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Docs Make Cost-Saving House Calls,Fiscal Times -- Business Insider - (November 22, 2011)

“The U.K. and the few countries that rank high on the attributes we want don't have anything called a medical home,” noted Dr. Robert Berenson, a fellow at the Urban Institute. “They have robust systems for primary care and have emphasized it for decades.”


Gingrey says 8 million "extra" people to join Medicaid, PolitiFact Georgia - (November 15, 2011)

The Urban Institute estimated that 16.8 million more people would be covered by Medicaid if health care reform took effect in 2010.


Medicare Rx needed to deal with system's exploding costs, Columbus Dispatch - (November 14, 2011)

A study by the Urban Institute shows that a married couple earning a combined $87,000 a year and planning to retire this year will have paid $119,000 in Medicare taxes over their careers. They would receive an estimated $357,000 in Medicare benefits in their retirement.


Reducing Health Care Costs While Improving CareHealth Affairs - (November 9, 2011) 

Robert Berenson of the Urban Institute and Steve Phurrough of the Center for Medical Technology offered several proposals for improving the Medicare coverage process.


Why insurance companies want the individual mandate, Marketplace - (November 9, 2011)

Randy Bovbjerg at the Urban Institute says the individual mandate gets rid of this leverage by forcing everyone to buy insurance even if they're healthy.

Randy Bovbjerg: If you leave in place most of the reform and you get rid of the mandate, you increase the incentive to go uninsured, because you know if you ever need it, you can just sign on the dotted line and get it.


Medical malpractice reform efforts stalled, Politico - (November 7, 2011)

“It doesn't look like anything big is going to happen soon,” said Urban Institute scholar Randall Bovbjerg. The $250 million DoJ request to finance alternatives including so-called health courts, safe harbor and “disclose and apologize” models, “could have been a meaningful effort,” he added.

The ACA provisions, on the other hand, were worth little to begin with. The proposed $50 million “showed they cared about responding to reform and defensive medicine and such, but the restrictions in the law made it impossible for it to amount to anything,” Bovbjerg said.


Employers continue to shift more costs to workers, with high-deductible health plans getting closer attention, Modern Healthcare - (November 7, 2011)

“The claim that there are incentives (to drop health benefits) misunderstands fundamental economics and the terms of the law, to put it bluntly,” says Judy Feder, a public policy professor at Georgetown University and an Urban Institute fellow who was one of the report's authors.

Employers would not gain financially from dropping benefits, she says. Well-paid workers pushed into an exchange would not qualify for subsidies and would lose tax breaks for employer-sponsored coverage. To stay competitive, employers also would be forced to increase pay to cover workers' premium costs.


Health Expert Urges States To Slow The Move To Medicaid Managed Care, Kaiser Health News - (October 31, 2011)

Medicare, rather than private insurers, should take the lead in improving health care for duals, Feder said at a Friday forum sponsored by the Alliance for Health Reform and the insurer Centene Corp., which operates Medicaid managed care programs in more than a dozen states. Feder, who is also a fellow at the Urban Institute, said Medicare should conduct aggressive oversight of the Medicare Special Needs Plans, which are private insurers in the Medicare Advantage program that care for duals and other beneficiaries with chronic health needs. Medicare must also conduct better oversight of skilled nursing facilities to prevent unnecessary hospitalizations for nursing home residents, Feder said.


Study: Health care reform won't decrease employer-sponsored insurance, NJBiz - (October 24, 2011)

According to the analysis, completed by the Urban Institute, the insurance exchange subsidy provided through the ACA will only benefit employees earning 250 percent or less of the federal poverty level.

"What's important for employers to understand is what will really be available to their employees once the law goes fully into effect," said Judy Feder, a fellow at the Urban Institute who worked on the study and a professor of public policy at Georgetown University. "For most of their workers, it really doesn't change much at all — the expectation (is) that they will get benefits from their employers."


Lawmakers told Medicare reform begins with elimination of SGR, American Medical News - (October 24, 2011)

Corker asked witnesses at the hearing to submit ideas that Democrats and Republicans could agree on. They agreed on SGR reform but also mentioned reforms to beneficiary cost sharing and increasing Medicare's eligibility age to 67. Among the witnesses were Holtz-Eakin and John Holahan, PhD, director of the Urban Institute's Health Policy Research Center, a progressive think tank in Washington.

Any increase in patient fees also should include protections for low-income beneficiaries, Holahan said.  


Insurer divvies up excess profits among policyholders, Marketplace - (October 14, 2011)

Rebates could become more common in the industry. The health care law sets a cap on insurance company profits and administrative expenses. Blue Shield, a nonprofit, may be doing what regulators will soon mandate, says Randy Bovjberg of the Urban Institute.

Randy Bovjberg: It is noticeable that they got out in front, by voluntarily providing the rebate.


Independent Medicare Commission Backs Doc Fix, National Journal - (October 6, 2011)

Robert Berenson, vice chairman of the Urban Institute, said the example Castellanos gave was an unfortunate anomaly, but said something needed to be done beyond giving doctors the stable pay they've asked for.

“I've been doing this off and on for 35 years,” Berenson said. “My observation is that stability basically equals complacency. You provide stability, and everybody's happy with preserving the status quo,” and not innovating to get away from the fee-for-service system, Berenson said.


Why ending the tax exemption for health insurance won’t contain health-care costsWashington Post (October 5, 2011) 

The tax exemption has “been sold as a root cause of high health-care spending,” says John Holahan, director of the health policy center at the Urban Institute. “We only buy that a little bit. It may reduce costs slightly, but don't expect it to fix everything.”

Holahan and his team released a paper on Wednesday that considers how ending the tax exemption for employer-sponsored health insurance would effect health spending. The short answer: not much.


Medicare payment system "badly broken?," San Diego Union-Tribune - (October 4, 2011)

“I think it's regulatory inertia,” said Stephen Zuckerman, one of the 17 expert panelists. He is a senior fellow and health economist at The Urban Institute's Health Policy Center and a national authority on Medicare funding.

“The problem, nationally, is the system hasn't been updated since the mid-1990s. Meanwhile, costs are not stagnant, metropolitan areas evolve … and they haven't gone back and redefined the areas at all.”


Family Medicine Crisis, Inside Jersey - (October 1, 2011)

And the need for primary care doctors is only going to increase as the health care reform is implemented. "In 2013-14, there will be a very dramatic expansion of the people covered by Medicaid. The number of uninsured will drop dramatically; some are saying it will be cut in half," says Stephen Zuckerman, a health economist at the Urban Institute, a Washington think tank. For New Jersey, with 1.2 million currently uninsured, it will mean hundreds of thousands of newly insured people could begin seeking primary care. "I think this is one of the big issues hanging over health care reform: the number of people with insurance and the number of people coming into the system for regular care," says Zuckerman. "I think there is a real question about whether the supply of primary care doctors is there to serve that need. There is a limit in how quickly you can change the number of primary care physicians."


Dementia patients suffer dubious hospitalizations, Associated Press (AP) - in Denver Post online - (September 29, 2011)

The study is important because more than 1.6 million Americans live in nursing homes, and nearly one-quarter of people admitted to one after hospitalization wind up back in the hospital within a month, Dr. Joseph Ouslander of Florida Atlantic University in Boca Raton and Dr. Robert Berenson of the Urban Institute in Washington, D.C., wrote in an editorial in the journal. Nursing homes may fear legal liability if they don't hospitalize a very sick patient, they wrote.


Urban Institute: Save on Health Care by Spending More on Staffing, National Journal - (September 19, 2011)

“One of the things that private insurers do with that money is look out for fraudulent billing and overutilization,” said John Holahan, the director of the Urban Institute's Health Policy Center. “Medicare does much less of that.” 


HHS Pushes Federal-State Partnerships For Insurance Exchanges,Kaiser Health News - (September 19, 2011)

Planning for exchanges is something the Obama administration is working to encourage. "The notion of having many state exchanges completely federally run may not be appealing to the administration," said Linda Blumberg, senior fellow at the Urban Institute's Health Policy Center. "The feds have been trying to be more aggressive about discussing partnership options with the states. They are looking for mechanisms for more flexibility to give states a hand in it without this being overwhelming to the states."


O. Marion Burton: Health-care law helps children, saves money, Providence Journal - (September 17, 2011)

A new study by the Urban Institute estimates the number of children in Medicaid and CHIP increased in 30 states between 2008 and 2009, with 16 states achieving enrollment rates of 90 percent or higher in 2009. Yet, while the number of eligible but uninsured children fell by about 340,000, there are 4.3 million children still eligible for these public programs but not enrolled.


Positive effect of the Affordable Care Act, Sacramento Bee - (September 14, 2011)

A new study conducted by the Urban Institute estimates the number of children in Medicaid and CHIP increased in 30 states between 2008 and 2009, with 16 states achieving enrollment rates of 90 percent or higher in 2009. Yet, while the number of eligible but uninsured children fell by about 340,000, there are 4.3 million children who are still eligible for these public programs but not enrolled.


More businesses plan to drop health insurance as costs rise, News-Press - (September 11, 2011)

-An Urban Institute study projected that the healthcare overhaul will have little effect on employer-sponsored insurance.


Editorial: Lessons on Health Care, New York Times - (September 4, 2011)

By contrast, Mr. Perrys personal-responsibility approach has left a quarter of the states population uninsured. His supporters give Mr. Perry huge credit for limiting medical malpractice awards. That has reduced liability awards and allowed some hospitals to save money. But it has not increased the states supply of doctors any faster than it was already increasing and has not reduced Medicare spending compared with trends in other states that did not cap malpractice awards. Texas has traditionally kept its Medicaid spending down by keeping income eligibility levels low and impeding enrollment. An Urban Institute study last year found that Texas and California were the worst offenders in failing to enroll children who were eligible for Medicaid or a related childrens program. That helps save the state money while leaving poor children without the coverage they need and are legally entitled to. As for the free market being the answer, Texas has one of the lowest percentages of people covered by employer-based insurance, and its employers dump a lot of the cost on the workers. The Kaiser Family Foundation reports that average premiums for a family policy in Texas and Massachusetts were roughly the same in 2010 (more than $14,500), but the average worker in Texas had to pay 31 percent of that and the average worker in Massachusetts only 24 percent.


5 Challenges for CO-OPs, Health Leaders Media - (September 7, 2011)

Analyst Bradford Gray, Ph.D., wonders if that will be enough to guarantee the success of this latest option to individual and small business healthcare coverage. Gray, a senior fellow at the Washington, D.C.-based Urban Institute, a nonpartisan policy research organization, explained that "CO-OPs may become important insurance options in some markets, but it is difficult to foresee their having a transformative effect that was expected of the public option."


Federal COBRA Insurance Subsidies End For Laid-Off Workers, Kaiser Health News - (August 31, 2011)

Randall Bovbjerg, senior fellow at the nonpartisan Urban Institute, said the subsidy did nothing to help many of the the uninsured struggling with cost of coverage. "It only helped those who had job-based coverage," Bovbjerg said. "But for them it was a real godsend." 


U.S. Rep. Ron Kind says that "thanks to Medicare," 75% fewer seniors are in poverty, and most have health coverage, PolitiFact - (August 25, 2011)

Interview with Judith Feder, Health Policy Center, Urban Institute, Aug. 17, 2011


Survey: Overhaul may push employee benefits shift, Associated Press (AP) - Indianapolis Bureau - published in Forbes (August 24, 2011)

The Obama administration took issue with the Towers Watson survey, pointing out that studies by the nonpartisan Congressional Budget Office and nonprofits like Urban Institute reached different conclusions.

