Publications by Lokendra Phadera for Health Policy Center

Back to Browse by Author

More about Lokendra Phadera's areas of expertise can be found on this Urban Institute expert's page.

Nationwide, 9 million individuals are dually eligible for Medicaid and Medicare services and are among the country's most vulnerable. Despite their policy importance, limited work has been done that examines combined Medicaid and Medicare service use and spending patterns for duals. In this brief, we present findings based on analysis of linked 2007 Medicare and Medicaid data, and examine characteristics, health status, utilization, and spending for duals compared to the non-dual Medicare population. We find, among other things, considerable diversity among duals' spending. Results show that being a dual is not synonymous with high-spending, and factors that make duals more expensive than other Medicare beneficiaries are not the same factors that make them expensive relative to other Medicaid beneficiaries. Results suggest that decision-makers should adopt a multi-pronged approach in developing approaches to improve care delivery and efficiency for duals.

The nearly nine million duals who receive Medicare and Medicaid benefits constitute one of the nation’s most vulnerable and costly populations. Several initiatives authorized by the ACA are intended to improve the care delivered to duals and achieve greater control of spending growth for Medicare and Medicaid. We examined the 2007 costs and service use associated with duals. Although the population is indeed costly, we found nearly 40 percent of duals had lower average per capita spending than non-dual Medicare beneficiaries. We also found that about 20 percent of duals accounted for more than 60 percent of combined Medicaid and Medicare spending on duals. But even among high-cost duals, we found subgroups. Findings suggest that decisionmakers should tailor reforms to account for subpopulations of duals.

The Massachusetts Health Insurance Survey (MHIS) collects information on health insurance coverage and access to and use of health care for the non-institutionalized population in Massachusetts. It is funded by the Massachusetts Division of Health Care Finance and Policy (DHCFP) and is conducted by the Urban Institute, along with its subcontractor, Social Science Research Solutions (SSRS). This report presents the detail tabulations from the 2008 MHIS on health insurance coverage and access to and use of health care in Massachusetts.

The Massachusetts Health Insurance Survey (MHIS) collects information on health insurance coverage and access to and use of health care for the non-institutionalized population in Massachusetts. It is funded by the Massachusetts Division of Health Care Finance and Policy (DHCFP) and is conducted by the Urban Institute, along with its subcontractor, Social Science Research Solutions (SSRS). This report presents the detail tabulations from the 2009 MHIS on health insurance coverage and access to and use of health care in Massachusetts.

The Massachusetts Health Insurance Survey (MHIS) collects information on health insurance coverage and access to and use of health care for the non-institutionalized population in Massachusetts. It is funded by the Massachusetts Division of Health Care Finance and Policy (DHCFP) and is conducted by the Urban Institute, along with its subcontractor, Social Science Research Solutions (SSRS). This report examines health care access and use in 2008 and 2009 in Massachusetts.

Although Massachusetts' 2006 health reform initiative led to significant gains in insurance coverage and improvements in access to health care, barriers to obtaining care still exist for some Massachusetts residents, including difficulties finding providers who will see them and high health care costs. This policy brief uses the 2008 and 2009 Massachusetts Health Insurance Survey (MHIS) to examine reported difficulties in obtaining health care for insured residents in the state, focusing on difficulties related to access to providers and unmet need for care because of health care costs.

This issue brief presents findings from the 2009 District of Columbia Health Insurance Survey conducted August to November 2009. It presents a profile of nonelderly adult residents in DC who reported that they were uninsured looking at gender, race and ethnicity, income, length of residence in DC, ward of residence, and employment status. It also presents the reasons that residents gave for not having health coverage.

This chartbook presents results from a survey of insurance status and options in the District of Columbia, conducted with 4,717 households in fall 2009. Only 6.2% of residents report being currently uninsured, among the lowest rates nationally. Somewhat more, 10.2%, report having been uninsured at some time during the year. Employer-sponsored insurance was the most common source of coverage for non-elderly adults. Among children, public coverage was nearly as important as employer-sponsored coverage. Only about 10% of publicly insured children have the option of employer-sponsored insurance. Among employed adults with public coverage, about half work in firms that offer coverage.

This issue brief presents findings from the 2009 District of Columbia Health Insurance Survey conducted August to November 2009. It compares the characteristics of nonelderly DC residents with employer-sponsored insurance and to those with public insurance coverage. We consider type of insurance across gender, race, income, ward of residence, and health and disability status. For workers, we look at work status (full-time vs part-time) and type of firm.

Massachusetts, which enacted a landmark health care reform bill in April 2006, is now beginning the fourth year of its ambitious health reform initiative, with evidence of strong and continuing gains in insurance coverage. This policy brief, which is based on the 2009 Massachusetts Health Insurance Survey (HIS), shows uninsurance in Massachusetts continuing at historically low levels—at 2.7% for the overall population, 1.9% for children and 3.5% for non-elderly adults. The findings suggest that the recession had had limited impact on health insurance coverage as of spring of 2009.

Return to list of authors.