Health Policy Center Authors
Publications by Sharon K. Long for Health Policy Center
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More about Sharon K. Long's areas of expertise can be found on this Urban Institute expert's page.
Taking Stock at Mid-Year: Health Insurance Coverage under the ACA as of June 2014 (Policy Briefs/Health Policy Briefs)
Sharon K. Long, Genevieve M. Kenney, Stephen Zuckerman, Douglas A. Wissoker, Adele Shartzer, Michael Karpman, Nathaniel Anderson, Katherine Hempstead
The Affordable Care Act (ACA) has brought major changes to the US health insurance system: In January 2014, Medicaid was expanded to nearly all adults with family incomes at or below 138 percent of the federal poverty level in 24 states and the District of Columbia, and enrollment under the new health insurance Marketplaces officially began in all states and the District of Columbia. We use the June 2014 Health Reform Monitoring Survey (HRMS) to examine changes in health insurance coverage since the beginning of the previous year for nonelderly adults. The HRMS was designed to provide early feedback on ACA implementation to complement the more robust assessments that will be possible when the federal surveys release their estimates of changes in health insurance coverage later in 2014 and in 2015.
Who Are the Remaining Uninsured as of June 2014? (Policy Briefs/Health Policy Briefs)
Adele Shartzer, Genevieve M. Kenney, Sharon K. Long, Katherine Hempstead, Douglas A. Wissoker
It is now widely agreed that the number of nonelderly (age 18–64) uninsured adults has fallen dramatically since the Affordable Care Act’s (ACA’s) Marketplace open enrollment began. According to the June 2014 Health Reform Monitoring Survey (HRMS), the number of uninsured adults fell by an estimated 8 million between September 2013 and June 2014, with proportionately larger coverage gains among low- and middle-income adults and in states that implemented the ACA’s Medicaid expansion. However, 13.9 percent of adults still remain uninsured as of June 2014. In this brief, we use data from the June 2014 wave of the HRMS to assess the characteristics of those who remain uninsured, providing valuable information for ongoing Medicaid outreach and enrollment efforts, as well as preparations for the next open enrollment period in the Marketplaces.
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.
Strategies in 4 Safety-Net Hospitals to Adapt to the ACA (Research Brief)
Teresa A. Coughlin, Sharon K. Long, Rebecca Peters, Additional Authors
Safety-net hospitals have long played an essential role in the US health care system. The Affordable Care Act fundamentally changes the health care landscape and safety-net hospitals need to make major changes to compete. This report examines four safety-net hospitals to learn how they are preparing for health reform. While hospitals were employing strategies with different intensities, we found that the study hospitals had implemented an array of financial strategies focused on tapping Medicaid revenues. They also adopted delivery systems reforms, particularly ones related to developing community-based partners, and implemented changes in hospital leadership and management structure as well as efforts to better align physician incentives with hospitals and altering the culture of patient care to be more responsive to the shifting market.
Who Are the Newly Insured as of Early March 2014? (Policy Briefs/Health Policy Briefs)
Adele Shartzer, Sharon K. Long, Stephen Zuckerman
In May 2014, the US Department of Health and Human Services announced that enrollment in health plans through the health insurance Marketplaces had exceeded 8 million people. Estimates suggest that another 5 million people purchased Affordable Care Act (ACA)-compliant plans outside the Marketplace. In addition, it is estimated that total Medicaid and CHIP enrollment increased by an estimated 4.8 million people. Knowledge about the characteristics of these newly insured individuals provides an early assessment of how well the different components of the ACA are working at expanding coverage as of early March. Further, information on the health needs and health care experiences of newly insured individuals is important for understanding their likely health care demands as they gain coverage, along with their potential effect on the risk pools in private and public insurance programs.