An Urban Institute study projected that the overhaul will have little effect on employer-sponsored insurance. When lawmakers debated the legislation, the CBO projected it would only have minimal impact on employer plans. About 3 million fewer people would be covered through work, but they'd be able to get insurance elsewhere.


Hospitals seek more ER patients even as Medicaid tries to lessen demand, Kaiser Health News - (August 22, 2011)

Medicaid officials in Washington state were so concerned by hospitals ER marketing that they issued new rules making it harder for hospitals to qualify for Medicaid bonus payments if they promote their ER for primary care. They sure dont help us when we are trying to get word out that the ER is not the place you go for primary-care diseases like treating asthma or diabetes, said Jeffrey Thompson, chief medical officer for the state Medicaid program. States are focusing on Medicaid recipients in part because these patients use ERs three times as much as people with private insurance and twice as much as people with no health insurance, according to federal researchers. Medicaid recipients visit ERs more often because they are generally sicker than people with private insurance or the uninsured, said Genevieve Kenney, a senior fellow with the Urban Institute. In many parts of the country, people on Medicaid use the ER because they have trouble finding a doctor who accepts Medicaid patients. Medicaid recipients also can use ERs for free or nominal costs.


Pima Community Access Program gets $1 million boost, Arizona Daily Star - (August 19, 2011)

A new study just released by the Urban Institute and the Robert Wood Johnson Foundation found that, despite an increase in eligible children between 2008 and 2009, the total number of eligible but uninsured children declined from 4.7 million in 2008 to 4.3 million in 2009, in part due to outreach and enrollment efforts.


CHIP Outreach Gets More Kids Covered, Kaiser Health News - (August 18, 2011)

Researchers and federal officials attributed part of the improvement in signing up uninsured kids to the March 2009 reauthorization of the CHIP program, which spurred states to increase eligibility in the program as well as provided new federal funding to increase outreach and streamline enrollment efforts. “Without the CHIP reauthorization we would not have seen these gains,” said Genevieve Kenney, a study author and a health economist with the Urban Institute. The report comes from the Urban Institute and the Robert Wood Johnson Foundation.


HHS seeks further gains in childrens' coverage, The Hill - (August 18, 2011)

Also on Thursday, the Urban Institute and the Robert Wood Johnson Foundation said the past few years have seen progress in reducing the number of eligible children who aren't enrolled. Almost 85 percent of eligible children were covered by Medicaid or CHIP in 2009, compared with roughly 82 percent the year before, according to the study.

The study shows that some 4.3 million children are eligible for Medicaid or CHIP but remain uninsured.


Report: There's no consensus on what constitutes 'medical homes' Connecticut Mirror - (August 16, 2011)

"The medical home model does have the potential to transform the way health care is delivered--but potential is the key word here," wrote the report's authors, Dr. Robert A. Berenson, Kelly J. Devers and Rachel A. Burton of the Urban Institute. "The danger posed by the current enthusiasm for the concept is that it could lead to the adoption of unproven models on a wide scale nationwide before evaluations of existing pilots can show us what works in what situations, and what levels of reimbursement are needed to get providers to engage in all the new activities encompassed by the medical home model."


Feeling pinched -- Hospitals, docs anxious as 'provider payment cuts are pretty easy to do'- Modern Healthcare - Washington Bureau (August 9, 2011)

The Social Security and Medicare boards of trustees predicted in May that Medicare's hospital trust fund will be exhausted by 2024. Moreover, Medicare reimbursements for physicians and drugs, which are paid for by general tax revenue, are expected to nearly double as a percentage of gross domestic product over the next 25 years. “The committee could look for changes in spending among current arrangements where there has been overspending,” said Judith Feder, a fellow at the liberal Urban Institute.


How Will Debt-Ceiling Deal Affect Medicare for Patients, Doctors?  PBS NewsHour - Public Broadcasting Service (PBS) - (August 4, 2011)

Judy Feder, a senior fellow at the Urban Institute and a former dean of the Georgetown Public Policy Institute, said that the super committee would be better served to look at ways of reducing spending across the entire health care system. Under the Affordable Care Act, she said, Medicare's growth has already dropped significantly.

"Although there may be room for broader reform in Medicare, we've gotten so focused on rhetoric about entitlement reform, what's often lost is that the problem is overall health care spending," she said. "And that requires changes across the system, not simply in Medicare."


Gingrey claims federal health care board can decide if you get dialysis, chemo,PolitiFact Georgia - (August 2, 2011)

Email interview, Linda J. Blumberg, senior fellow, the Urban Institute, July 20, 2011


Direct primary care model: Cutting out the insurer, American Medical News - Washington DC Bureau - (August 1, 2011)

Direct primary care might not be viable on a large scale, said Robert Berenson, MD, a senior fellow at the Urban Institute and a member of the Medicare Payment Advisory Commission. For example, some people still will need to see specialists and go to hospitals, increasing the chances that there will be gaps in care unless the wraparound plans are very well integrated with the primary care.


Health law boosts care, lowers cost, Politico - (July 31, 2011)

Under the Affordable Care Act, by 2019, businesses will save approximately $2,000 per family they insure. Small businesses can qualify for tens of billions of new health care tax credits. Affordable insurance exchanges will give small businesses the same competitive choices and purchasing clout that large businesses enjoy. According to the Urban Institute, employer spending on premiums is estimated to decrease by almost 4 percent, which would have been about $20 billion in 2010. And by 2014, families could save an estimated $2,300 a year if they buy health insurance in a new affordable insurance exchange.


Make Medicare available to all Americans, Democrat and Chronicle - (July 31, 2011)

The Urban Institute found that NYS could save $20 billion annually over 10 years by moving to a single-payer system.


Chairman Bryant, Jackson Free Press - Online - (July 27, 2011)

And that's it. Bryant inserted in his report that "not all of these costs are attributed to illegal immigrants." But that's not a very generous statement, especially considering that in 2009, whites were less likely to have employer-sponsored insurance than in 2007. Urban Institute Director John Holahan wrote that the uninsured rates for whites increased by 15 percent, during the most recent economic downturn, while blacks' and Latinos' income reductions were not as dramatic as those of whites—who had a lot further to fall economically. Holahan wrote that most of the increase in the number of uninsured people in the U.S. was among native-born U.S. citizens, rather than immigrants.
 


Experts discuss ways to trim health care, Business First of Louisville - (July 26, 2011)

Holahan said he doesn't see one silver bullet to reducing the growth of health care costs, which have increased more than the gross domestic product over the past several years.

Eliminating the tax breaks for health premiums, creating a public health insurance option to compete with the private market and reforming medical malpractice all would save money, he said.


Preparing Americans for Death Lets For-Profit Hospices Neglect End of Life, Bloomberg - (July 22, 2011)

“Long stays on hospice subvert the intent of the program and suggest a pattern of behavior that needs to be investigated,” said Robert Berenson, a fellow at the Urban Institute in Washington and vice chairman of the Medicare Payment Advisory Commission, or Medpac, which advises Congress on health care policy. 


Wither Medicare, Health Reform Talk blog (Wolters Kluwer) - (July 20, 2011)

With the Urban Institute, The Kaiser Family Foundation (KFF) reviewed the income, assets, and demographics of the current Medicare population in a report released earlier this year, "Projecting Income and Assets: What Might the Future Hold For The Next Generation Of Medicare Beneficiaries?" Key findings of the KFF and Urban Institute researchers include the following. . .


ObamaCare's IPAB Is A Loser For Democrats, Investor's Business Daily - Washington DC Bureau - (July 15, 2011)

Adding to the Democrats' discomfort was witness Judith Feder, a Georgetown professor and fellow at the liberal Urban Institute, who urged Congress to expand IPAB so that it applied to the entire health care system, not just Medicare. The Democrats didn't bother to explore that idea.

Feder was also there, testifying on the hearing's third panel with six other witnesses. Rep. Phil Gingrey, R-Ga., asked if any of the panel members would consider serving on IPAB. Guess who was most enthusiastic?


Editorial: Will health care be there when you need it? The Oakland Press - (July 15, 2011)

The House Budget Plan includes two major provisions relevant to Medicaid, according to an analysis conducted by the Urban Institute for the Kaiser Commission on Medicaid and the Uninsured.

“First, it would repeal the Affordable Care Act, which includes a major expansion of Medicaid with mostly federal funding to nearly all non-elderly individuals, including adults without dependent children, up to 138 percent of poverty,” the analysis states. “The repeal of ACA would result in substantial reductions in currently-projected Medicaid enrollment and federal spending.The House Budget Plan includes two major provisions relevant to Medicaid, according to an analysis conducted by the Urban Institute for the Kaiser Commission on Medicaid and the Uninsured."


States could save $14 billion due to federal spending under healthcare reform act, study finds, McKnight's Assisted Living - Online - (July 15, 2011) 

Due to an increase in federal spending under the healthcare reform law, state governments can expect a net savings in healthcare spending of $14 billion from 2014 to 2019, a new study from the Urban Institute finds.


Guaranteeing heath care affordability, Politico - (July 13, 2011)

Commentary by Judith Feder.


Rationing Care or Controlling Costs? Medicare Board Takes Heat on the Hill, Public Broadcasting Service (PBS) - Online - (July 13, 2011)

That's exactly what appeals to Judy Feder, a senior fellow at the Urban Institute and a former dean of the Georgetown Public Policy Institute.

"This is a backup to make sure the commitments of the Affordable Care Act are actually realized," she told the NewsHour. "It mobilizes experts to keep an eye on things, to weigh what works against what doesn't and to make sure the system moves forward in the right direction."

Asked during Wednesday's Energy and Commerce Committee hearing if she would serve on the panel, Feder said she hasn't been "asked" but the prospect has come up in her talks with administration officials. "I indicated I would be proud to serve on the IPAB," she told the committee.


Rising Health Care Curve Won't Bend, Even for Obama, The Fiscal Times - Washington DC Bureau - (July 13, 2011)

Robert Berenson, a health analyst at the Urban Institute, admits many of the demonstrations on delivery system reforms have had mixed results. But a careful analysis of the successful elements of those demonstrations could be replicated across the country and lead to significant savings. “There are positive elements in a lot of those demos,” he said. “You could pick and choose the ones that worked.”


GOP Decries 'Rationing' IPAB; Dems Downplay Its Role, Investor's Business Daily - Online - (July 12, 2011)

Judith Feder, a Georgetown professor and fellow at the liberal Urban Institute said, "IPAB exists ... to recommend ways to achieve specified reductions in Medicare spending by changing the way Medicare pays health care providers."

She claimed that IPAB would recommend lowering payments for bad behavior by providers and providing bonuses for good behavior. IPAB reforms "have the potential to transform both Medicare and by example ... the nation's health care delivery system to provide better-quality care at lower cost."

She encouraged Congress to go even further: "Rather than moving to abandon IPAB ... I urge you to modify IPAB's current spending target not just to Medicare but to private insurance — all health care spending, and extend its authorities to trigger recommendation for all-payer payment reform if the target is breached."


Access to Primary Care Doctors Lowers Death Rates for Seniors, AARP The Magazine - Online - (July 12, 2011)

"The U.S. has one of the lowest primary-care-to-specialty ratios among the developed countries," says Robert Berenson, M.D., a health policy expert with the Urban Institute in Washington, D.C., and a former practicing internist.


HHS officials quiet about high-risk pool expenses, CQ HealthBeat - (July 11, 2011)

"Saying this program is life saving is no overstatement," said Urban Institute economist Linda Blumberg. "This is the most vulnerable population healthwise. We need to both give credit for those who are being helped and realize that the stakes are incredibly high for this population. These people can't wait until 2014. And when I talk to people who can benefit [from the program], they don't know anything about it."


