Publications by Leighton Ku for Health Policy Center

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This paper examines the contribution of immigration to the increase in the number of uninsured Americans between 1994 and 1998. The study found that non-citizens comprised 20 percent of the total uninsured in the U.S. Recent immigrants and their children who lacked health coverage (2.3 million) constitute only 5 percent of the 44 million uninsured. The number of new immigrants entering the U.S. between 1994 and 1998 actually fell, resulting in a decrease of 100,000 in the number of recent immigrants who are uninsured. Thus while recent immigrants have high rates of being uninsured (46 percent), they are not significant reason for the growth in the number of uninsured. Native citizens contributed most of the growth in the number of uninsured, 2.7 million of the 4.2 million increase (or 64 percent) in the number of uninsured between 1994 and 1998. (Published by the Kaiser Commission on Medicaid and the Uninsured; 2001 February.)

In 1996, the number of people on Medicaid fell for the first time in recent history. This report presents the results of an econometric analysis of the factors that affected state Medicaid participation from 1984-96 and applies these results to estimate which factors contributed to the 1995-96 downturn. The principal finding is that welfare reform and the economy both significantly affected the Medicaid caseload decline at roughly similar levels.

Paper based on UI survey on the sources of state funds and the uses of DSH expenditures. Paper will also examine how states intend to respond to cuts in federal DHS payments.

Since 1991, three federal laws have sought to reform the Medicaid disproportionate share hospital (DSH) program, which is designed to provide financial support to safety net hospitals. The article provides findings from a 40-state survey about Medicaid DSH and upper payment limit programs in 1997. Results indicate that the overall size of the DSH program did not increase from 1993 to 1997, but the composition of the DSH revenues and expenditures changed substantially: A much higher share of DSH funds were being paid to local hospitals and relatively less was being retained by states. The study also revealed that large differences in states’ use of DSH still persist. Finally, the survey indicated that a growing number of states established upper payment limits programs in the late 1990s. (Health Care Financing Review 2000 Winter; 22(2):137-158).

As publicly funded health insurance programs shift more toward coverage of working families in low and moderate incomes, there has been a growing interest in beneficiary cost sharing in the form of sliding-scale premiums. In this study we examined four publicly-sponsored health insurance programs aimed at working-class families--Hawaii’s QUEST, Minnesota’s MNCare, Tennessee’s TennCare, and Washington’s BHP. The experience in these states indicates that it is feasible to require cost sharing of premiums, but there are a number of design and operational complexities. A preliminary analysis indicates that higher out-of-pocket premium shares were associated with lower participation rates.(Inquiry Winter 1999/2000; 36(4):471-480).

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