Health Policy Center Authors
Publications by Matthew Buettgens for Health Policy Center
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More about Matthew Buettgens's areas of expertise can be found on this Urban Institute expert's page.
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.
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.
Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States (Policy Briefs/Timely Analysis of Health Policy Issues)
Matthew Buettgens, Genevieve M. Kenney, Hannah Recht
The authors estimate that in 2014, 56 percent of the uninsured became eligible for financial assistance with health insurance coverage through Medicaid, CHIP, or subsidized marketplace coverage. In states that expanded Medicaid eligibility, 68 percent of the uninsured became eligible for assistance, compared with only 44 percent in states that did not. Because of this difference in eligibility, the ACA is projected to reduce the number of uninsured people by 56 percent in states that expanded Medicaid, compared with only 34 percent in states that did not. The authors also provide estimates of what would happen if states that have not yet expanded Medicaid were to do so.
Why Not Just Eliminate the Employer Mandate? (Policy Briefs/Timely Analysis of Health Policy Issues)
Linda J. Blumberg, John Holahan, Matthew Buettgens
Employers of 50 or more workers are required to provide health insurance or pay a penalty. This requirement has been delayed until 2015 for employers with 100 and more workers and until 2016 for those with 50-99 workers. But there are reports of changes in employer labor practices, such as reducing the hours of part-time workers and concerns about increasing workforce above 50 workers. In this brief we argue that the employer mandate should simply be eliminated. We show that it would not reduce insurance coverage significantly, but it would eliminate the labor market distortions that have troubled employer groups and that could have negative effects on some workers. The penalties on employers do bring in some new revenues that would have to be replaced.
Measuring Marketplace Enrollment Relative to Enrollment Projections: Update (Policy Briefs/Health Policy Briefs)
Linda J. Blumberg, John Holahan, Genevieve M. Kenney, Matthew Buettgens, Nathaniel Anderson, Hannah Recht, Stephen Zuckerman
This brief compares Affordable Care Act Marketplace enrollment as of April 19, 2014 (the most recent state-specific data) to projected enrollment for 2014 and 2016 and estimates of the number of people eligible for subsidies. Nationally, by April 19, the Marketplaces had enrolled 115 percent of projected 2014 enrollment. Collectively, both State-Based Marketplaces (SBMs) and Federally Facilitated Marketplaces (FFMs) exceeded projected enrollment. However, there is considerable variation across the states within each group.
Measuring Marketplace Enrollment Relative to Enrollment Projections (Research Report)
Linda J. Blumberg, Genevieve M. Kenney, Matthew Buettgens, John Holahan, Nathaniel Anderson, Hannah Recht, Stephen Zuckerman
This brief compares Affordable Care Act Marketplace enrollment as of March 1, 2014 (the most recent state-specific data) to projected enrollment for 2014 and 2016 and estimates of the number of people eligible for subsidies. Nationally, by March 1, the Marketplaces had enrolled 61 percent of projected 2014 enrollment of subsidized and unsubsidized individuals. They had enrolled 63 percent of the subsidized population expected to enroll in 2014. Collectively, State-Based Marketplaces (SBMs) have been more successful in reaching projected enrollment than the Federally Facilitated Marketplaces (FFMs), with SBMs overall also having significantly higher rates of subsidized enrollment than FFMs.
Overlapping Eligibility and Enrollment: Human Services and Health Programs Under the Affordable Care Act (Research Report)
Stan Dorn, Julia Isaacs, Sarah Minton, Erika Huber, Paul Johnson, Matthew Buettgens, Laura Wheaton
The Affordable Care Act (ACA) has created new opportunities for health and human services programs to integrate eligibility determination, enrollment, and retention. Using two large microsimulation models—the Transfer Income Model, Version 3, and the Health Insurance Policy Simulation Model—we find considerable overlaps between expanded eligibility for health coverage and current receipt of human services benefits, particularly with Earned Income Tax Credits, the Supplemental Nutrition Assistance Program, and the Low-Income Home Energy Assistance Program. In an appendix, we identify specific data sharing strategies that seek to increase participation, lower administrative costs, and prevent errors.
Tax Preparers Could Help Most Uninsured Get Covered (Policy Briefs/Timely Analysis of Health Policy Issues)
Stan Dorn, Matthew Buettgens, Jay Dev
More than 74% of uninsured consumers who qualify for ACA health coverage file federal income tax returns. This includes over 90% of consumers under age 35 who qualify for subsidies in health insurance marketplaces. Most low-income taxpayers use tax preparers, including 64.6% of EITC claimants, more than 78% of whom file by March 31, the final day of open enrollment. State and federal officials and private leaders concerned about ACA enrollment should seriously explore partnering with commercial and nonprofit tax preparers to reach the eligible uninsured and move towards a healthy, balanced risk pool.
Will Those With Cancelled Insurance Policies Be Better Off in ACA Marketplaces? (Policy Briefs/Timely Analysis of Health Policy Issues)
John Holahan, Linda J. Blumberg, Matthew Buettgens
In recent months, there has been considerable focus on cancellations of nongroup health insurance policies. It is difficult to directly obtain data on premiums that individuals were paying prior to the ACA, but we can provide data on the premium cost to enrollees for the lowest cost bronze plans and the second lowest cost silver plans by age and income group in each state. We conclude that it would be difficult for the majority of individuals, particularly those qualifying for subsidies, to obtain coverage for a lower premium than those available in the Marketplaces today. Unsubsidized individuals, particularly those in older age groups, are more likely to face higher premiums.
Using Past Income Data to Verify Current Medicaid Eligibility (Research Report)
Stan Dorn, Matthew Buettgens, Christopher Hildebrand, Habib Moody
Using data from the 2008 Survey of Income and Program Participation, we find that information about past income and employment that is available to state Medicaid programs can potentially verify (a) initial financial eligibility for between 55 and 79 percent of eligible applicants and (b) renewed eligibility for between 60 and 71 percent of eligible enrollees. Verifying eligibility based on data matches, rather than documentation from consumers, could lower administrative costs; cut paperwork burdens for consumers, thereby increasing participation levels among those who qualify for help; and prevent eligibility errors.