Healthcare reform to save states $100B, United Press International (UPI) - Online - (July 11, 2011)

Matthew Buettgens, Stan Dorn and Caitlin Carroll of the Robert Wood Johnson Foundation and the Urban Institute used their Health Insurance Policy Simulation Model to estimate federal and state spending and savings as healthcare reform increases access to healthcare.


Why 'Obamacare' May Live, The Daily Beast - (July 8, 2011)

Democrats did not exactly mount a vigorous defense of the law in 2010. But Obama will be its chief defender this time, and he'll have advantages that were not available to the hapless Dems running for the House and Senate. One is the klieg lights of a presidential campaign; whether it's in ads, debates or speeches, people will be paying close attention to what the president says. “The best person to articulate the case for the law is Obama himself,” says Stephen Zuckerman, a health economist at the Urban Institute. “He will be the one explaining it and trying to put people's minds at ease.”


McKinsey Health Insurance Survey Raises Ruckus, Questions, NPR - (June 17, 2011)

Another thing that raised eyebrows: The McKinsey findings were so out of line with studies done by other outfits, the Mercer consulting group, the Urban Institute and the Rand Corporation. All those studies found the impact on employer-provided insurance likely to be much smaller.


Democrats to McKinsey: 'Prove it'  Modern Healthcare - Online - (June 17, 2011)

Among DeParle's specific criticisms was that the McKinsey study was an “outlier” because three previous studies by the RAND Corp., the Urban Institute and the consulting firm Mercer concluded that private employers would drop their employee coverage at much lower rates.


Will Nonprofits Drop Health Insurance after Health Care Reform? The Nonprofit Quarterly - Online - (June 17, 2011)

House Speaker John Boehner's office immediately pronounced the McKinsey findings as proof that employers would dump ESI "en masse," while numerous other sources, including the New America Foundation, eviscerated the McKinsey methodology. A January 2011 report from the Urban Institute, also written by a McKinsey guy, suggests that ESI isn't DOA in 2014. Our brief review of the McKinsey controversy leads us toward seeing the McKinsey research as almost akin to a push poll, methodologically dubious to say the least.


Wonkbook: Debt negotiators focusing on Medicaid, Washington Post - Blogs - (June 16, 2011)

In his Urban Institute paper, Garrett dismantles 'claims that the ACA would cause major declines in [employer-sponsored health insurance],' calling them, 'greatly exaggerated.'


More Questions About that McKinsey Study, The New Republic - (June 16, 2011)

That controversial McKinsey & Company study, the predicting severe disruptions from health care reform, isn't going away. It may be at odds with what the Congressional Budget Office, Rand Corporation, and Urban Institute found. It may raise severe doubts among the firm's employees, one of whom has said, flatly, that the survey is "not a good tool for prediction." But conservatives are still citing as proof in their attacks on the Affordable Care Act. The latest is Karl Rove, who uses the story as the peg for a Wall Street Journal column titled "The Obamacare Bad News Continues."


The McKinsey controversy keeps percolating, The Washington Monthly - (June 16, 2011)

One of the main arguments from the White House has been that the McKinsey findings are at odds with all available evidence, including independent research from the Congressional Budget Office, the Rand Corporation, and the Urban Institute. Today, Greg Sargent advances this quite a bit with an amusing revelation.


Commentary: Help for high health care costs, ColoradoBiz - Online - (June 16, 2011)

There's substantial evidence to suggest that the exchange will in fact help rein in costs and expand access to health insurance for entrepreneurs like Nora. A study released by the Urban Institute in January found that total healthcare spending by small firms would decline by 8.7 percent, due mainly to cost savings in the exchanges. It also found that the average employer contribution per employee would decrease by 7.9 percent for small businesses. That's a huge chunk of cash for entrepreneurs struggling to keep their doors open, wanting to expand their company or needing to hire a new employee. 


AAFP seeks changes from the RUC, Healthcare Finance News - Online - (June 15, 2011)

A study done last year for the Medicare Payment Advisory Commission, or MedPAC, a Congressional watchdog, by staff from the Urban Institute and the Medical Group Management Association Center examined what doctors' hourly pay rates would be if everyone were paid at Medicare rates only. Primary care doctors were at the bottom of the scale at $101.52 an hour; non-surgical, non-procedural specialties like psychiatry, rheumatology and emergency medicine came in at $134.43 an hour; and at the highest end of the scale, non-surgical, procedural specialties, such as cardiology, came in at $214.45.


Pushback on McKinsey Health Benefits Study, Business Finance - (June 14, 2011)

...(the McKinsey) report is pretty starkly at odds with the experts from the Congressional Budget Office, the RAND Corporation, the Urban Institute, and it is also starkly at odds with history. History has shown that reforms motivates more businesses to offer insurance. Health reform in Massachusetts, for example, uses a similar structure as the Affordable Care Act with an exchange, a personal responsibility requirement and an employer responsibility requirement. And the number of individuals with employer-sponsored insurance in Massachusetts has increased. We are confident the Affordable Care Act will strengthen our existing system, employer-based system going forward. So we simply just disagree with those conclusions...We believe that the Affordable Care Act will reduce costs overall. It is one of the reasons why the president pursued insurance reform, because he wanted to address the burden that costs were placing on individuals as well as businesses. So yes, we disagree with the conclusions of the report.


Fact-checking the GOP debate in New Hampshire, Washington Post - Online - (June 14, 2011)

This eye-catching figure comes from a study by two respected analysts at the Urban Institute that was the subject of a widely read New York Times article. Paul quoted the numbers right, but others have reached different conclusions.


IOM report targets accuracy of Medicare regional payments, American Medical News - Online - (June 13, 2011)

"The real objective here is to accurately reflect the differences in the input prices that providers face," said committee member Stephen Zuckerman, a senior fellow with the Urban Institute in Washington, D.C.


Is health care cost-shifting real? Washington Post, Right Turn blog - (June 11, 2011)

“A study conducted by George Mason University Prof. Jack Hadley and John Holahan, Teresa Coughlin and Dawn Miller of the Urban Institute, and published in the journal Health Affairs in 2008, found that so-called cost shifting raises private health insurance premiums by a negligible amount. The study's authors conclude: “Private insurance premiums are at most 1.7 percent higher because of the shifting of the costs of the uninsured to private insurance.” For the typical insurance plan, this amounts to approximately $80 per year.


White House Pushes Back Against McKinsey Healthcare Report, ABC News Radio - Online - (June 9, 2011)

The Obama administration argues that the report is an outlier, and cites studies by the Rand Corporation, The Urban Institute and Mercer that found that businesses would not change their insurance programs substantially as a result of the Affordable Care Act.


House revives bill to allow interstate health insurance sales, American Medical News - Online - (June 6, 2011)

Many states already offer low-cost individual health plans. The problem is that these plans offer limited coverage that some people may not think is worth the premium cost, said Linda Blumberg, PhD, senior fellow in the Urban Institute's health policy center.

Also, health insurance does not function like a free market, Blumberg said. In nongroup health insurance, "the way you get the biggest decrease in premiums is by dividing the risk. Yes, you have made coverage more affordable for the healthy, but at a direct cost for the people who are not healthy."


Spending more on Medicare benefits seen, UPI.com - (May 31, 2011)

Jack Hadley, senior health services researcher at the George Mason University, and Urban Institute colleagues Timothy Waidmann, Stephen Zuckerman and Robert Berenson say greater spending on medical services means better overall health for Medicare participants.


Medicare beneficiaries who receive higher medical spending have better health outcomes, News-Medical.Net - (May 30, 2011)

A new study from George Mason University and the Urban Institute reveals that greater spending on medical services means better overall health for Medicare participants. Health Administration and Policy Professor Jack Hadley and his co-authors, Urban Institute researchers Timothy Waidmann, Stephen Zuckerman, and Robert Berenson, analyzed data from more than 17,000 Medicare beneficiaries to draw this conclusion.


How far does liability travel when a patient neglects to seek healthcare early? ModernMedicine.com - (May 28, 2011)

The uninsured, it has been stated, are less likely to receive recommended preventive and primary care services, face significant barriers to care and ultimately face worse healthcare outcomes. An Urban Institute study showed that uninsured women with breast cancer are diagnosed later during its development, when treatment is less effective. Increasing the risk of serious harm, uninsured men with hypertension are more likely to go without screenings and prescribed medication and to skip recommended doctor visits.


EDITORIAL: GOP could face unhealthy situation in 2012, Delaware County Daily Times - (May 27,2011)

Two of the biggest targets are Medicare, which provides health care for the elderly, and Medicaid, which provides health insurance for the poor. Ryan’s plan essentially ends Medicare and replaces it with a voucher system so seniors could purchase coverage from insurance companies. The Medicaid proposal, according to the Kaiser Family Foundation and the Urban Institute, would end coverage for 44 million poor people, including most nursing home residents.


Compare health insurance quotes from top companies - fast, Insure.com - (May 25, 2011)

A recent study by the Urban Institute on employer-sponsored coverage under health reform concludes "reports of its demise are premature." Using a "health insurance policy simulation model," researchers found that overall employer-sponsored coverage under the Affordable Care Act would not be much different from what it would have been without reform.


The Single-Payer Solution, Governing - (May 24, 2011)

What would the House Republican budget plan mean for federal Medicaid payments to your state? Authors from the Urban Institute break out the likely impact on a state-by-state basis (see figure 3 on page 6.) The average state reduction from 2012 to 2021: 33.9 percent. The biggest loser: Wyoming, which would face a 44.4 percent reduction.


Excluded groups want in on health information technology funding, iWatch News - (May 23, 2011)

Stephen Zuckerman, health economist for the Health Policy Center at the Urban Institute, doubts either bill will make it past the Democratic-controlled Senate or gain the president's signature. But he also doubts HITECH will gain any additional funds for excluded providers. That leaves one other possibility: that more providers find a way to qualify, but without the pot of funds increasing.

That scenario presents its own challenges. "If the goal is to give every provider who qualified in the original bill some fixed or minimum amount of funding, then adding new categories of providers without adding new dollars would not make sense," said Zuckerman. "Unless new money is made available, and this seems unlikely, the only way to add new providers would be to reduce the funding available to each provider in the original group."


Bad Economy Means Medicare Will Run Out Of Cash Sooner, Shots: The NPR Health Blog - (May 13, 2011)

Still, the looming cash crunch underscores the need for action. At the same briefing, economist Robert Reischauer, one of two public trustees for Social Social and Medicare, declared, "Under current law these vitally important programs are on unsustainable paths." He urged that steps be taken sooner rather than later to shore up Medicare.


Atkins hopes to put junk-food tax on the menu, Lowell Sun - (May 13, 2011)

The Urban Institute, a Washington think tank, published a report in 2009 proposing a national sales tax on fattening food in order to finance campaigns for anti-obesity and national health-care reform.


Editorial: Middle class, poor and seniors in bull's-eye, Delaware County Daily Times- (May 13, 2011)

Medicaid is a federal-state program that now covers more than 60 million people, including poor children, most nursing home residents, and the disabled of any age. An analysis by the Kaiser Family Foundation and the Urban Institute found health care for the poor under the GOP proposal would be “significantly compromised ... with no obvious alternative to take its place.” It would also repeal a coverage expansion to low-income adults under the Affordable Health Act.


Mitt Romney defends Mass. health law, Politico - (May 12, 2011)

About 401,000 Massachusetts residents have become insured since the 2006 reforms came online, translating into a decrease of uninsured, working-age adults from 13 percent to 4 percent, according to an Urban Institute study.


 

Critics Fear G.O.P.'s Proposed Medicaid Changes Could Cut Coverage for the Aged, New York Times - (May 10, 2011)

According to a report released Tuesday by the foundation with the Urban Institute, by 2012, under the Ryan plan, Medicaid enrollment nationally could be 44 million people fewer than what it is projected to be under current law, which includes new additions to the program under the health care overhaul.


