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.
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.
Administrative Renewal, Accuracy of Redetermination Outcomes, and Administrative Costs (Research Report)
Stan Dorn, Matthew Buettgens
When a Medicaid beneficiary approaches the end of a 12-month enrollment period, coverage should be "administratively renewed," according to ACA a regulation, if "reliable information" shows the beneficiary remains eligible. The beneficiary is sent a notice explaining the basis for renewal and the legal duty to make needed corrections. If none are forthcoming, coverage continues. We find that using administrative renewal should lower the number of mistaken outcomes if it is used with beneficiaries known to have an 80 percent or greater likelihood of eligibility. However, administrative renewal will change most mistakes from incorrect terminations to incorrect renewals.
Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States (Research Report)
Matthew Buettgens, Genevieve M. Kenney, Hannah Recht, Victoria Lynch
This report examines how many of the uninsured in each state would be eligible for health coverage assistance programs - i.e. Medicaid, the Children's Health Insurance Program and subsidized private coverage through the new health insurance marketplaces - under the Affordable Care Act. The report also estimates the anticipated decrease in the uninsured population under the ACA in each state. Finally, the report examines the share of those remaining uninsured under the ACA in each state who would be eligible for, but not enrolled in, assistance programs.
No Wrong Door: Improving Health Equity and the Health Coverage Consumer Experience in Connecticut (Policy Briefs)
Matthew Buettgens, Stan Dorn
"No Wrong Door" (NWD) is a system that allows consumers to apply for health insurance through different agencies, and then seamlessly routes them to the program for which they qualify. We find that over the course of a year under the Affordable Care Act, NWD would prevent 36,000 Connecticut residents from losing health insurance coverage for at least part of the year. Connecticut's leaders have committed to full implementation of NWD by the end of 2015. If this commitment is fulfilled, significant gains will result for both state government and residents. However, monitoring implementation in the transition period is critical.
The Cost of Not Expanding Medicaid (Research Report)
John Holahan, Matthew Buettgens, Stan Dorn
As states make decisions about whether to implement the Medicaid expansion under the Affordable Care Act, this new analysis highlights the implications of these decisions for coverage, state finances, and providers. The results show that the decisions by as many as 27 states not to adopt the Medicaid expansion will leave 6.4 million people who could have been eligible for Medicaid uninsured. States that do not expand Medicaid will forego significant federal funding, which could have had a positive impact on state economies and general revenues. Moreover, hospitals in these states will receive substantially less revenue than they would have had the state expanded coverage while they will still have to serve a large uninsured population. These findings present a strong economic case for Medicaid expansion.
It's No Contest: The ACA's Employer Mandate Has Far Less Effect on Coverage and Costs Than the Individual Mandate (Policy Briefs/Timely Analysis of Health Policy Issues)
Linda J. Blumberg, John Holahan, Matthew Buettgens
The Obama administration announced a 1-year delay in imposition of penalties for large employers who do not offer affordable coverage to their full-time workers under the Affordable Care Act (ACA). The announcement led to some suggesting that the employer penalties amounted to a key component of the ACA, and others stating that it was "unfair" to delay employer penalties but to leave the penalty on individuals in place. However, our analysis shows that the ACA can achieve all its major objectives without the employer mandate. Conversely, the individual mandate is a central component of the law and its coverage expansion.
Documentation on the Urban Institute's American Community Survey Health Insurance Policy Simulation Model (ACS-HIPSM) (Research Report)
Matthew Buettgens, Dean Resnick, Victoria Lynch, Caitlin Carroll
The model documented here builds off of the Urban Institute's base HIPSM, which uses the Current Population Survey (CPS) as its core data set, matched to several other data sets including the Medical Expenditure Panel Survey-Household Component (MEPS-HC), to predict changes in national health insurance coverage and spending under ACA using a micro-simulation modeling approach. To create HIPSM-ACS, we apply the core behavioral estimates coming from base HIPSM to ACS records (using a series HIPSM-estimated imputation models) to exploit the much larger sample size for more precise estimates at the state and sub-state level.