy Briefs/Timely Analysis of Health Policy Issues)
Elizabeth Docteur, Robert A. Berenson

Researchers compare and contrast the U.S. public policy approach to tackling the problem of health disparities with the European approach in this paper. They begin by providing an overview of the ways in which the issue of health disparities has been framed in American and European policy discourse. They next compare how health disparities have been addressed in policy statements produced by the U.S. Department of Health and Human Services and by the European Commission, the executive body of the European Union. In so doing, they seek to illuminate implicit choices that stand to have a bearing on the outcomes of these initiatives.

Posted to Web: June 30, 2014Publication Date: June 24, 2014

Increase in Medicaid under the ACA Reduces Uninsurance, According to Early Estimates (Policy Briefs/Health Policy Briefs)
Lisa Clemans-Cope, Michael Karpman, Adam Weiss, Nathaniel Anderson

An important strategy for increasing health insurance coverage under the Affordable Care Act (ACA) is expanded enrollment in Medicaid, which provides free or very low cost health insurance to low-income people. Over 6 million individuals enrolled in Medicaid or the Children’s Health Insurance Program between October 2013 and April 2014 despite the fact that only about half of the states have expanded Medicaid and the early problems with the federal health insurance website. This brief takes advantage of new data from the Health Reform Monitoring Survey to examine how much of the increase in Medicaid coverage is a net gain in insurance coverage rather than a shift to Medicaid from other coverage, as well as whether there are differences in the patterns of Medicaid changes across states and among different population subgroups.

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

Obtaining Information on Marketplace Health Plans: Websites Dominate but Key Groups Also Use Other Sources (Policy Briefs/Health Policy Briefs)
Fredric Blavin, Stephen Zuckerman, Michael Karpman

After the highly publicized troubled start, enrollment in the Affordable Care Act's health insurance Marketplaces exceeded 8 million. Despite many early problems, the vast majority of people who looked for Marketplace information had either used or tried to use a website to find it, and most had found the website they used very or somewhat easy to navigate. But not everyone used a website to obtain information on Marketplace health insurance plans. In this brief, we explore how different groups relied on many sources—website, direct assistance (e.g., call center, navigator, insurance broker, Medicaid agency office), the media, or indirect or informal channels—to find information on Marketplace plans. While Healthcare.gov and the state-based Marketplace websites are often viewed as the cornerstone of the ACA, consumers have used, and will likely continue to use, other sources of information on health insurance plans.

Posted to Web: June 24, 2014Publication Date: June 09, 2014

The ACA and America's Cities: Fewer Uninsured and More Federal Dollars (Policy Briefs/Timely Analysis of Health Policy Issues)
Matthew Buettgens, Jay Dev

This report estimated the effect of the Affordable Care Act (ACA) on 14 large and diverse cities: Los Angeles, Chicago, Houston, Philadelphia, Phoenix, Indianapolis, Columbus, Charlotte, Detroit, Memphis, Seattle, Denver, Atlanta, and Miami. For each city we estimated changes in health coverage under the ACA, particularly the resulting decline in the uninsured. We also estimated the additional federal spending on health care that would flow into these cities. For cities in states that have not expanded Medicaid eligibility, we provide estimates both with and without expansion.

Posted to Web: June 19, 2014Publication Date: June 19, 2014

Measuring Medicaid/CHIP Enrollment Progress Under the Affordable Care Act (Research Report)
Lisa Dubay, Genevieve M. Kenney, Matthew Buettgens, Jay Dev, Erik Wengle, Nathaniel Anderson

Since the beginning of the first open enrollment period under the Affordable Care Act (ACA) on October 2013 and April 2014, Medicaid/CHIP enrollment increased by 6.0 million. This accounts for almost half of enrollment increase projected by the Urban Institute's Health Insurance Policy Simulation Model to occur by the end of 2016 when the full ACA coverage effects are expected. Progress is greater in states that expanded Medicaid but there is variation even among these states. This variation is likely due in part to differences in outreach and application assistance efforts by states and whether they used fast-track enrollment strategies.

Posted to Web: June 13, 2014Publication Date: June 13, 2014

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