Study Details How GOP Budget Plan Would Cut States' Medicaid Funding, Kaiser Health News - (May 10, 2011)

The study was released by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured and conducted by researchers at the Urban Institute. (KHN is an editorially independent program of the foundation.)


Report: House GOP budget sharply cuts Medicaid money to states; up to 44m more uninsured, Associated Press (AP) Washington DC Bureau - (May 10, 2011)

The analysis by the Kaiser Family Foundation and the Urban Institute concluded that Medicaid's role as the nation's safety net health care program would be “significantly compromised ... with no obvious alternative to take its place,” if the GOP budget is adopted.


Despite differences, Obama, GOP eye Medicare limit, Associated Press (AP) - (May 9, 2011)

"They are both saying Medicare has to be on a budget," said economist Eugene Steuerle of the Urban Institute think tank. "But each of them is also saying it has to be my type of system on a budget, and not your type of system."


Public health workers are warned 50 jobs must go, Boston Globe - (May 3, 2011)

According to Brenda Spillman, Urban Institute senior fellow and coauthor of a January 2011 study published in the American Journal of Public Health, medical costs in Massachusetts could be reduced by nearly $3 billion over the next decade if effective community-based prevention programs were put in place now.


Interstate compacts offer new weapon against health care plan, Stateline.org - (May 2, 2011)

“It's interesting that the states that are most interested in the concept are the ones where the federal government already spends most of its health care dollars and will spend even more under the Affordable Care Act,” says Linda Blumberg, a health care expert with the Urban Institute. “That means their residents have the most to lose.” In general, those are the poorest states in the country.


GOP plan to change Medicare is rooted in bipartisan history, Washington Post - (May 1, 2011)

The term “premium support” was coined in 1995 by two respected health policy experts, neither a conservative: Henry Aaron, a Brookings economist, and Robert Reischauer, president of the Urban Institute. “The idea of vouchers was abroad in the land,” Aaron recalled. “We thought there was sort of a free-market-will-cure-all mentality.”


Is Medicare's price-setting power the cause of high health costs? Palm Beach Post - (April 29, 2011)

Liberal economists like Paul Krugman have argued persuasively that if the private insurance system were to be asked to provide the benefits that Medicare now provides, costs would go up dramatically. In this essay for the New York Review of Books he quotes an Urban Institute study that found costs per Medicare beneficiary in poor health would rise to nearly $15,000 per person if that person were privately insured.


Bloomberg: Medicaid Expansion Cost Could Exceed Forecast, National Journal - Online - (April 25, 2011)

John Holahan, a health-policy analyst at the nonprofit Urban Institute in Washington, says politics plays no small role in making these estimates.

States with Republican governors, such as Texas and Florida, “want to make it sound like they're getting killed by health reform and that they'll go broke,” Holahan told Bloomberg. “It's just simply not the case.”


The future of your health care, CNNMoney - (April 25, 2011)

And the new health care law cuts payments to the private plans, which will cause more insurers to quit, says Stephen Zuckerman, health economist at the Urban Institute. Others will be dropping some benefits, such as dental or vision, or hiking out-of-pocket costs. 


Medicare study weighs cost, care of dying seniors, Tampa Tribune - Online- (April 24, 2011)

Getting a handle on Medicare costs means finding a way to smooth out those differences among hospitals and across regions, said Stephen Zuckerman, a health economist with the Urban Institute in Washington.

But that's easier said than done, Zuckerman said.

"You can't paint with a broad brush," he said. "The fact that one area has a higher cost than another area doesn't mean every provider in that area should be paid the same. We want to give hospitals incentives to be more efficient."

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Even though they may reduce costs significantly, palliative and hospice care are butting up against the Medicare fee system and, in some cases, the wishes of families and patients, who may request costly treatments, Zuckerman said.


Lawmakers Wrestle With Plans To Cut Medicare Costs, All Things Considered - NPR - (April 21, 2011)

Robert Reischauer, who used to direct the Congressional Budget Office, says if the government did that strictly by limiting payments to doctors, Medicare recipients might not notice - at first.

Mr. ROBERT REISCHAUER (Economist): The question is for how long? At some point, when you begin chipping away at the payments to providers, providers are going to be less and less willing to serve Medicare patients.


Entitlements Can't Survive Unless They're Reformed, Investor's Business Daily - Online - (April 21, 2011)

Baby boomers retiring today will receive far more in Medicare benefits than they ever paid in taxes. Researchers at the Urban Institute project that a married 66-year-old couple paid $110,000 in Medicare taxes, but will receive about $340,000 worth of benefits.  


How the Budget Deficit Could Lead to Generational Warfare, U.S. News & World Report - (April 18, 2011)

This excluded group, however, consists of all current retirees and more than half of the baby boom generation. It's this cohort of Medicare recipients that is bankrupting the system, not the much smaller population of people who will be retiring in later decades. According to a study by the Urban Institute, most Medicare beneficiaries receive much more in benefits than they pay into the Medicare trust fund in payroll taxes. 


Celebrating Romney's true role, Boston Globe -  (April 18, 2011)

Still, conservatives might be more favorably disposed if they understood the part Romney played in warding off various schemes feared by business. After an Urban Institute study recommended an individual mandate, Romney made that the core of his plan. That was a way of sidestepping the approach many Democrats favored: a payroll tax of 5 to 7 percent on businesses that did not offer health coverage. That idea, the subject of a planned ballot question, became the preferred approach of then-House speaker Sal DiMasi. Businesses worried, and with good reason, about the costs such a plan would impose.


Paul Ryan is not pro-competition, and his critics are not anti-competition, Washington Post - (April 15, 2011)

Henry Aaron and Robert Reischauer, for instance, first developed the idea of “premium support,” which is the policy Ryan says he's included in his budget. But they don't think he's got it right, and both mild-mannered deficit hawks have been blisteringin their criticisms. Alice Rivlin worked with Ryan on a plan to bring consumer responsibility and market-based incentives to Medicare, and even went so far as to send it to the Congressional Budget Office. But she's abandonedthe play Ryan includes in his budget, as she thinks it's ultimately doomed to failure.


Obama poised to enter long-term budget fight, MSNBC.com - (April 12, 2011)

Stephen Zuckerman, an economist and Medicare expert at the Urban Institute, a non-partisan think tank in Washington, said he was "a bit surprised" that Plouffe re-opened the Medicare issue Sunday in his preview of Obama's speech. But cost-saving and revenue-raising avenues are open to the administration. 


Creator of premium support says Ryan has 'vouchers, not premium support', Washington Post - Ezra Klein's Blog - (April 11, 2011)

Brookings' Henry Aaron is one of Washington's most respected social policy experts. He's served as a Social Security trustee, vice president of the American Economic Association and much more. It was Aaron, alongside the Urban Institute's Bob Reischauer, who coined the term “premium support” to describe a model in which you'd open Medicare to competition but install certain safeguards to protect beneficiaries from cost shifting. Now, Paul Ryan has adopted that model and included it in his budget. There's only one problem, according to Aaron. Ryan may be calling his reforms “premium support,” but that's not what they are.


Hidden In Plain Sight, Youth Today - (April 4, 2011)

Enough new children enrolled last year – more than 2.6 million – to keep the percentage of uninsured children at 10 percent, despite the worst recession in decades, rising poverty levels and a sharp decline in employer-based coverage, according to a recent study by the Urban Institute.


Multi-State Insurance Exchanges Unlikely to Focus on Risk-Sharing, Becker's Hospital Review - (April 5, 2011) 

Author Linda Blumberg, senior fellow in the Urban Institute's Health Policy Center, explains four reasons why states may join together to establish multi-state exchanges:

Given the common tasks that need to be performed, administrative economies of scale could be significant.

Regional exchanges covering large metropolitan areas that cross state boundaries may simplify reform mandates.

Multi-state exchanges may promote pooling across state lines.

Multi-state exchanges could lead to a critical mass of insured persons to create stabilized risk pools in low-population states. Read Full Report Here.


Some medical practices move to monthly membership fees for patients, Washington Post - (April 5, 2011)

Some experts have more fundamental reservations about this approach. While agreeing that the current payment model for primary care doesn't work very well, "it doesn't make any sense" to provide primary care outside the health insurance system, says Robert Berenson, a fellow at the Urban Institute. "This is not going to work for a lot of patients who can't afford the out-of-pocket subscriptions," he says.


Home agencies warn rule burdens isolated, frail aged, Arizona Daily Star - (March 29, 2011)

Some Medicare experts have little sympathy. "Home health is a benefit that is out of control," said Dr. Robert Berenson of the Urban Institute. 


Dems: Potential Cuts to Medicaid Outlined by Administration 'Cruel'The Hill - (March 28, 2011)

The reason is no mystery: Medicaid payments, despite a 12 percent increase between 2003 and 2010, represent just 69 percent of what Medicare pays for the same services, said Stephen Zuckerman, health policy analyst at the Urban Institute.


Cost control the next step for Massachusetts health reform, American Medical News - Online - (March 28, 2011)

"If you can't get costs under control, you can't get the health care coverage expansions," said Robert Berenson, MD, a senior fellow at the Urban Institute who was an internist for 20 years. "And in the end, you need to get the population covered to reduce inefficient [health] spending."


Stressed States Open Doors to Medicaid Managed Care, Managed Care Magazine - (March 24, 2011)

Medicaid enrollment has grown steadily over the past decade, from a total of 31.7 million in June 2000 to 46.9 million in June 2009. And the recession has caused Medicaid rolls to spike. Source: Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on KCMU Medicaid enrollment data collected by Health Management Associates. States are scrambling for every solution they can find, and managed care has a track record of success, says Jeff Smith, senior vice president and Medicaid managed care adviser at the Lewin Group.


States May Yet Regret Their Many Mandates, Managed Care Magazine - (March 24, 2011)

But with most states finding their current spending plans already far too large to digest, adding new costs to the menu may not fly. I do think the states are going to change the laws, says Linda Blumberg, PhD, a senior fellow at the Urban Institute.


‘RomneyCare’ Facts and Falsehoods, FactCheck.org - (March 25, 2011)

Surveys by the Urban Institute and the BCBS of Massachusetts Foundation found that 67 percent of nonelderly adults in the state supported the health care law in the fall of 2009; in the fall of 2006, a few months after it was passed, 68.5 percent supported it. Another 2009 survey by the Harvard School of Public Health and the Boston Globe found 59 percent of state residents supported it, which was also similar to the poll's 2006 number, 61 percent. In 2009, 28 percent opposed it and 13 percent weren't sure. Support was much higher among Democrats and Independents than Republicans. Those are the most recent surveys we found.

Long, Sharon K. "What Is the Evidence on Health Reform in Massachusetts and How Might the Lessons from Massachusetts Apply to National Health Reform?" Urban Institute. Jun 2010.

Long, Sharon K. and Karen Stockley. "Health Reform in Massachusetts: An Update as of Fall 2009." Urban Institute and BCBS of Massachusetts Foundation. Jun 2010.


Juneau's 'creative vitality' gets high marks, Juneau Empire - Online - (March 24, 2011)

Patient Protection and Affordable Care Act will lead to a modest increase in jobs, concludes a new study by the Urban Institute.

The report, "How Will The Affordable Care Act Affect Jobs," counteracted claims in some circles that the healthcare reform law could cost the United States as much as 1.6 million jobs.


Cost of Medicaid reform mysterious, nwitimes.com - (March 15, 2011)

"It's an open question as to whether state spending will go up," said Stan Dorn, senior fellow at the Urban Institute. "(But) I think it's pretty clear that smart states will generally be able to come out ahead and see their spending on low-income people's health care goes down as federal spending goes up."

