Health Policy Center Authors
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.
Using Behavioral Economics to Inform the Integration of Human Services and Health Programs under the Affordable Care Act (Research Report)
Fredric Blavin, Stan Dorn, Jay Dev
Behavioral economics, which analyzes how behavior sometimes departs from the rational calculation of self-interest, can help Medicaid programs use targeted enrollment strategies more effectively by eliminating apparently modest procedural requirements, which can greatly reduce participation levels. It can also help health coverage applicants receive SNAP, even though demonstrating eligibility for health subsidies and choosing a health plan can tax many consumers' cognitive resources, making it hard to process information about SNAP. For example, health applicants could be given the option to have the state's food agency contact them later to complete a SNAP application by phone.
Navigating the Marketplace: How Uninsured Adults Have Been Looking for Coverage (Policy Briefs/Health Policy Briefs)
Stephen Zuckerman, Michael Karpman, Fredric Blavin, Adele Shartzer
A growing body of evidence shows that the number of uninsured adults declined significantly since the Affordable Care Act’s open enrollment period started in October 2013. Although the vast majority of people turned to websites for information on the federal or state Marketplaces, many consumers used, and will likely continue to use, other sources for health insurance plan information. In this brief, we focus on adults who were uninsured for some or all of the 12 months before June 2014. We consider the share who looked for information on health plans in the Marketplaces, comparing the approaches used by those who obtained coverage with those who remained uninsured as of June 2014. Our objective is to identify which approaches to obtaining Marketplace information are more likely to be associated with gaining insurance coverage.
Obtaining Information on Marketplace Health Plans: Websites Dominate but Key Groups Also Use Other Sources (Policy Briefs/Health Policy Briefs)
Fredric Blavin, Stephen Zuckerman, Michael Karpman
After the highly publicized troubled start, enrollment in the Affordable Care Act's health insurance Marketplaces exceeded 8 million. Despite many early problems, the vast majority of people who looked for Marketplace information had either used or tried to use a website to find it, and most had found the website they used very or somewhat easy to navigate. But not everyone used a website to obtain information on Marketplace health insurance plans. In this brief, we explore how different groups relied on many sources—website, direct assistance (e.g., call center, navigator, insurance broker, Medicaid agency office), the media, or indirect or informal channels—to find information on Marketplace plans. While Healthcare.gov and the state-based Marketplace websites are often viewed as the cornerstone of the ACA, consumers have used, and will likely continue to use, other sources of information on health insurance plans.
Trends in Prescription Drug Spending Leading Up to Health Reform (Article)
Fredric Blavin, Timothy Waidmann, Linda J. Blumberg, Jeremy Roth
Over the past decade, prescription drug expenditures grew faster than any other service category and comprised an increasing share of per capita health spending. Using the 2005 and 2009 Medical Expenditure Panel Surveys, this analysis identifies the sources of spending growth for prescription drugs among the nonelderly population. We find that prescription drug expenditures among the nonelderly increased by $14.9 billion (9.2%) from 2005 to 2009 and expenditures increased in 12 out of the 16 therapeutic classes. Changes in the number of users and expenditures per fill were the drivers of spending fluctuations in these categories. The main results also provide insight into generic entry, the price gap between brand and generic drugs, and from a health reform evaluation perspective, the importance of separating pre-policy secular trends in expenditures from changes attributable to specific forces, such as shifts toward generic versions of blockbuster drugs.
The Effects of Express Lane Eligibility on Medicaid and CHIP Enrollment among Children (Article)
Fredric Blavin, Genevieve M. Kenney, Michael Huntress
We estimate the impact of Express Lane Eligibility (ELE) implementation on Medicaid/CHIP enrollment in eight states using 2007-2011 data from the Statistical Enrollment Data System. We use fixed effects difference-in-differences models to allow the experience of non-ELE states to serve as a counterfactual to assess the changes in the ELE states. Across specifications, ELE effects on Medicaid enrollment among children were consistently positive, ranging between 4.0 and 7.3 percent, with most estimates statistically significant at the 5 percent level. Our results imply ELE has been an effective way for states to increase enrollment and retention among children eligible for Medicaid/CHIP.
Who Has Been Looking for Information in the ACA Marketplaces? Why? And How? (Policy Briefs/Health Policy Briefs)
Fredric Blavin, Stephen Zuckerman, Michael Karpman
As of February 25, 2014, approximately 4 million people have enrolled in a health plan through the health insurance Marketplaces established by the Affordable Care Act (ACA) and approximately 1.85 million people have enrolled since January 1st alone. While the low October–December 2013 enrollment likely reflects a lack of awareness of the ACA combined with early technical problems with the federal eligibility and enrollment system (i.e., HealthCare.gov) and the state-based Marketplaces, the most recent estimates provide some optimism on the viability of the Marketplaces. This brief complements Marketplace enrollment data by providing information about who looked or was planning to look for health coverage in the Marketplaces during the first two to three months of the rollout, as well as why and how they looked for information.
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.
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.
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.