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.

Information on the role of Medicaid is once again taking center stage as federal and state policymakers debate how to address budget deficits and states consider next steps in extending coverage to their low-income populations. Using the Medicaid Expenditure Panel Survey, Urban researchers examine the use and cost of health care among low-income nonelderly adults who are covered by Medicaid relative to their expected service use and costs if they instead had employer-sponsored insurance coverage or were uninsured. Consistent with previous work, the analysis demonstrates that Medicaid provides access to health care services comparable to that of ESI but at significantly lower costs. Also, compared to ESI coverage direct out-of-pocket spending for health care services would be three times higher if Medicaid beneficiaries were instead covered by ESI. The analysis also confirms the better access and financial protection Medicaid beneficiaries have over their uninsured counterparts.

Following the introduction of a question on health insurance coverage in 2008, the American Community Survey (ACS) has increasingly been used as a source for state-level health insurance estimates. This reflects a number of key advantages of the ACS, including a survey design that supports state representative estimates for all states and the large size of its sample. As a result, the ACS yields relatively precise state-level estimates of annual health insurance coverage. This paper explores the feasibility of expanding the value of the ACS for tracking health insurance coverage by generating subannual estimates.

While Massachusetts has the lowest uninsurance rate in the nation following its 2006 health reform initiative, some residents of the state continue to go without health insurance coverage. This study focuses on those lacking health insurance coverage in the state, considering the potential impacts of the changes being introduced under the Affordable Care Act.

While the impacts of the Affordable Care Act will vary across the states given their different circumstances, Massachusetts' 2006 reform initiative, the template for national reform, provides a preview of the potential gains in insurance coverage, access to and use of care, and health care affordability for the rest of the nation. Under reform, uninsurance in Massachusetts dropped by more than 50%, due, in part, to an increase in employer-sponsored coverage. Gains in health care access and affordability were widespread, including a 28% decline in unmet need for doctor care and a 38% decline in high out-of-pocket costs.

The question of whether the Affordable Care Act (ACA) will lead to job loss was revisited in the first presidential debate. This brief summarizes what would be expected based on economic theory and the evidence under health reform in Massachusetts, the template for the ACA. Employment trends in Massachusetts closely mirrored those of the rest of the nation in the periods before and after reform, while gross domestic product grew at a faster rate than in the rest of the nation after reform. The evidence suggests that the ACA will have little effect on employment and may support stronger economic growth.

Safety-net hospitals will continue to play a critical role in the US health care system, as they will need to care for the more than twenty-three million people who are estimated to remain uninsured after the Affordable Care Act is implemented. Yet such hospitals will probably have less federal and state support for uncompensated care. At the same time, safety-net hospitals will need to reposition themselves in the marketplace to compete effectively for newly insured people who will have a choice of providers. We examine how five leading safety-net hospitals have begun preparing for reform. Building upon strong organizational attributes such as health information technology and system integration, the study hospitals' preparations include improving the efficiency and quality of care delivery, retaining current and attracting new patients, and expanding the medical home model.

This report to the Medicaid and CHIP Payment and Access Commission (MAPCAC) was prepared to support MACPAC’s June 2012 Report to the Congress on Medicaid and CHIP. The report presents national findings on access to care for non-elderly Medicaid adults using measures from two national household surveys—the National Health Interview Survey (NHIS) and the Household Component of the Medical Expenditure Panel Survey (MEPS). These estimates give a national picture of how access to care for non-elderly adults enrolled in Medicaid compares to that of adults with ESI and uninsured adults, building on prior reports and analyses.

In 2006, Massachusetts enacted an ambitious health care reform bill that greatly expanded insurance coverage in the state. This brief explores whether the State's reform initiative led to a dampening of employment and, thus, economic growth. Employment trends in Massachusetts immediately after health reform was implemented and over the period of the recession closely mirrored those of comparison states that had similar employment patterns to Massachusetts prior to health reform. The evidence suggests that Massachusetts has achieved its goal of near-universal health insurance coverage under its 2006 health reform initiative, with no indication of negative job consequences.

Massachusetts is in its sixth year of a reform initiative that provided the template for the federal Affordable Care Act of 2010. This Health Affairs article reports on the status of health reform in Massachusetts as of 2010, providing an early indication of potential gains and challenges under national reform.

Five years after the enactment of Massachusetts health reform initiative, gains in insurance coverage and access to care have been sustained. This report provides an update on trends in the Bay State since fall 2006, just prior to the implementation of the state's health reform initiative, along with a more in-depth overview of the circumstances of working-age adults in 2010, as the state begins implementation of the Affordable Care Act.

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