Total costs between 2014 and 2019, may range somewhere between $1.2 billion to $2.5 billion, according to a February study prepared by the Urban Institute and published by the Kaiser Family Foundation.


Home agencies warn rule burdens isolated, frail aged, Arizona Daily Star - (March 29, 2011)

Some Medicare experts have little sympathy. "Home health is a benefit that is out of control," said Dr. Robert Berenson of the Urban Institute.


Cardiologists pull support for Conn. SustiNet bill after malpractice protection was removed, New Haven Register - (March 25, 2011)

The Urban Institute, which ran the financial models for the plan, said it will attract more federal funds, save the state millions annually and should cut the delivery of health care. Its opponents say it is too ambitious, doesn't have enough resources and will hurt insurance workers.


Medicare Rule Sparks Concerns About Patients' Access To Home Health Care, Kaiser Health News - (March 24, 2011)

But some Medicare experts have little sympathy for industry complaints. "Home health is a benefit that is out of control," said Dr. Robert Berenson, a health policy expert at the Urban Institute.

Medicare advisers to Congress say the regulation doesn't go far enough to reduce waste and fraud because it allows patients to start getting home health services before first seeing a doctor to ensure they need it. "Such a large window … does not ensure that beneficiaries receive an examination in a timely manner before home health care is delivered," the Medicare Payment Advisory Commission wrote in a report to Congress this month. Berenson is a member of the commission.


Urban Institute: ACA will help healthcare, but not overall economy, Health Care Finance News - (March 23, 2011)

The Patient Protection and Affordable Care Act will have little net effect on overall employment but should provide a modest boost in healthcare sector employment, according to the Urban Institute.

The organization's new report, “How Will the Affordable Care Act Affect Jobs?”, contradicts claims that the new law would place an undue burden on individual business owners, causing them to reduce their labor force.

“It is almost impossible for the ACA to have a significant effect on the overall economy or on unemployment simply because the effect of net new federal spending on healthcare (over and above reductions on spending on Medicare and other government programs) is very small relative to the size of the economy,” said study authors John Holahan and Bowen Garrett.


Health Care Law Will Not Impact Jobs, According to Report, Health & Wellness News - (March 23, 2011)

Healthcare reform debate continues as people advocate for the repeal of the Affordable Care Act, saying it will increase unemployment. Researchers at the Urban Institute emphasize it will not have a noticeable impact on jobs.

John Holahan and Bowen Garrett site three reasons why it won't impact jobs.

Also, the authors say other factors, like monetary and fiscal policies, are likely to have a much greater impact on the economy than healthcare reform.


Jendal: no exchange here, Politico - (March 22, 2011)

– The Urban Institute’s John Holahan and Bowen Garrett argue in a report that the health law will not have a “noticeable effect” on net levels of employment for several reasons, among them: the Medicare premium cuts and new taxes will be offset by the expansion of coverage through Medicaid and income-related subsidies that will increase employment and many employers already meet the coverage requirements. The Urban Institute report http://bit.ly/fggOVZ.


More Maryland's All-Payer Answer, Governing - (March 22, 2011)

To see a PowerPoint deck of a presentation Murray recently presented at the Urban Institute, visit www.urban.org/events/upload/Robert-Murray.pdf.


As health-care law turns 1, supporters using occasion to shape its image, Washington Post - (March 22, 2011)

In one, federal officials are working at a fevered pace, writing regulations, planning innovations for the delivery of care, and giving states grants and guidance. That complex work is “even a little ahead” of expectations, said Urban Institute President Robert D. Reischauer, an authority on health-care policy.In the other world, Reischauer said, the future “is very uncertain right now. . . Today, I wouldn’t give much more than a 50-50 chance that all of the critical components of the Affordable Care Act will be alive and well . . . Court decisions, defunding efforts or actual repeal of some major provisions could eviscerate the dreams of universal coverage and restrained cost growth.”

Obamacare is not ‘job-destroying’  Washington Post - (March 22, 2011)

Obamacare is not “job-destroying.” And the next time you hear someone insist that the Affordable Care Act (ACA) is that sort of pernicious economic malady, click on this report, which the the non-partisan and well-respected Urban Institute released Monday.

“The basic conclusion,” the report reads, “is that the ACA will not have a noticeable effect on net levels of employment.” Note, as Ezra Klein has, that this doesn't accord with Democratic claims that the health-care law will be a job creator, either. There are three major reasons.

 OVERNIGHT HEALTH: WH starts weeklong reform rally, The Hill - Online, (March 22, 2011)

Report says no effect on jobs: A new report from the Urban Institute says healthcare reform will have "no noticeable effect on net levels of employment." The widely panned "employer mandate" will have little effect because most firms with 50 or more employers already offer private insurance in accordance with federal standards, the organization said.


Healthcare reform: No job levels change, UPI.com - (March 22, 2011)

John Holahan and Bowen Garrett, both of the Urban Institute, conclude the Affordable Care Act will not have a noticeable effect on net levels of employment for three reasons:

-- The law's net new expenditures are too small relative to the overall size of the U.S. economy to have much of an effect on employment.

-- The expansion of coverage through Medicaid and income-related subsidies in the exchanges would likely increase employment in the health sector, countering negative effects of Medicare payment cuts and new taxes.

-- The new law will not affect most firms, because they already provide health insurance meeting the new federal standards, or they are exempt from the new requirements because they employ fewer than 50 workers.


Health care law turns a year old, Marketplace - Online - (March 21, 2011)

Randy Bovjberg: What they're saying is, look, if we have to go to this right away, we're going to have to raise premiums a lot or drop coverage.

Randy Bovjberg is a senior fellow for the Urban Institute. He says the Obama administration granted those wavers rather than risk two million workers being dropped from coverage before subsidies and exchanges kicked in in 2014.

Bovjberg: That's right and what will happen in 2012 and 2013 is still up for grabs. These are one-year waivers. In 2014, the typical thing that is said is that these plans won't be necessary.

[Warner: You mean the mini-med plans?]

Bovjberg: Yeah. That the exchanges will offer much better coverage at an affordable level and people who can't afford it would get subsidies.


ER use forces hospitals to grow, Pittsburgh Tribune-Review - Online - (March 20, 2011)

Long waits in emergency departments are frowned upon by hospitals because they don't bode well for public attitudes or quality of care, said Dr. Robert Berenson, a fellow at the Urban Institute in Washington, an expert on hospital competition and pricing.

"So there have been lots of emergency room expansions in the country," he said.


Excluded Voices: Health Care CostsColumbia Journalism Review - (March 18, 2011)

During the health reform debate, we periodically presented Q and A interviews with health care experts whose voices were scarce. Too often journalists sought out the same organizations and the same expert sources for their stories, offering up what became the conventional wisdom on different aspects of reform. To bring more variety into the conversation, our Excluded Voices series featured experts who weren’t on the media’s A-list of sources. We continue this series in the post-reform era. In this, the eighth entry in that series, we talk with Dr. Robert Berenson, an Institute Fellow at the Urban Institute in Washington D.C. The entire series is archived here.


A not very happy birthday, The Economist - (March 17, 2011)

Republicans have often claimed that employers will scrap corporate insurance, preferring to pay a fine and dump their workers on the subsidised exchanges. That sounds plausible, but two new studies—by the RAND Corporation and the Urban Institute, both non-partisan think-tanks—debunk the argument. In fact, the boffins at RAND calculate that the new reforms could even increase employer-sponsored coverage, as employees confronted with the new mandate clamour for (tax-assisted) coverage from their employers now that they are obliged to have it.
 


A Challenge to Congress: A Critical Care Blueprint, Health Affairs Blog - (March 17, 2011)

Terminally ill hospitalized patients will likely be subjected to tests and interventions they don't want, that won't have any material benefit to their condition, and that will detract from, rather than enhance, the quality of their end-of-life experience. The Urban Institute recently found that taxpayers could save more than $90 billion over 10 years by avoiding such mismanagement of care. By better aligning care with the wishes of patients and family members, we can  achieve the Institute for Healthcare Improvement's “Triple Aim” goals of improved population health and improved care of individual patients at a lower cost. 

Business advocates that oppose the health reform law say the requirement for employers to offer a minimum level of health coverage to their workers starting in 2014 will cause significant increases in employer health costs, prompting many businesses to drop coverage altogether. But the report, conducted for the foundation by the Urban Institute, rejects these predictions.


Health Connector patients mostly satisfied with service, Boston.com - (March 11, 2011)

One of the goals of the 2006 law was to reduce patients’ use of expensive emergency rooms for the flu, sprains, and other non-urgent care, by providing health coverage for most of the uninsured. But about a third of patients surveyed said they had gone to a hospital emergency room in the past year. That mirrors the findings of an Urban Institute study last year of patients statewide, including those who have private health insurance.


SustiNet: As Debate Intensifies, Stakes Rise, New Haven Independent - (March 9, 2011)

For supporters of universal coverage, it’s time to move. Stan Dorn, a senior fellow at the Urban Institute, a Washington, D.C.-based think tank, has worked closely with the Universal Health Care Foundation of Connecticut, which has been pushing the concept for years.  Dorn said that for a number of reasons, not least because the federal health care law is loaded with financial incentives for states, it’s imperative that the state move forward this year.


For A Price, The Doctor Will See You Anytime, NPR - (March 8, 2011)

But it's too soon to break out the champagne, say experts. "Reports of reduced spending have to be taken with some skeptism until done in well-controlled environments," says Robert Berenson, a fellow at the Urban Institute, speaking generally of changes in the use of medical care, not of Qliance specifically. In fact, Qliance's own figures contain this qualifier: The reduction in ER use and other services is "based on best available internal data, (and) may not capture all non-primary care claims."


Some medical practices move to monthly membership fees for patients, Chicago Tribune - (March 8, 2011)

Some experts have more fundamental reservations about this approach. While agreeing that the current payment model for primary care doesn't work very well, "it doesn't make any sense" to provide primary care outside the health insurance system, says Robert Berenson, a fellow at the Urban Institute. "This is not going to work for a lot of patients who can't afford the out-of-pocket subscriptions," he says.


Doctors try new models to push health insurers asideWashington Post - (March 7, 2011)

Some experts have more fundamental reservations about this approach. While agreeing that the current payment model for primary care doesn't work very well, Robert Berenson, a fellow at the Urban Institute, says "it doesn't make any sense" to provide primary care outside the health insurance system. "This is not going to work for a lot of patients who can't afford the out-of-pocket subscriptions."


Hospital stays cost more in Northern California than Southern California, Los Angeles Times - (March 6, 2011)

"They are a very powerful hospital system that has proved very successful," said Dr. Robert Berenson, a fellow at the Urban Institute in Washington who has studied California's healthcare markets. "They are in a position to drive hard bargains. I don't think there are many hospital systems in the country that have that kind of market power."


As health costs soar, Mass. seeks solution, The Columbus Dispatch - (March 6, 2011)

Any meaningful reform would have to do two things at once, says health-care policy expert Robert Berenson, of the Urban Institute. It's important to move to a more cost-effective payment model, he says, but the savings won't get passed along to consumers unless the state restrains the fees doctors and hospitals are able to negotiate. “Everyone has a big stake in making this work,” Berenson adds. “If it doesn't, the whole thing could fall apart.”


Health reform discord still pervasive, Employee Benefit News - (March 3, 2011)

According to the Urban Institute, which conducted the research for the Robert Wood Johnson Foundation, a Washington-based research organization, a full implementation of the law would reduce the number of uninsured younger than 65 to 23.2 million (currently at 50.9 million).


