Publications by Dawn M. Miller for Health Policy Center

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In 2005, Missouri adopted sweeping Medicaid cutbacks. More than 100,000 people lost coverage, and many more faced reduced benefits and higher cost-sharing. Using a range of data sources, we show that the cutbacks were followed by a major increase in the numbers of uninsured people, greater uncompensated care burden on hospitals, and revenue shortfalls that forced community health centers to obtain larger state grants and charge patients more. Competing demands on state budgets and the need to balance budgets even during recessions could result in policies that disadvantage those with great needs as well as the providers who serve them.

People uninsured for any part of 2008 spend about $30 billion out of pocket and receive approximately $56 billion in uncompensated care while uninsured. Government programs finance about 75 percent of uncompensated care. If all uninsured people were fully covered, their medical spending would increase by $122.6 billion. The increase represents 5 percent of current national health spending and 0.8 percent of gross domestic product. However, it is neither the cost of a specific plan nor necessarily the same as the government's costs, which could be higher, depending on plans' financing structures and the extent of crowd-out.

The Maine Health Care Access Foundation funded this profile of Maine health insurance coverage. According to data from the Current Population Survey, 124,000 Maine residents did not have health insurance during the 2004–2005 period. The majority (84%) of uninsured people were adults. Just over half of Maine residents who were uninsured came from low-income families residents. Low-income young adults (ages 19–34) were particularly at risk for being uninsured, and one-quarter lacked coverage. Over 86,000 of Maine's uninsured people were workers. Forty-seven percent of this uninsured group were low-income, over half (55%) were employed by firms with fewer than 25 workers, and just over two-thirds worked in industries with low rates of job-based health coverage. Over two-thirds (67%) of Maine's uninsured people came from families with one or more full-time worker, while another 19 percent are from families with a part-time worker.

This study, funded by the Maine Health Access Foundation, presented alternative estimates of the costs of health care that uninsured Maine residents receive and determined how much public revenue was available to offset those costs. Using data from health care providers, the study estimated that the costs of caring for the uninsured in Maine were $138 million in 2005, with hospitals and Veterans' Affairs facilities identified as the largest providers. Estimates based on household survey data from the Medical Expenditure Panel Survey showed that uncompensated care costs for the uninsured were only $81 million in 2005. The report discusses possible reasons for the large discrepancy between these two sources. Our review of federal and state funding sources in 2005 suggests there were roughly $110 million available to offset these costs of caring for the uninsured.

Even though most low income children in the U.S. are entitled to public health insurance, many children are still uninsured. One reason for this problem is that when insurance expires (after, for example, one year of enrollment) parents may fail to re-enroll their child. This report examines rates of renewal in three public health insurance programs in San Mateo County, California: Healthy Families, Healthy Kids, and Medi-Cal. Renewal rates were low in all three programs; only about 50 percent of children renewed coverage after a year. The report provides recommendations regarding improving monitoring systems for tracking retention over time.

About 2.5 million New Yorkers were uninsured in 2005, and medical providers that serve them incurred some $2.8 billion in uncompensated care. Two separate analyses in this report agreed on this estimate, one using provider cost reports and the other household survey data. Budgetary and other sources showed that state, local, and federal governments supplied about $3.5 billion in revenues that offset these costs, through a complex mix of programs. If these uninsured people had all had insurance for the full year, their projected medical spending would have been higher by about $4.1 billion. Any insurance expansion program would incur these and additional costs as well.

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