Health Policy Center Authors
Publications by Vicki Chen for Health Policy Center
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More about Vicki Chen's areas of expertise can be found on this Urban Institute expert's page.
Behavioral and Developmental Health Problems and Medicaid Costs for Youth Approaching Adulthood by Gender and Basis of Eligibility in Selected States: FY 2006 (Policy Briefs)
Embry M. Howell, Mike Pergamit, Vicki Chen
Older youth face many challenges including continuing health care as they approach adulthood. The Affordable Care Act will provide new coverage for young adults. This 10 state study provides new data on Medicaid health costs for youth turning age 18. On average, boys are more expensive than girls at this age. Three groups are particularly high cost, disabled youth enrolled in Supplemental Security Income, foster care youth, and those with behavioral health problems. These three groups account for less than 20 percent of all youth that age, but over half the cost of the program.
Providing Medicaid to Youth Formerly in Foster Care Under the Chafee Option (Research Report)
Mike Pergamit, Marla McDaniel, Vicki Chen, Embry M. Howell, Amelia Hawkins
This report draws lessons from 30 states' implementation of existing optional Medicaid coverage for youth who age out of foster care and applies them to decisions and plans states will consider as they implement new ACA coverage that goes into effect in 2014. Wide variations in how states have implemented the socalled Chafee Option are focused on eligibility criteria, enrollment processes, and recertification processes. States' implementation choices had implications for the frequency with which youth enroll in Medicaid coverage after foster care and in their continuity of coverage over time.
National and State-by-State Impact of the 2012 House Republican Budget Plan for Medicaid (Research Report)
John Holahan, Matthew Buettgens, Caitlin Carroll, Vicki Chen
The House Budget Plan that would repeal the Affordable Care Act (ACA) and convert Medicaid to a block grant would trigger significant decreases in federal Medicaid spending and could result in substantial reductions in enrollment and payments to providers compared to current projections. The analysis finds that projected federal spending on Medicaid for the period 2013 to 2022 would fall by $1.7 trillion compared to current estimates, a 38 percent decline. Of that total, $932 billion in spending reductions would come from the repeal of the federal support for the ACA Medicaid expansion and another $810 billion would be due to federal Medicaid spending reductions that accompany the block grant. State-specific estimates are provided.
Deteriorating Health Insurance Coverage from 2000 to 2010: Coverage Takes the Biggest Hit in the South and Midwest (Research Report)
Fredric Blavin, John Holahan, Genevieve M. Kenney, Vicki Chen
This study creates a pre-reform baseline trend for an evaluation of the Affordable Care Act's (ACA) impact on health insurance coverage in the United States. Using the 2000 to 2010 Current Population Survey (CPS), this brief analyzes coverage trends among children, parents, and childless adults, overall and by ACA-relevant income groups. We find that over the past decade, rates of employer-sponsored insurance (ESI) have steadily deteriorated across these population groups, with more substantial declines occurring among the lower-income categories; all three population groups saw increases in Medicaid/CHIP coverage, with children experiencing the largest increase; and the percent of parents and childless adults without health insurance steadily increased whereas the percent of children without health insurance has slightly decreased.
ACA Implementation-Monitoring and Tracking: Virginia Site Visit Report (Research Report)
Linda J. Blumberg, John Holahan, Vicki Chen
This report is one in a series of 10 on state implementation of the Affordable Care Act. There is significant political opposition to the implementation of health reform in Virginia. The state has not yet indicated how it will respond to the now optional expansion of Medicaid coverage or whether it will establish an exchange. But meanwhile, the state has created a highly regarded process for debate on the exchange. The state experiences ongoing budget pressure because of the recession which is affecting state decision-making. The state could benefit from strong competition within its insurance and provider markets under reform.
ACA Implementation-Monitoring and Tracking: Minnesota Site Visit Report (Research Report)
Brigette Courtot, Stan Dorn, Vicki Chen
A longstanding leader in private- and public-sector health reform, Minnesota is making remarkable progress implementing the Patient Protection and Affordable Care Act (ACA), despite a challenging political environment. The state’s ability to accomplish as much as it has including the creation of two task forces, securing multiple grants to support different pieces of ACA implementation, adopting the early Medicaid expansion, implementing early insurance reforms, and taking vigorous steps toward building an effective Exchange in time to meet challenging federal deadlines testifies to remarkable collaboration between multiple state agencies and stakeholders in transforming the state’s health system.
ACA Implementation-Monitoring and Tracking: Declining Health Insurance in Low-Income Working Families and Small Businesses (Research Report)
John Holahan, Vicki Chen
Employer-sponsored insurance (ESI) rates are lower and declines in ESI in the past decade are higher for low-income individuals and small businesses relative to high-income individuals and larger businesses. In this brief, we show that even high-income people in small firms and low-income people in large firms both have experienced relatively large declines in ESI, while higher income people in larger firms have experienced relatively small declines in ESI. We conclude that the provisions of the ACA, which attempt to address coverage problems of low-income families and small business, are well targeted and that monitoring health coverage changes of low-income individuals and small businesses will be important.
A Decade of Coverage Losses: Implications for the Affordable Care Act (Research Report)
Fredric Blavin, John Holahan, Genevieve M. Kenney, Vicki Chen
This study creates a pre-reform baseline trend for an evaluation of the Affordable Care Act’s (ACA) impact on health insurance coverage in the United States. Using the 2000 to 2010 Current Population Survey (CPS), this brief analyzes coverage trends among children, parents, and childless adults, overall and by ACA-relevant income groups. We find that over the past decade, rates of employer-sponsored insurance (ESI) have steadily deteriorated across these population groups, with more substantial declines occurring among the lower-income categories; all three population groups saw increases in Medicaid/CHIP coverage, with children experiencing the largest increase; and the percent of parents and childless adults without health insurance steadily increased whereas the percent of children without health insurance has slightly decreased.
Changes in Health Insurance in the Great Recession, 2007-2010 (Research Report)
John Holahan, Vicki Chen
John Holahan and Vicki Chen use the Current Population Survey to examine trends in health insurance coverage during the "Great Recession" of 2007-2010, as well as over the past decade. The uninsured have increased since 2000 with nonelderly adults shouldering the entire burden. Generous Medicaid coverage for children was able to offset falling ESI coverage, which caused the overall uninsured number of children to decrease. 2010 saw the continuation of many trends from 2007; ESI rates continued to fall, the share and number people who are low-income continued to grow, and unemployment continued to rise. Patterns of insurance coverage were similar across groups of all race/ethnicity, citizens and non-citizens, and all geographic areas. The one exception to recent trends in private coverage is coverage for young adults (ages 19-25). This group had an increase in private coverage while all other age groups experienced a decline in private coverage.
House Republican Budget Plan: State-by-State Impact of Changes in Medicaid Financing (Research Report)
John Holahan, Matthew Buettgens, Vicki Chen, Caitlin Carroll, Emily Lawton
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.