Ariz. Medicaid Cuts Spur Debate Over Impact On ProvidersKaiser Health News - (March 2, 2011)

The study's lead author, Stephen Zuckerman, said few Arizona health care providers would feel a big impact from the proposed cuts because most Medicaid recipients are treated by a relatively small percentage of hospitals and doctors.

"Not all hospitals or health providers feel the impact equally," said Zuckerman, a senior fellow at the Urban Institute, a nonpartisan Washington research group.


Medicaid cost makes Ohio's budget ill, Politico - (March 2, 2011)

The Urban Institute estimates that, between 2014 and 2019, Ohio will spend between $830 million and $1.34 billion on Medicaid. At the federal level, in the first 10 years alone, it will cost over $2.7 trillion and add more than $823 billion to the national debt.


GOP Panel Claims Medicaid Costs of Health Law Are Double Previous Estimates, FoxNews.com - (March 1, 2011)

But the Urban Institute issued its own report on Tuesday estimating that 12 million newly eligible Medicaid enrollees would cost $54 billion nationally, of which the federal government would pay about $45 billion.

There were several reasons for the discrepancy in numbers. The GOP report calculated costs through 2023; the Urban Institute took only a one-year snapshot. The GOP report also looked at just the cost to states; the Urban Institute looked at total costs.

Urban Institute senior researcher Matt Buettgens said that if they used the same parameters as the GOP report, the estimate would probably line up more with the CBO estimate of $60 billion. However, Buettgens said the GOP report is probably factoring in administrative costs, as opposed to just the direct cost of health care, which would account for why the GOP number is so much higher.


Say Farewell to the Family Doctor, SmartMoney.com - (March 1, 2011)

Price increases also have the potential to bleed outward—affecting not only the patients of the absorbed doctor, but also the cost of health care citywide. That's because when hospitals sit down at the bargaining table with insurers, they're almost always able to negotiate higher payment rates for their big groups of doctors than a lone physician with little bargaining power. Fast-growing hospital systems, including Hospital Sisters and Bozeman Deaconess, say that their growth will eventually make care more efficient and bring costs back down, since they'll be able to cut back on unnecessary care and duplicate tests. But Robert Berenson, a fellow with the Urban Institute, a think tank, says the new relationship sets up a vicious cycle: Hospitals become emboldened to ask for 60 or 75 percent price increases one year, and then insurers have to step up premiums to cover costs. "Unless something major changes in how we pay for care," Berenson says, "this could be the Achilles' heel of our health care system."


Health reform law impact would vary by state: Analysis, Business Insurance(March 1, 2011)

The research conducted for the Robert Wood Johnson Foundation by the Urban Institute, a Washington-based research organization, estimates that 2011 implementation of the law would reduce the number of uninsured younger than 65 to 23.2 million from 50.9 million. Correspondingly, the uninsured rate would decline to 8.7% from 18.9%.


Republicans shift focus to Medicaid complaints, Washington Post - (March 1, 2011)

These figures do not appear to include an analysis of several potential sources of savings to states identified by researchers. A recent report by analysts at the Urban Institute calculated these savings could range from $40.6 billion to $131.9 billion between 2014 and 2019.  


Employers weigh next step in health care, Milwaukee Journal Sentinel - (February 19, 2011)

[Frakt expects the federal law to increase the number of people getting health insurance through an employer.]

Studies by Rand Health, part of Rand Corp., a public policy research institute, and the Urban Institute, a policy research institute, came to the same conclusion.


Handicapping a 'grand bargain', Washington Post, Ezra Klein’s blog - (February 17, 2011)

Medicaid: "Republicans seem to have settled on, at least as a talking points, instituting block grants to states for Medicaid," reports Politico. This is something George W. Bush proposed in 2004. Right now, the federal government, in partnership with the states, acts like any other insurer and pays the medical costs that members of Medicaid incur, and tries to control costs by negotiating better rates with providers and implementing various programs to make people healthier or manage disease. In a block-grant system, the federal government would stop paying those costs. Instead, it'd just give the states X amount of money, and if that sufficed, great, and if it didn't, too bad. As the Kaiser Family Foundation explains (pdf), "block grants limit federal spending to a predictable level that can be controlled without regard to actual costs or spending at the state level." The Urban Institute makes it clearer: "A block grant shifts financial risk from the federal government to the states." But even if Republicans can agree on this, Democrats won't go for it, so it's not likely to happen in the near term.


State's poor pose intricate challenge, Sacramento Bee - (February 13, 2011)

But California also pays its medical providers low rates. The state ranks 46th in the nation in payments to physicians serving Medicaid patients, according to a study by the Urban Institute and California Healthcare Foundation.


The Individual Mandate: Neither Essential Nor Enough, Health Affairs blog - (February 10, 2011)

A 2009 Urban Institute/Robert Wood Johnson study found that the success of Massachusetts health reform can be traced largely to factors other than its individual mandate – including automatic enrollment when existing government data demonstrates eligibility, participation by health care providers and community organizations in helping consumers to complete applications, and a massive public education and outreach campaign, including use of public figures like sports stars.

Romney tries to have it both ways, Boston Globe - (February 10, 2011)

The requirement was originally recommended by the Urban Institute, a Washington, D.C., think tank hired by the Blue Cross Blue Shield Foundation to develop a “roadmap to coverage’’ for Massachusetts. “Much to everyone’s astonishment,’’ Romney picked it up and promoted the concept that every citizen obtain health insurance, recalled Philip W. Johnston, who chairs the foundation. He said the late Senator Ted Kennedy went along with it “in order to get the bill done.’’

SC docs face rate cuts for Medicaid patients, Associated Press - The Charlotte Observer - (February 6, 2011)

South Carolina's reimbursement levels ranked 17th nationally in the Urban Institute's most recent state-to-state comparison, which used 2008 data. Many states have gradually cut rates since 2008, but when state health officials tried to do that, legislators passed laws barring cuts.

Experts offering alternatives to health care mandate, Minnesota Public Radio - (February 7, 2011)

Linda Blumberg of the Urban Institute says despite the alternatives, she still prefers the individual mandate. She says it would stabilize the insurance market and people's lives.

"We need to make sure that medical care is accessible and affordable for when individuals need it," Blumberg said. "And the most stable and financially viable way to do that is to make sure that close to everyone is in the pool all of the time."


Missing out on health, Los Angeles Times - (February 6, 2011)

It wasn't that there weren't enough eligible kids in the state. This happened, let's remember, during a year when unemployment in California peaked at 12%. Researchers at the Urban Institute estimated in October that the state was home to nearly 700,000 uninsured children who qualified for state or federal programs but hadn't been enrolled. So why couldn't the state meet its enrollment goals? Because California has a cumbersome system that acts as a roadblock to enrolling eligible children.


Crushed by Medicaid costs, states expand managed care, Stateline.org - (February 4, 2011)

In the past, states backed away from managed care solutions for people with disabilities or elderly people who required long-term care, says Stephen Zuckerman, health policy analyst with the Urban Institute. “They required more specialized care than people perceived managed care plans were prepared to provide.”

But now, with more experience behind them, states are starting to put their costliest patients into managed care. ”When you look at Medicaid spending, you have to look at those populations,” Zuckerman says.


Why Aren’t The Uninsured Protesting In The Streets Like The Egyptians?  Forbes, Science Business blog - (February 2, 2011)

In 2009, a staggering 51 million Americans from every walk of life and every corner of the nation had no health insurance. The Urban Institute estimates that 400 of them die each week due to lack of access to care. However, instead of pouring into the streets to protest when an activist judge calls the health reform law unconstitutional or conservative ideologues threaten to cut off funding, the uninsured leave the loudest push-back to (well-insured) political partisans.


Health Policy Brief: Medicaid & CHIP Enrollment, Health Affairs blog, - (January 31, 2011)

The same study, by Genevieve Kenney of the Urban Institute and co-authors, found that although a vast majority of parents wanted to enroll their uninsured children in either Medicaid or CHIP, their lack of familiarity with the eligibility requirements and the complicated application processes proved to be barriers for participation.  


Health benefits for members of Congress generous, Scripps Howard News Service - (January 27, 2011)

The health care options available to Congress have grown even more remote to many Americans buffeted by recession. Lost jobs and declining income swelled the number of those without some employment-based health insurance to 50 million from 45 million, according to the Urban Institute, a liberal-leaning think tank in Washington, D.C.


Setting up health insurance exchanges, states face big decisions, Stateline.org - (January 26, 2011)

“The art of the exchange is striking a balance between getting carriers to participate and providing consumers with the best competitive choices,” says health care policy analyst Linda Blumberg of The Urban Institute. “You won’t get that balance if you let all carriers in and charge anything they want.” Likewise, too many restrictions may force some insurance companies out of the exchange market. 


Remember the uninsured?, Washington Post, Ezra Klein’s blog - (January 19, 2011)

But that doesn't make the plight of the uninsured any less wrenching. The Urban Institute estimated that 22,000 people died in 2006 because they didn't have health-care insurance. John Ayanian, a professor of medicine and health-care policy at Harvard Medical School, testified before Congress on this issue. “Uninsured adults are 25 percent more likely to die prematurely than insured adults overall," he said, "and with serious conditions such as heart disease, diabetes or cancer, their risk of premature death can be 40 to 50 percent higher.” And none of that takes into account the unnecessary suffering and physical damage that flourishes in the absence of effective medical care. Nor does it speak to the economic devastation that illness unleashes on uninsured families.


New Scrutiny For Insurance Mandate After Repeal Vote, Kaiser Health News - (January 19, 2011)

Robert D. Reischauer, president of the Urban Institute:

The Democrats should stick with the policy that they and virtually every health care expert have said is the most effective way to cover the uninsured while holding down the growth of costs. All the other policies are distant second bests. I don't think there is an alternative strategy especially if the government is fiscally constrained. If you had money to throw at the problem, then you could bribe people to participate but we don't have the resources nor should they devote resources to something that can be effectively done through a regulation enforced with penalties.


Repeal And Replace -- But Replace With What? Kaiser Health News - (January 19, 2011)

You don't have to take my word for it. When John McCain embraced this idea as part of his 2008 presidential campaign, the Urban Institute's Linda Blumberg analyzed it and concluded that it would leave "many more people with health problems unable to purchase private coverage at any price … . The typical coverage would become less comprehensive as well, with benefit exclusions and limitations becoming the norm across the country." Other experts have reached similar conclusions.


States Brace for Medicaid Crisis With Reform Relief Years Away, WNYC.com  (NY public radio website) - (January 13, 2011)

John Holahan, director of Health Policy at the Urban Institute, said the next few years will be really tough ones for states in this between time. The federal government, in exchange for past supplemental Medicaid support, required states to not lower their eligibility level.

"Right now the states are sort of stuck," says Holahan. Dealing with the time between now and when the Obama reforms kick in "is a nasty problem," he concedes.


FAQ On ACOs: Accountable Care Organizations, Explained, Kaiser Health News - (January 13, 2011)

Hospitals, doctors and insurers are all vying to run ACOs. Kelly Devers, a senior fellow at the nonprofit Urban Institute, explains that the question was left purposely vague in order to be flexible. "We know there are a range of provider organizations" that could manage an ACO, "but we don't know which one is superior."

Some regions of the country, including parts of California, already have large multispecialty physician groups that may become an ACO on their own, likely by networking with neighboring hospitals. "A lot of health care organizations are going to dust off the existing structures they had in place" in the past, Devers says.


Md. should expand Medicaid now, Baltimore Sun - (January 13, 2011)

As noted in the article, experts agree that covering the uninsured reduces long-term costs. The Urban Institute predicts a 25 percent decline in uncompensated care by 2019 compared with more than a doubling of expenses without federal reform. We wouldn't see most of these savings, of course, until after 2014, when the federal government pays for covering low-income adults through Medicaid.