Changes in Mortality After Massachusetts Health Care Reform: A Quasi-experimental Study (Article)
Benjamin D. Sommers, Sharon K. Long, Katherine Baicker
The Massachusetts 2006 health care reform has been called a model for the Affordable Care Act. The law attained near-universal insurance coverage and increased access to care. Its effect on population health is less clear. This study compares mortality rates before and after reform in Massachusetts versus a control group with similar demographics and economic conditions. The results show that reform in Massachusetts was associated with a significant decrease in all-cause mortality and mortality for conditions amenable as compared with the control group. Changes were larger in counties with lower household incomes and higher pre-reform uninsured rates.
Early Estimates Indicate Rapid Increase in Health Insurance Coverage under the ACA: A Promising Start (Policy Briefs/Health Policy Briefs)
Sharon K. Long, Genevieve M. Kenney, Stephen Zuckerman, Douglas A. Wissoker, Dana Goin, Katherine Hempstead, Michael Karpman, Nathaniel Anderson
By the end of March, enrollment in Marketplace plans created by the Affordable Care Act (ACA) was reported at just over 7 million and the Centers for Medicare and Medicaid Services (CMS) reported that Medicaid enrollment increased between the beginning of October 2013 and the end of February 2014. However, neither the Marketplace enrollment figures nor the CMS Medicaid report provide an accurate picture of how many uninsured people have gained coverage since open enrollment began, because both sets of enrollment figures may include newly insured people as well as those who had other sources of coverage before 2014. We use the March 2014 Health Reform Monitoring Survey (HRMS) to examine changes in health insurance coverage in early March 2014 relative to coverage over the prior year, including more disaggregated information on coverage changes and additional details on the statistical precision of the estimates.
QuickTake: Number of Uninsured Adults Falls by 5.4 Million since 2013 (Policy Briefs/Health Policy Briefs)
Sharon K. Long, Genevieve M. Kenney, Stephen Zuckerman, Douglas A. Wissoker, Dana Goin, Michael Karpman, Nathaniel Anderson
The Urban Institute's Health Reform Monitoring Survey (HRMS) has been tracking insurance coverage since the first quarter of 2013. Today, we report the first estimate of how the uninsurance rate has changed through early March 2014. These results track changes through most of the first Affordable Care Act's (ACA) open-enrollment period, which ended on March 31, 2014. Analysis of data from the March 2014 HRMS shows the uninsurance rate for nonelderly adults (age 18–64) was 15.2 percent for the nation, a drop of 2.7 percentage points since September 2013, the month before ACA open enrollment began. This represents a gain in coverage for about 5.4 million adults.
Health Care Access and Cost Barriers for Adults with Physical or Mental Health Issues: Evidence of Significant Gaps as the ACA Marketplaces Opened their Doors (Policy Briefs/Health Policy Briefs)
Dana Goin, Sharon K. Long
More than one-third of nonelderly adults in the US reported that their physical health or mental health was not good for one or more days in 2012. Physical and mental health problems translate into higher levels of health care need and higher risks for poor health outcomes if those needs are not met. Historically, such health problems have been compounded by preexisting condition exclusions employed by health insurance companies to reduce costs. While the Affordable Care Act (ACA) has eliminated this practice, barriers to care for those with high health care needs are likely to remain. In this brief we examine the health care access and affordability challenges reported by nonelderly adults in December 2013—comparing the experiences of healthy adults to those of adults reporting physical and mental health problems in order to identify whether the latter are more likely to face barriers in getting the care they need.
An Update on Health Insurance Coverage and Health Care Access, Use and Affordability in Massachusetts as of 2012 (Research Report)
Sharon K. Long, Ariel Fogel
This collection of reports provides an update on trends in health insurance coverage, health care access and use, and health care affordability in Massachusetts since fall 2006, just prior to the implementation of the state's health reform initiative. The publications also provide a more in-depth overview of the circumstances of working-age adults in 2012, as the state begins implementing the Affordable Care Act and other changes under the state's 2012 Chapter 224 cost-containment legislation. Findings show that while coverage and access to care remain strong in Massachusetts, health care costs continue to be a burden for many individuals and families.