Health Policy Center Authors
Publications by Alshadye Yemane for Health Policy Center
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The Expansion of Medicaid Coverage under the ACA: Implications for Health Care Access, Use, and Spending for Vulnerable Low-income Adults (Article)
Lisa Clemans-Cope, Sharon K. Long, Teresa A. Coughlin, Alshadye Yemane, Dean Resnick
The expansion of Medicaid coverage under the ACA offers the potential for significant increases in health care access, use, and spending for uninsured nonelderly adults with chronic conditions. Using pooled data from the Medical Expenditure Panel Survey, we estimate the potential effects of Medicaid, controlling for individual and local community characteristics. We project significant gains in access and use, except outpatient Emergency Department use, for uninsured adults who enroll in Medicaid coverage and have chronic and mental health conditions. Annual per capita health care spending for newly insured individuals is projected to grow from $2,677 to $6,370 in 2013 dollars, while out-of-pocket spending drops by $921.
Enrollment Is Driving Medicaid Costs - But Two Targets Can Yield Savings (Research Report)
John Holahan, Alshadye Yemane
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.
Racial and Ethnic Differences in Insurance Coverage and Health Care Access and Use (Discussion Papers)
Bowen Garrett, Alshadye Yemane
Several studies conducted as part of the Urban Institute's Assessing the New Federalism project have focused on documenting and explaining racial and ethnic differences in insurance coverage and health care access and use. ANF's National Survey of America's Families has enabled studies of trends in insurance coverage gaps, analyses of under-studied populations, and multivariate decompositions of the factors related to racial and ethnic differences. This paper reviews those studies and highlights their contribution to the large and growing literature regarding racial and ethnic differences. It supplements the review with findings from the authors' analyses of the 2002 NSAF.
Commercial Plans in Medicaid Managed Care: Understanding Who Stays and Who Leaves (Article)
Sharon K. Long, Alshadye Yemane
This study examines the role of Medicaid policies, plan characteristics, and local health care market conditions in a commercial plan's exit decision. We find that many of the factors that influence commercial plan exits from Medicaid are within the control of state policymakers and program administrators, including capitation rates, service carve-outs, mandatory enrollment policies, and the number of Medicaid enrollees and areas served by the plan. (Long, Sharon and Yemane, Alshadye. July/August 2005. "Commercial Plans in Medicaid Managed Care: Understanding Who Stays and Who Leaves." Health Affairs 24(4): 1084-1093.)
The Effect of Parents' Insurance Coverage on Access to Care for Low-Income Children (Article)
Amy J. Davidoff, Lisa Dubay, Genevieve M. Kenney, Alshadye Yemane
This study examines the effects of having an uninsured parent on access to health care for low-income children. Data from the 1999 National Survey of America's Families indicates that having an uninsured parent decreases the likelihood that a child will have any medical provider visit by 6.5 percentage points, and decreases the likelihood of a well-child visit by 6.7 percentage points. Efforts to increase insurance coverage of parents, either by extending eligibility for public insurance or through other policy interventions, will have positive spillover effects on access to care for children. (Davidoff, Amy, Genevieve Kenney, and Alshadye Yemane. Fall 2003. "The Effect of Parents' Insurance Coverage on Access to Care for Low-Income Children." Inquiry 40(3): 254-268.)
Effects of Medicaid Managed Care Programs on Health Services Access and Use (Article)
Bowen Garrett, Amy J. Davidoff, Alshadye Yemane
Medicaid enrollees' access to and use of health care may be affected by the type of Medicaid managed care (MMC) program operating in their county. Using National Health Interview Survey data linked to county-level Medicaid managed care characteristics, we found that, relative to traditional fee-for-service programs, mandatory programs with both primary care case management (PCCM) and HMO options did the most to improve health care access and utilization for children. In contrast, we found potentially negative health care impacts for women in mandatory HMO programs. Mandatory PCCM programs had virtually no effects on access and use for women or children. (Health Services Research 38(2): 575–94.)
Recent Changes in Health Policy for Low-Income People in Florida (State Report)
Alshadye Yemane, Ian Hill
Florida responded to its Medicaid budget crisis with innovative cost-control initiatives, such as its pioneering preferred drug list program. Questions surround the state's ability to realize these cost-savings given the state's rocky experience with cost-control programs in the past. Florida reduced uninsurance rates among children by expanding coverage through the SCHIP program and actively promoting the program. Uninsurance rates for adults remained relatively high because of the low levels of employer sponsored coverage and few options for adults to access basic coverage. Florida dramatically increased funding for home- and community-based services for persons with developmental disabilities. The state addressed the troubles facing the nursing home industry by increasing quality of care requirements and implementing controversial tort reform laws that limit the punitive damages nursing homes have to pay if found guilty of misconduct.
Patterns of Child-Parent Insurance Coverage (Policy Briefs)
Amy J. Davidoff, Genevieve M. Kenney, Lisa Dubay, Alshadye Yemane
Navigating health insurance and health care delivery systems to obtain adequate access to health care can be challenging, and parents must act as advocates for their children in this process. Parents who are covered by the same insurance as their children are likely to be the most effective advocates because they are familiar with the specific systems. The burden on parents may be magnified if the child and the parents have different insurance plans or different types of coverage. Parents who do not have their own insurance are likely to be the least effective in working with the insurance system that covers their child. Changes in public program eligibility over the past 15 years have enhanced access to public insurance coverage, but they have created a situation in many low-income families where only some members are eligible for specific programs.
Medicaid-Eligible Adults Who Are Not Enrolled (Policy Briefs/ANF:Issues and Options for States)
Amy J. Davidoff, Bowen Garrett, Alshadye Yemane
When uninsured Medicaid-eligible adults are compared with Medicaid-enrolled adults with the same health and demographic characteristics, the uninsured are more likely to report unmet need, to lack a usual source of care, and to make less use of physician services. Families of the uninsured are also more likely to be burdened with out-of-pocket health care costs. Medicaid-eligible adults with private health insurance coverage are less likely to report unmet medical needs than their Medicaid-enrolled counterparts, but they are more likely to be burdened by out-of-pocket health care costs. Research is based upon data from the 1997 National Health Interview Survey.