Wishful Thinking on Health Costs, The New York Times, Economix blog- (January 13, 2011)

Former CBO director Robert Reischauer, best known for his unwillingness to bend to the White House during the Clinton reform effort, supports the legislation as a crucial first step in long-term cost containment, and so too does former CBO director Alice Rivlin….


Record slowdown, bigger share, Modern Healthcare - (January 10, 2011)

That suggests pent-up demand for medical care—treatment delays that could be potentially harmful and costly—or more cost-conscious consumers who have opted to forgo unnecessary testing or procedures. “It's not just how much are we spending and how fast is it growing, but what are we getting for it,” said Stephen Zuckerman, a health economist at the Urban Institute, a nonpartisan, public policy not-for-profit.


Single payer is tried, tested; it’s Mass. plan that’s risky, Boston Globe - (January 9, 2011)

A 2009 Urban Institute survey of the evidence on global payment reform found that the concept would not be a game changer for cost control in the short run, but that further experiments would be welcome. Moreover, we know that fee-for-service is not causing our high and rising health care costs; two recent studies by the state both found that it is rising costs per service, not growing utilization of care, that are driving our costs.



6 states to watch on health reform, Politico - (January 3, 2011)

“Unless states move forward as fast and as hard as they can this year, they will be lost in 2014 when the bulk of health reform hits,” says Stan Dorn, a senior health policy researcher at the Urban Institute. “The pressure is just enormous on state policy makers.”

California – Under Republican Gov. Arnold Schwarzenegger, the Golden State established itself as a health reform leader by passing the first legislation in the country to authorize a health exchange under the federal law. A failed California Health Exchange, which opened in 1993 and shuttered five years ago, left the state “with a pool of people who were will poised to move forward very quickly,” says Dorn of the Urban Institute. “Now you have an incoming Democratic governor [Jerry Brown] who is a ‘small is beautiful’ Democrat. What he’s going to do on health reform, how he uses that pool of expertise, will be interesting to watch.”



Editorial: Return of the 'death panel'?,  Chicago Tribune - (December 30, 2010)

That doesn't always happen, of course. Many patients don't have these conversations with their doctors, says Dr. Robert Berenson of the Urban Institute.

In a 2009 Urban Institute study, Berenson and his co-authors suggested a raft of ways to pay for health care reform. They estimated that the government could save $90 billion over 10 years, not by denying care but by better managing end-of-life care. That means helping terminally ill patients avoid futile treatment and manage their pain once they choose to stop treatment. It also means focusing on comfort and emotional support, not on exhausting every option technology offers.



At The National Health Policy Conference, The Latest On ACOs, Health Affairs blog - (December 29, 2010)

Many provisions of the Affordable Care Act are designed to promote new health care models that will deliver better care more efficiently. At the 2011 National Health Policy Conference (NHPC), the Urban Institute’s Robert Berenson will lead a discussion of “accountable care organizations” (ACOs), one of the most important of these models. Panelists will discuss the eagerly awaited federal rules governing ACOs, which are expected to be issued early next year.

California misses chance for extra kids' health funding, The Sacramento Bee - (Dec. 29, 2010)

About 700,000 uninsured California children are eligible for state and federal programs but are not enrolled, according to the Urban Institute.


HHS Hands Out Bonuses for States That Stepped Up Medicaid, SCHIP Enrollment for Kids, Youth Today - (December 28, 2010)

The bonus offer has yet to draw in some of the states with the highest number, or highest percent, of uninsured children. About 40 percent of Medicaid/SCHIP-eligible, uninsured children live in three states (Florida, Texas and California), according to research by the Urban Institute. Of the ten states where 60 percent of eligible, uninsured children live, only Illinois and Ohio received bonuses.



Medicaid Bonuses to Reward States for Insuring More Children, New York Times - (December 27, 2010)

Because of expanded eligibility and simplified enrollment, the percentage of children without insurance has actually declined this decade, even as the percentage of uninsured adults has soared, according to a study by John Holahan, director of the Urban Institute Health Policy Center. He estimated that about 10 percent of children were uninsured in 2009, the lowest rate in more than a quarter-century. That compares with 23 percent of nonelderly adults.


Medicaid fraud crackdown to affect where seniors buy medical equipment, TCPalm (FL) - (December 25, 2010)

Policy wonks said the changes are sorely needed. Screening vendors, limiting the number allowed to bill the program, and letting market forces drive down prices will improve the system, predicted Dr. Robert Berenson, an Urban Institute fellow who writes about Medicare policy.

"This is one of the sectors in Medicare where some people suspect there's fraudulent behavior going on - billings for people who don't exist, somebody stealing somebody's provider number," Berenson said. "We've got to do something if we are going to be serious about medical costs."


Editorial: Mandate prevents health 'free riders', Star Tribune - (December 23, 2010)

Without the mandate, taxpayers and health consumers would continue footing the bill for the uninsured, concluded researchers in a paper from the respected Robert Wood Johnson Foundation and the Urban Institute.


Mandate key to gains in coverage: study, Modern Healthcare - (December 22, 2010)

A report authored by the Urban Institute and funded by the Robert Wood Johnson Foundation (PDF) concluded that without the mandate, the benefits of insurance expansion would essentially be limited to the people covered under the expanded criteria of Medicaid. The number of people who would have employer-sponsored coverage would slightly decline without the mandate, according to the study.


New Medicare rules on medical supplies aim to save, Palm Beach Post - (December 20, 2010)

But most changes are invisible to consumers. They bolster the health system by adding doctors and streamlining costs. "We're still in the transition phase to big things in 2014," says Stephen Zuckerman, a health economist at the Urban Institute, which does nonpartisan policy research. "Some of these will work, some won't."

Also, doctors will be paid higher incentives to stay in Medicare programs. "This should help if you're having problems finding primary care," says Zuckerman. "It's an increasing problem with a graying population."



OVERNIGHT HEALTH: Feds propose reviews of insurance rate hikes, The Hill - (December 21, 2010)

Dropping mandate drops coverage: A new Robert Wood Johnson Foundation/Urban Institute study says that keeping the individual mandate will cut the number of uninsured Americans in half, but dropping the mandate while keeping the reform law will only reduce the rate of uninsured by 20 percent.  


5 health reform goodies for 2011, Bankrate.com - (December 21, 2010)

But most changes are invisible to consumers. They bolster the health system by adding doctors and streamlining costs. "We're still in the transition phase to big things in 2014," says Stephen Zuckerman, a health economist at the Urban Institute, which does nonpartisan policy research. "Some of these will work, some won't."

Also, doctors will be paid higher incentives to stay in Medicare programs. "This should help if you're having problems finding primary care," says Zuckerman. "It's an increasing problem with a graying population."


New Medicare rules on medical supplies aim to save, The Palm Beach Post - (December 20, 2010)

Policy wonks said the changes are sorely needed. Screening vendors, limiting the number allowed to bill the program, and letting market forces drive down prices will improve the system, predicted Dr. Robert Berenson, an Urban Institute fellow who writes about Medicare policy.

"This is one of the sectors in Medicare where some people suspect there's fraudulent behavior going on - billings for people who don't exist, somebody stealing somebody's provider number," Berenson said. "We've got to do something if we are going to be serious about medical costs."


Degrees of accountability: Everyone's looking to gain an edge in the upcoming regs governing ACOs, Modern Healthcare - (December 20, 2010)

Adding financial risk, however, also comes with its own potential hazards for patients, warned Robert Berenson, an institute fellow with the Urban Institute. Berenson is vice chairman MedPAC but stressed that he spoke for himself and not the commission.

Berenson argued in an interview that quality measures, as proposed, won't be enough to ensure that financial incentives to curb spending don't compromise patient care. “Others think performance is all we need to know,” said Berenson.


Editorial: Health care reform law has legal precedents, Mercury News - (December 15, 2010)

Congress already has the authority to impose a payroll tax on employers in order to buy insurance for people as they get older. It's called Medicare.

Mandating individuals to purchase health insurance or face a penalty differs little from forcing companies to meet certain standards or face a significant fine.

And it works, as Massachusetts' experiment with individual mandates is proving. A new survey by the Urban Institute shows that the number of uninsured in Massachusetts has dropped from between 6 and 11 percent to less than 3 percent since the state adopted its individual mandate, and just 0.2 percent of children are uninsured.


What works in the deficit reform proposals, Washington Post - (November 28, 2010)

ROBERT REISCHAUER
President of the Urban Institute; director of the Congressional Budget Office from 1989 to 1995

As both the Bowles-Simpson and Domenici-Rivlin deficit-reduction proposals have suggested, it's time to phase out the special tax treatment afforded employer-paid health premiums and even the tax-sheltered premiums paid by employees through mechanisms such as flexible spending accounts.


Norton, Humana involved in pilot program emphasizing wellness, preventive care, Courier Journal (Louisville, Ky.) - (Nov. 21, 2010)

A 2009 report by the Urban Institute and the Robert Wood Johnson Foundation defined an accountable care organization as “a related set of providers…that can be held accountable for the cost and quality of care delivered to a defined population.”


Health plan would save Conn. at least $174 million, consultants say, New Haven Register - (Nov. 19, 2010)

As important, the plan aims to lower the cost of health care delivery and estimates are that SustiNet would slow the annual growth rate of these costs by 1 percent, although consultant Stan Dorn of the Urban Institute thinks it is closer to about 2 percent.


Connecticut's Public Health Plan, SustiNet, Could Save Taxpayers $200 Million A Year By 2017, Hartford Courant - (Nov. 19, 2010)

And, said Stan Dorn, senior policy fellow at the Urban Institute, who prepared the report, some researchers believe the same ideas SustiNet intends to impelement could cut the growth rate by two percentage points, not one.

"We were trying to err on the side of being conservative," Dorn said.


Charting SustiNet's course after federal reform, Connecticut Mirror - (November 18, 2010)

"The state budget situation would improve," said Stan Dorn, a senior fellow at the Urban Institute and a consultant to the SustiNet board who presented the analysis.

Getting coverage through SustiNet would cost those adults less than purchasing coverage on the exchange, even with the subsidies, Dorn said. The federal government would pay the costs of covering that group, saving the state between $47 million and $50 million, he said. And it would make the SustiNet coverage pool larger, giving it more leverage.


Payment Reform Proposals Take Shape, The Hospitalist - (Nov. 17, 2010)

“I think it’s not at all clear that there are very many conditions amenable to bundling,” says Robert Berenson, MD, a senior fellow in the Urban Institute’s Health Policy Center and vice chair of the Medicare Payment Advisory Commission (MedPAC). “Once you get down to the cases that everybody agrees lend themselves to bundling, it may be you're dealing with too small a percentage of spending to really want to go this route."



2014 Question Looms: Could Medicaid Recipients Buy Insurance On Exchanges?
Kaiser Health News - (Nov 15, 2010)

But Medicaid can offer generous benefits, such as extensive coverage for kids with medical problems, and many states provide eyeglasses and transportation. Robert Reischauer, president of the Urban Institute and a former director of the Congressional Budget Office, predicts that some of that would be lost in the switch to private insurance.


Number of Sandusky County uninsured doubled since 2005, The News-Messenger (Fremont, Ohio) - (November 12, 2010)

According to 2008 research by The Urban Institute, uninsured people have a 10 to 25 percent increased risk of dying early and 22,000 deaths in the United States were linked to the absence of health insurance. 


Few use mobile phones to access health infoAmerican Medical News, (Nov. 8, 2010)

An analysis of the March 2009 U.S. Census Current Population Survey by the Urban Institute and Kaiser Commission on Medicaid and the Uninsured found that 32% of the nonelderly uninsured population is Hispanic, and 32% of Hispanics are at risk of being uninsured; 15% of the uninsured are blacks and 21% of the black population is at risk of being uninsured. Non-Hispanic whites make up 46% of the uninsured, and 13% are at risk of being uninsured.

