Publications by Stacey McMorrow for Health Policy Center

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Maximizing health insurance coverage for children under the ACA will require addressing the complex scenarios that prevent some children from obtaining or retaining coverage. These scenarios include situations where children are eligible for Medicaid or CHIP but their parents are not, as well as those where children are living without at least one of their parents. We provide national estimates of the number of children in these complex coverage scenarios and find that children facing at least one complex scenario are more likely to be uninsured than other children. In addition to national estimates, we present state-level estimates for California, New York, and Texas.

We use the Behavioral Risk Factor Surveillance System (BRFSS) to explore state-level changes in access to care over the past for all nonelderly adults and for uninsured adults. Deterioration in access to care was evident in virtually every state and the situation was worse for the uninsured than for other adults in most states. At the end of the decade, the uninsured were at a dramatic disadvantage relative to the insured. This analysis suggests that the potential benefits of the coverage expansion in the Affordable Care Act (ACA) are large and exist in every state.

The pending Supreme Court decision and next fall's election raise concerns about what would happen if the insurance expansion in the Affordable Care Act is curtailed. The National Health Interview Surveys for 2000 to 2010 show that access and use for non-elderly adults - the primary targets of the ACA - deteriorated throughout the decade, particularly among those who are uninsured. Children – many of whom qualify for Medicaid and CHIP - generally maintained or improved their access to care. This provides a reason for optimism about the ability of the ACA to improve access for adults, but suggests that eliminating the ACA would likely result in continued erosion of adults’ access to care.

Understanding what is driving the spending growth in Medicare and Medicaid is important for identifying appropriate policies to address it. This paper finds that spending in both programs has been and will continue to be significantly affected by growth in enrollment. Over the next decade, projections suggest that annual growth in spending per enrollee in both programs will be close to growth in GDP per capita, a target often advocated by those concerned with the nation's deficit. These findings suggest a need for continued vigilance in monitoring Medicare and Medicaid spending levels and growth, but do not support an argument for major restructuring of either program.

The Affordable Care Act calls for the creation of health insurance exchanges in each state, where individuals and small employers can purchase health insurance. States have considerable flexibility in how they design and implement their health insurance exchanges. This study analyzes several exchange design options using the Urban Institute's Health Insurance Policy Simulation Model (HIPSM), looking specifically at the cost and coverage implications of creating separate versus merged small group and non-group markets; eliminating age rating in these markets; removing the small employer credit; and defining the size threshold for the small group market at 50 versus 100 workers.

The growth in U.S. health care spending has become a focal point in debates over federal and state health care reform. While the problem is easy to quantify, strategies for slowing rising expenditures are controversial, and evidence of their effectiveness is often elusive. Our full report provides background that describes the problem and reviews the cost containment provisions of the Affordable Care Act (ACA). It also presents estimates of cost savings from several policies that go beyond those included in the ACA. In this appendix, we provide more detail on the methods used to generate these cost savings estimates.

The United States spent an estimated $635 billion on the chronically ill and disabled in 2010; about half of this was spent on those dually eligible for Medicare and Medicaid. Recently, there has been a series of innovative chronic care management programs that have shown considerable promise in reducing hospital admissions, readmissions, specialty care and prescription drug use. Considerable savings could be achieved if these programs could be expanded broadly. In this paper, we argue that this should primarily be a Medicare initiative because most of the current expenditures and savings from these programs would accrue to Medicare. We estimate potential savings of close to 1% of national health expenditures.

In this paper we review data on health care spending growth and the reasons for the persistent high rates of growth. We discuss the cost containment provisions that are incorporated into the Affordable Care Act. A number of options that are not included in the ACA are then analyzed. We use a consistent analytic framework for making estimates relying on an extensive body of research evidence. We make estimates of the savings from eliminating tax exclusion, malpractice reform, chronic care management, prevention and various approaches to setting rates for providers. We conclude that no one option could provide substantial savings by themselves and that a combination of several policies is necessary to reduce the rate of growth.

This brief consolidates the results of several UI studies addressing the effects of the Affordable Care Act (ACA) on small firms. We find generally positive effects of the ACA on small employers and their workers. Employers with fewer than 50 workers will experience substantial savings on health costs; employers with 50 to 100 workers will see a very small cost increase. The smallest firms are expected to have higher offer rates, resulting in a small increase in employer coverage. Small firm workers and their families will reap substantial benefits from the Medicaid expansion and subsidies to low-income families.

Maximizing insurance coverage for children under the Affordable Care Act will require considering how the new system and its rules will apply to children facing complex coverage scenarios. The purpose of this brief is to explore several scenarios in which children may face particular challenges in accessing health insurance coverage. We find that roughly 20 million children live in situations that create particular challenges in accessing insurance coverage due to within-family variation in eligibility for different types of coverage and that nearly 28 million children live apart from at least one of their parents, creating additional complexities in accessing coverage.

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