Publications by Additional Authors for Health Policy Center

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Adding Medicaid expansion to the remainder of the Patient Protection and Affordable Care Act (ACA) would increase Ohio’s Medicaid costs between $2.4 and $2.5 billion during FY 2014 to 2022. The state could reduce $1.5 billion in spending on medically needy adults, inpatient prison costs, and other services to the poor uninsured. Expansion would yield $2.7 and $2.8 billion in new revenue, including premium taxes, general revenue from economic activity generated by increased federal Medicaid dollars, and prescription drug rebates. Altogether, expansion would generate between $1.8 and $1.9 billion in net state budget gains while covering more than 400,000 uninsured.

The implementation of the Patient Protection and Affordable Care Act will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer care and research. Successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform.

This Evaluation Highlight is the first in a series that presents descriptive and analytic findings from the 18-state evaluation of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA)'s Quality Demonstration Grants. In this Highlight, we discuss the early accomplishments, challenges, and lessons learned from the following four States pursuing practice-level quality measurement: Maine, Massachusetts, North Carolina, and Pennsylvania. Our analysis is based on work completed by the States during the first two years of their five-year demonstration projects. These two years included a one-year planning period followed by a year of implementation.

In a March 2012 article in Health Affairs, a team of authors from the Urban Institute and Mathematica Policy Research finds that achieving ambitious goals for the adoption of electronic health records and the nationwide exchange of electronic health information will require overcoming a number of hurdles. First and foremost, providers and patients have to be persuaded of the value of exchanging information and have to be supportive of steps to make it possible. For example, there are broad concerns about the tradeoffs between sharing information electronically and safeguarding the privacy and security of patients’ health care data. A case in point: existing federal law provides for the use of a single identification number for every US patient, but Congress has blocked the use of federal funds to develop this ID system because of privacy concerns.

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.

With financial support from the Robert Wood Johnson Foundation, the Urban Institute is undertaking a comprehensive monitoring and tracking project to examine the implementation efforts and effects of the Affordable Care Act on 10 states—Alabama, Colorado, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island, and Virginia. The second case study report draws on a site visit and key informant interviews, to provide an in-depth description of Rhode Island's efforts to implement health reform. The report chronicles Rhode Island's successes thus far, with a special look at exchange establishment, private market reforms, and preparations for Medicaid expansion.

When the Affordable Care Act is fully implemented, it will extend health insurance coverage to many uninsured adult Americans. New analysis projects that the ACA will also cut the number of uninsured children by about 40 percent and the number of uninsured parents by almost 50 percent, provided states continue their Medicaid and CHIP coverage for children. However, if the maintenance of effort requirement is rescinded and if Congress does not continue funding CHIP, the uninsurance rate for children could be higher than it is today.

The United States has embarked on a major effort to achieve "meaningful use" of health information technology (HIT) by clinicians and hospitals. This paper, from The Commonwealth Fund's international program, describes meaningful use in three countries with very high levels of HIT adoption—Denmark, New Zealand, and Sweden. None has reached 100 percent in all meaningful use categories, but providers share many kinds of information with other health care organizations and health authorities. Less information is shared with patients. Useful strategies have included providing economic incentives to encourage adoption and designating an organization to take responsibility for standardization and interoperability.

This latest edition of our annual chartbook series for New York State features detailed information about differences in insurance coverage and uninsurance around New York State and within New York City. Overall, 12.9 percent of New Yorkers (889,000 total) under the age of 65 lacked health insurance in 2009, unchanged from the previous year despite an ongoing recession. Data for 14 separate regions across New York State, including the five boroughs of New York City and for 55 separate neighborhoods within the city itself show enormous variation in health insurance coverage across the state.

Measurement gaps hamper understanding of late-life disability trends and dynamics. This article reports findings that validate the self-reported components of the disability protocol used in the new National Health and Aging Trends Study (NHATS). The protocol was designed to improve on existing measures by incorporating environmental aspects of disability, capturing a broader range of capacity to perform tasks and including participation restriction items. New items and summary measures demonstrate robustness over a short time period. Summary measures correlate as expected with age, sex, residential status, and performance-based constructs. Two factors, representing activity limitations and participation restrictions, were confirmed. The NHATS protocol preserves the ability to examine more traditional measures of functioning while offering new insights into how activities are performed.

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