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Publications by Fredric Blavin for Health Policy Center
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More about Fredric Blavin's areas of expertise can be found on this Urban Institute expert's page.
The Health Reform Monitoring Survey: Addressing Data Gaps To Provide Timely Insights Into The Affordable Care Act (Article)
Sharon K. Long, Genevieve M. Kenney, Stephen Zuckerman, Dana Goin, Douglas A. Wissoker, Fredric Blavin, Linda J. Blumberg, Lisa Clemans-Cope, John Holahan, Katherine Hempstead
The Health Reform Monitoring Survey (HRMS) was launched in 2013 as a mechanism to obtain timely information on the ACA during the period before federal survey data will be available. The HRMS provides quarterly data on insurance coverage, access to health care, and health care affordability, along with changing topics of relevance to current policy and program issues. For example, data from summer 2013 show that more than 60 percent of those targeted by the health insurance exchanges struggle with understanding key health insurance concepts, raising concerns about their ability to evaluate trade-offs when choosing coverage.
The Feasibility of Using Electronic Health Data for Research on Small Populations (Research Report)
Kelly J. Devers, Bradford H. Gray, Christal Ramos, Arnav Shah, Fredric Blavin, Timothy Waidmann
This report explores the feasibility of using electronic health record (EHR) and other electronic health data for research on small populations. The first part of the report illustrates the challenges and limitations of using existing federal surveys and federal claims databases for studying small populations. The second part explores the potential of the increasingly available EHR and other existing electronic health data to complement federal data sources, as well as potential next steps to demonstrate and improve the feasibility of using EHRs for research on small populations.
What Health Insurance Coverage Changes Are the Uninsured Anticipating for 2014? (Policy Briefs/Health Policy Briefs)
Fredric Blavin, Michael Karpman
On January 1, 2014, millions of uninsured adults became eligible for subsides to purchase health insurance or newly eligible for Medicaid through the Affordable Care Act (ACA). Many factors could shape whether uninsured adults decide to take advantage of the ACA’s coverage expansions. This brief examines one such factor—uninsured adults’ expectations about their coverage status and their access to financial assistance for obtaining coverage as the ACA rollout begins. As ACA implementation proceeds, this analysis offers new insight into uninsured adults’ expectations for gains in health insurance coverage under the ACA and provides an early indication of the potential coverage changes for the uninsured in the year ahead.
How the Currently Uninsured Perceive the Cost and Affordability of Health Insurance Coverage (Policy Briefs/Health Policy Briefs)
Fredric Blavin, Katherine Hempstead, Michael Karpman, Ariel Fogel
The ACA Marketplaces specifically target nonelderly adults with incomes above the national Medicaid-eligibility cutoff (138 percent of the federal poverty level) who are currently uninsured or are purchasing individual coverage. Thus, how well this population understands health insurance plans, and its willingness to tackle the challenges of plan selection, will largely determine the ACA’s enrollment success. These challenges range from demonstrating income eligibility and citizenship status to comparing premium, benefit, cost-sharing, and provider network alternatives. Selection and enrollment may be particularly demanding for uninsured adults who have no previous experience with, or negative impressions of, shopping for health coverage. In this brief, we focus on the prior nongroup market experience of the currently uninsured adult Marketplace target population, to assess how their perceptions of coverage cost and affordability are likely to influence the ACA’s success in reaching its enrollment targets.
Lessons from the Literature on Electronic Health Record Implementation (Research Report)
Fredric Blavin, Christal Ramos, Arnav Shah, Kelly J. Devers
This report summarizes the findings of 75 articles that identify best practices for implementing and optimizing electronic health records (EHRs). The report includes a conceptual framework to structure the analysis and describe lessons learned for organizations that might be facing EHR implementation obstacles. Throughout the EHR implementation process, planning and modifications are continually needed to address technological, professional, and organizational perspectives. These perspectives must be incorporated at each stage to promote implementation and optimization of a system that is technically functional, integrated into the workflow of its users, and is part of a larger strategy to meet organizational goals.
An Early Look at the Impact of Express Lane Eligibility on Medicaid and Children's Health Insurance Program Enrollment: (Research Report)
Fredric Blavin, Genevieve M. Kenney, Michael Huntress
With ELE, a state's Medicaid and/or CHIP program can rely on another agency's eligibility findings to qualify children for public coverage. Using 2007 to 2011 quarterly enrollment data, we estimate difference-in-difference equations with quarter and state fixed effects to measure the effect of ELE on enrollment. The estimated impacts of ELE on Medicaid enrollment were consistently positive across model specifications, ranging between 4.0 and 7.3 percent. The analysis also finds that ELE increased Medicaid/CHIP enrollment. Our results imply that ELE has been an effective way for states to increase new enrollment or improve retention among eligible children.
CHIPRA Mandated Evaluation of Express Lane Eligibility: First Year Findings (Research Report)
Sheila Hoag, Sean Orzol, Margaret Colby, Adam Swinburn, Fredric Blavin, Genevieve M. Kenney, Michael Huntress
The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) reauthorized CHIP and funded it through 2013. Under CHIPRA, Congress provided states with new policy tools to address shortfalls in enrollment and retention, one of which is Express Lane Eligibility (ELE). With ELE, a state's Medicaid and/or CHIP program can rely on another agency's eligibility findings to qualify children for public health coverage. This evaluation describes existing state ELE programs including the administrative costs and ELE enrollment trends, estimates the impact of ELE adoption on total enrollment, and previews the issues that will be examined through future evaluation activities.
Uninsured New Yorkers After Full Implementation of the Affordable Care Act: Source of Health Insurance Coverage by Individual Characteristics and Sub-State Geographic Area (Research Report)
Fredric Blavin, Linda J. Blumberg, Matthew Buettgens
The Urban Institute developed a New York state-specific version of its Health Insurance Reform Simulation Model (HIPSM) to support to the state in its effort to assess the implications of the implementation of the Affordable Care Act (ACA). Initial findings from this work were made available in March of 2012.The tables presented here provide sub-state analyses, focusing on those without insurance coverage of any kind prior to reform. We show the share of uninsured expected to gain coverage under the ACA, and include the distribution of characteristics for those anticipated to gain insurance of each type whenever sample sizes allow.
Uninsurance Is Not Just a Minority Issue: White Americans Are a Large Share of the Growth from 2000 to 2010 (Research Report)
Fredric Blavin, John Holahan, Genevieve M. Kenney, Megan McGrath
This brief compares changes in health insurance coverage from 2000 to 2010 across nonelderly racial and ethnic groups. We find that employer-sponsored insurance deteriorated among all groups, with whites and blacks experiencing larger percentage point declines relative to Hispanics and Asians/other. The uninsured rate increased by four percentage points among whites and blacks, while remaining constant for the Hispanic and Asian/other populations as Medicaid/CHIP enrollment gains were large enough to offset ESI declines for these groups. These general patterns were found across all income groups, with more pronounced deterioration in coverage among those with income below 400 percent of FPL.
Trends in U.S. Health Care Spending Leading Up to Health Reform (Research Report)
Fredric Blavin, Linda J. Blumberg, Timothy Waidmann, Lokendra Phadera
Using the 2001-2009 MEPS, we examine a variety of trends that illustrate patterns of health care use in the U.S. and find that growth rates in per capita spending varied by type of service. We decompose trends into changes in the fraction using services, the intensity of utilization among users, and the cost per unit. We also decompose spending changes into changes in the distribution of individuals' socio-economic characteristics, health insurance status, and prevalence of chronic conditions. We find the majority of the increase in per capita health spending over the decade is explained by factors (e.g., technology growth) outside our model.