Publications by Caitlin Carroll for Health Policy Center

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Using the Washington State Population Survey (WSPS) augmented with results from the Urban Institute's Health Insurance Policy Simulation Model (HIPSM), we estimated eligibility, enrollment, and costs for a Basic Health Program (BHP) for Washington State under the rules defined in the Affordable Care Act (ACA). We find that more than 160,000 Washington residents would be eligible for BHP. Enrollment would be between 75,000 and 111,000. Even with BHP, the exchange in Washington would still cover about 250,000 lives, and BHP would not notably affect premiums in the individual market.

Racial and ethnic differentials in uninsurance rates could be greatly reduced under the Affordable Care Act, potentially cutting the black-white differential by more than half and the Hispanic-white differential by just under one-quarter. Improving coverage for these populations will depend on states adopting policies that promote high enrollment in Medicaid/CHIP and new insurance exchanges. Coverage gains among Hispanics will depend on policies in California and Texas (where almost half of Hispanics live). If the projected coverage gains are realized, long-standing racial and ethnic differentials in access to care and health status could shrink considerably. This research was funded in part by the Annie E. Casey Foundation.

The federal requirement for most Americans to have health insurance-the individual mandate-is an important part of how the ACA would reduce the number of uninsured. We use the Health Insurance Policy Simulation Model to estimate the effects of health reform with and without the mandate. With the mandate, the number of uninsured would decrease from 50 million to 26 million. Without a mandate, about 40 million would remain uninsured. Depending on the effectiveness of the health benefit exchanges in enrolling those eligible for subsidized coverage, exchange premiums would be 10 to 25 percent higher without a mandate.

We estimate national and state effects of implementing the Basic Health Program option in national health reform to provide near-poor adults with coverage like Medicaid and the Children's Health Insurance Program. Implemented nationally, such a policy would reduce these adults' annual premium and out-of-pocket costs from $1,652 to $196; lower the number of uninsured by 600,000; provide federal dollars that exceed baseline Medicaid/CHIP costs by 23 percent; reduce exchange enrollment from 9.8 to 8.2 percent of non-elderly residents; save states $1.3 billion annually in Medicaid costs; and raise risk levels in individual markets. State policy choices could change these results.

This report finds that state governments are likely to spend $92-129 billion less from 2014 to 2019 with implementation of the Affordable Care Act, thanks to provisions reducing the uninsured population and increasing federal support for health care previously financed by states. The authors find that, overall, the federal government would spend $704 to $743 billion more under reform from 2014 to 2019. Even after 2019, when the federal government' share of Medicaid costs declines to its permanent level, states will still come out ahead, realizing net savings in 2020 alone of $12 to $19 billion.

The House Republican Budget Plan would make major changes to the structure of the Medicaid program. In this brief we estimate reductions in federal Medicaid spending due to both the repeal of the Affordable Care Act on Medicaid and the block grant provisions themselves. We find that the House Budget Plan would reduce federal spending by $1.4 billion between 2012 and 2021, a cut of 34 percent relative to current law. The impacts are greatest in states that would have the largest coverage expansions due to the Affordable Care Act. We also estimate the loss of Medicaid coverage that would be likely under different assumptions of states’ success in constraining spending. Finally we estimate the increase in state expenditures that would be necessary to maintain their current programs even assuming some cost containment success.

In this report, the authors use the Institute’s Health Insurance Policy Simulation Model (HIPSM) to predict results as if ACA were fully implemented in 2011 and contrast the results with the pre-reform baseline estimates for the year. They find that uninsurance rates among the nonelderly would decrease in all 50 states and in Washington, D.C., ranging from 1 percentage point in Massachusetts to 17 percentage points in Texas. There would be $82.3 billion in new federal Medicaid and exchange subsidies flowing to the states, led by California ($9.5 billion), Texas ($8.2 billion) and Florida ($6.7 billion).

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