Publications by John Holahan for Health Policy Center

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More about John Holahan's areas of expertise can be found on this Urban Institute expert's page.

This paper examines various reasons for the growth in Medicaid spending in the current decade. Although Medicaid spending has grown faster than the rate of increase in national health spending, much of this is explained by increased enrollment. Per enrollee, Medicaid spending actually compares favorably to increases in medical care prices and gross domestic product. The relative success in Medicaid cost containment seems to be attributable to limits on provider payment rates, expansion of managed care, limits on the use and pricing of prescription drugs, and expansion of community-based long-term care programs. We suggest two strategies for further cost containment.

This paper used the Health Insurance Policy Simulation Model to examine the impact on insurance coverage in government, employer, and family spending in all 50 states in absence of reform. In all states employer sponsored insurance would fall, and Medicaid enrollment and the number of uninsured would increase. Employer spending would increase despite drops in coverage. Government spending for public health insurance programs and for financing of uncompensated care would increase. The results differ among states depending on the distribution of employees by firm size and wage levels, the breadth of coverage in public programs and projected population growth.

In this paper and brief, the authors discuss alternative ways that health reform could be financed. They analyze different options including several proposals for delivery system reforms and for reduction in Medicare and Medicaid payments. They estimate the cost savings that could occur due to the introduction of a public plan option. Finally, they explore a range of revenue options. The key message of the paper is that health reform can be paid for, but it is best to obtain funds from a large number of measures to spread the burden broadly.

Under contract to the State of New York, researchers conducted in-depth micro-simulation analyses of four types of health care reforms being considered for state implementation: a single payer public health insurance option, Assembly Member Gottfried's New York Health Plus proposal that provides an option for all New Yorkers to enroll in Family Health plus, public-private hybrid options that simplify and expand existing public programs and reform private health insurance, and a market-based option that relies on regulatory flexibility and tax credits. The cost and coverage implications of state reform options falling into these four categories are presented in this report.

Recently, the Congressional Budget Office (CBO) estimated that the Senate Finance Committee's health reform plan would cost $1.6 trillion over 10 years. The estimate left many in Washington and around the country with sticker shock. Authors Linda Blumberg and John Holahan place the estimate in context by showing that the costs of health reform are less than 1 percent of estimated GDP and a small fraction of expected health care spending for that period as well. They also contend that the costs associated with inaction are at least as big as those of directly addressing the problems we currently face.

This paper makes the argument that a public plan is important to health reform because it will contribute to cost containment, primarily by addressing problems caused by increased concentration in insurance and hospital markets. We describe how the public plan might be structured, how many people might be expected to enroll, and how much money the public plan might save. We discuss the most frequent arguments that are made in opposition to the public plan. We conclude that the private insurance industry would survive at about the same size but be more efficient and more effective in controlling health care spending.

The testimony begins by mentioning a large number of positive aspects of the legislation. The role and importance of an individual mandate is then briefly discussed. It argues that the public plan that is proposed in the plan is important for overall cost containment and for budget savings. The plan would address problems in the current market that are caused by increasing concentration in insurance and hospital markets. Further it is argued that it is in fact possible to structure a fair competition between public and private health insurance plans. Finally, the testimony makes recommendations for the financing of the Medicaid expansion and for modifying the employer mandate proposal.

The voluntary nature of the US health system has led to an insurance market centered on segmenting health care risk as opposed to one focused on providing affordable access to necessary and efficiently provided high-quality medical services. This can be corrected through comprehensive health care reform that includes a requirement that all individuals have at least a minimum level of health insurance coverage, a so-called individual mandate. While significant government subsidies would be required to fairly implement an individual mandate, we contend that it is the most politically feasible route to universal coverage in the United States today. Published by The New England Journal of Medicine

Medicaid provides a strong platform on which reform efforts to expand health insurance coverage can be built as two-thirds of the nation’s uninsured are low-income. Medicaid coverage could be broadened to reach more of the low-income uninsured by eliminating categorical restrictions and establishing a national eligibility standard based on income. This paper analyzes several options for expanding Medicaid using various income eligibility thresholds for adults and children under both current and enhanced participation rates. The analysis shows coverage and cost implications of the options, as well as impacts by region and with payment rates adjusted to promote provider participation.

This report uses the Health Insurance Policy Simulation Model (HIPSM) to quantify the intermediate and longer-term implications if America’s health care system is not significantly overhauled. Under a range of economic scenarios, the analysis shows an increasing strain on business owners and their employees over the next decade if reform is not enacted. There would be a dramatic decline in the number of people insured through employers, and millions more could become uninsured. There would be large growth in Medicaid/CHIP enrollment and spending, and increased spending on uncompensated health care. Middle-income working families would be the most affected.

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