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.

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.

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.

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.

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.

This analysis examines the potential costs and savings that health reform may generate for state budgets. It discusses the major expected sources of costs and savings as the new law is implemented and explains why recent estimates of the likely state budgetary impact vary widely. It identifies many opportunities for states to offset costs related to Medicaid expansion, such as the reduced need for payments for uncompensated care as uninsurance declines. The review of state analyses found most reflected potential cost increases but did not account for the full range of potential savings. The actual impact on states will vary depending on current state coverage and on how each state chooses to implement the law.

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