New health law is a prescription for distortion, Bucks County Courier Times (Pa.) - (October 28, 2010) 

The reduced rate increases for providers should not hurt access for Medicare beneficiaries, though keeping them longer than several years could lead to differences in private and Medicare rates, the Medicare Payment Advisory Commission and the Congressional Budget Office have suggested. It's also too early to know the impact other provisions that introduce new payment and delivery system reforms will have on access to care, according to the Urban Institute.


Little-Known AMA Group Has Big Influence On Medicare Payments, Kaiser Health News - (October 27, 2010)

Dr. Robert Berenson, a physician, health policy expert, and fellow at the Urban Institute, said the time it takes doctors to perform medical procedures usually falls over time. Years after tackling what was once an innovative surgery, for example, a surgeon can often perform the same procedure in a fraction of the time. But that efficiency rarely leads to a cut in Medicare value.

Berenson represented the American College of Physicians on the RUC from 1992 to 1994. He left in frustration. “Every specialty society requested up values and never came in requesting down values,” Berenson said. “I became the protagonist saying this system does not work. I made a motion to seek medical directors of managed care plans to help us identify overvalued services. I was roundly jeered.”
 
Since leaving the RUC, Berenson has become a proponent of using objective measures to value physician procedures. “If we are spending $70 billion on physician payments, surely we can find a way to rely on real data to inform the values rather than relying on self-interested estimates,” Berenson said.


Physician Panel Prescribes the Fees Paid by Medicare, The Wall Street Journal - (October 26, 2010) 

The imbalance has stoked fears of a shortage of primary-care doctors, as well as a relative shortfall in the amount of primary-care services patients receive, compared to specialist procedures. "The fee schedule we use to pay physicians in Medicare leads to the wrong mix of services and the wrong mix of doctors," says Robert Berenson, vice chair of MedPAC and a researcher at the Urban Institute. "It produces increased spending for Medicare and for the rest of the system."


 

Treasury Geithner Swears In Social Security, Medicare Trustees,Wall Street Journal - (October 26, 2010)

Treasury Secretary Timothy Geithner on Tuesday swore in two trustees for the Social Security and Medicare funds.

Robert Reischauer and Charles Blahous were nominated by President Barack Obama to fill the positions.

Blahous is a senior research fellow with the New America Foundation's Fiscal Policy Program. Reischauer is president of the Urban Institute.


The price problem that health-care reform failed to cure, Washington Post - (October 24, 2010)

But the Dartmouth rankings, and the concept they supported, did a "disservice" to the debate, said Robert Berenson of the Urban Institute. For one thing, he and others say, the figures overstate regional differences in Medicare spending, which shrink when socioeconomic factors are taken into account. Second, rates of Medicare spending are not necessarily representative of health-care spending for people under 65. Some of the places that do well in the Dartmouth rankings charge high prices for non-Medicare patients -- and were, not surprisingly, among those pushing hardest against a public option.


When Obama Appears on ‘Health Care Mythbusters’, Forbes, Merrill Matthews’ blog - (October 20 2010)

So they go to health care actuaries who point out that there is a clear difference between what the uninsured spend on health care vs. the insured.  In 2008 the insured spent $3,915 per person compared to $1,686 for the uninsured—that’s 43% of what the insured spent—according to an Urban Institute report.


Health care law fact check: Medicaid, health spending, and abortion myths and missteps, Washington Post - (October 18, 2010)

In a study for the Kaiser Family Foundation, the Urban Institute estimated that, not counting offsetting savings, between 2014 and 2019, total state spending on Medicaid will increase by $22 billion, 1.4 percent more than they would have spent in the absence of the new law. But that masks considerable differences across states. Four will spend less than they would have otherwise. Nine will increase their spending by 3 or even 4 percent. While the Urban Institute's analysis tracks with Congressional Budget Office estimates, several states have come up with substantially higher projections.

But the Obama administration, citing estimates from the Urban Institute, the human resources consulting company Mercer and others, says the law isn't responsible for any increase greater than 1 to 2 percent. That assertion is supported by one of the first major surveys to forecast what might happen next year. Hewitt, a consulting firm, said that large companies' premiums are expected to rise 8.8 percent in 2011 - 1 to 2 percent due to the law, the rest due to higher medical costs.


John Raese says health care law forces patients to go to a bureaucrat before a doctor, PolitiFact.com - (October 18, 2010)

"This is purely ridiculous," said Linda Blumberg, a senior fellow at the nonpartisan Urban Institute. "Nothing changes in that respect relative to today’s system."


Health care law fact check: Medicaid, health spending, and abortion myths and missteps,Washington Post - (October 18, 2010)

In a study for the Kaiser Family Foundation, the Urban Institute estimated that, not counting offsetting savings, between 2014 and 2019, total state spending on Medicaid will increase by $22 billion, 1.4 percent more than they would have spent in the absence of the new law. But that masks considerable differences across states. Four will spend less than they would have otherwise. Nine will increase their spending by 3 or even 4 percent.

While the Urban Institute's analysis tracks with Congressional Budget Office estimates, several states have come up with substantially higher projections.  


New Jersey's Efforts in Insuring Children Look to Next Step, NJspotlight.com - (October 5, 2010)

The new report -- entitled “Uninsured Children: Who Are They and Where Do They Live?” -- provides estimates for all 50 states, along with census regions, and shows how the uninsured continue to reside in low-income and/or high-immigrant populations. New Jersey has plenty of both.

Published by the Robert Wood Johnson Foundation and the Urban Institute, the report shows the disparities in New Jersey -- along some predictable and not-so-predictable lines.


Rand Paul's Medicare Shorthand, Time, Swampland blog - (October 11, 2010)

This system is not perfectly progressive. As the Urban Institute noted in a July report on Medicare and the ACA, depending on which bracket seniors fall into, the percentage of income they will spend on Part B premiums varies. The Medicare income adjustments are like giant steps spaced far apart, compared to the gradual ramp of federal subsidies to help non-seniors buy insurance beginning in 2014. But the point is that existing Medicare and the ACA adjust premiums to account for income.

Many physicians see Medicaid pay cut as enrollment rises, American Medical News - (October 11, 2010)

The physician pay cuts are part of a reversal of Medicaid trends. As recently as 2007, no states planned to reduce program fees for doctors. Two dozen states adopted Medicaid pay hikes that year.

However, Medicaid pay remained relatively low, even before the recession. It averaged 72% of Medicare rates in 2008 for the same services, according to an article by Urban Institute researchers published online in Health Affairs in April 2009.


How will healthcare reform affect L.A.? Not much, KPCC (Southern California public radio) - (October 6, 2010)

Health Reform Profiles: A 6-Month Check-Up, PBS, The Newshour - (October 5, 2010)

"When people have decent coverage -- which this is, it's not great but it's decent -- we're not making big changes to affordability, because it costs money and there's not the political will to do it," Linda Blumberg, a health policy researcher at the Urban Institute, said last year.


Medicaid panel to study access to care, quality, American Medical News - (October 4, 2010)

One of the difficulties MACPAC faces is figuring out how well states are handling Medicaid and CHIP enrollees, said Urban Institute Senior Fellow Genevieve Kenney, who gave a presentation to MACPAC on gaps in knowledge about Medicaid. "We don't know much about variation in access to care across states."


Selling Insurance Across State Lines: Still A Partisan Fight, Kaiser Health News - (September 30, 2010)

That would "undermine insurance regulation in states doing serious regulation," said Linda Blumberg, a senior fellow at the Urban Institute's Health Policy Center.  "It would be destructive to those state efforts."

Setting up a compact would be complex since states would likely have to settle a number of questions about regulation and consumer safeguards, said Blumberg. Because of those types of bureaucratic issues and because many of the concerns about getting adequate health coverage are alleviated by the new federal law, she said, "I don't think much of this is going to happen."


Reversing a hidden epidemic with a new model of care, The Hill, Congress blog - (September 27, 2010)

It’s estimated that for every 100 high-risk adults who participate, fifteen cases of diabetes and $91,400 in health care costs are avoided. According to the Urban Institute, implementing community-based diabetes intervention programs through the Y nationwide could save $191 billion over the next ten years.


About Your Premiums, New York Times - (September 24, 2010)

The Department of Health and Human Services estimates that the average premium increase to pay for the new benefits should be about 1 percent to 2 percent, roughly consistent with an independent evaluation by the Urban Institute. If those estimates are optimistic, they are unlikely to be off by much. A Wall Street Journal analysis found insurers in various states seeking increases of 1 percent to 9 percent to pay for the new requirements and often even more to cover rising medical costs.


Insurance provision for young adults goes into effect, The Virginian-Pilot - (September 23, 2010)

About 30 percent of young adults between 19 and 24 held no insurance in 2008, according to an Urban Institute analysis of U.S. census data.


Delaware health: Reform's consumer protections beginTurning away sick kids now illegal, The News Journal - (September 23, 2010)

Linda Blumberg, a health policy expert at the liberal Urban Institute, said the protections taking effect today are important, particularly for ill Americans running up against coverage limits, or those who have been dropped by their health plans. But Blumberg cautioned that they won't be as broadly felt as provisions that take effect in 2014, such as the "individual mandate" that everyone carry insurance.

"I think that these are pieces that are going to impact certain people very significantly," Blumberg said. "They are provisions that are very popular and I think people are going to appreciate them. But they are interim types of reforms. These are not comprehensive reforms that are going to make people completely comfortable that they have secure, affordable health insurance."


Health consumers to start feeling effects, USA Today - (September 22, 2010)

"It's really putting in place long overdue consumer protections," Health Secretary Kathleen Sebelius said in an interview with USA TODAY. "It's getting rid of some of the worst rules of the industry that prevented people from getting covered at all or, at a time they needed coverage the most, limited the coverage they had."

She said analyses of the law's impact by various groups — including HHS, the Urban Institute and the Pennsylvania insurer Highmark — estimate a 1% to 2% impact on premiums.


GOP Plan To Change Or Repeal Health Law Could Bring New Complications, Kaiser Health News - (September 20, 2010)

A major problem with the defunding strategy is that since so much of the bill is inter-related, trying to dismantle it piecemeal could lead to unintended consequences. The GOP could also find itself with more than it bargained for, says Reischauer.

While the individual mandate is unpopular, "you can't pull it out of the law without all sorts of other elements falling apart," Reischauer says. And scrapping the mandate, which requires most people to have coverage or pay a penalty, would anger health insurers -- a core GOP constituency.


Threat from Sebelius defies economic reality, Kansas City Star - (September 18, 2010)

In her letter, Sebelius asserted that premium increases should be minimal, citing administration estimates and the work of “some” industry and academic experts. The Urban Institute, she said, projected rate increases at 1 to 2 percent.


50 Million Uninsured: Will That Change Minds? AOL News - (September 16, 2010)

"This is a very significant worsening of the situation," said Linda Blumberg, a health policy expert at the nonpartisan Urban Institute. "These numbers strongly support the need for comprehensive health care reform. They demonstrate that in bad economic times in particular we have to make sure there is financial assistance for those at risk of losing their private health insurance."


Medicaid expert says state's report flawed, Lincoln Journal Star, (September 15, 2010)

Ku said much lower estimates offered by the Urban Institute as part of a Kaiser Foundation report are more reliable.

Medicaid expansion would cost the state $106 million to $155 million over a six-year period, under the Urban Institute estimate.

In addition, the state will get $2.34 billion to $2.73 billion in new federal matching funds during those six years, the Urban Institute says."


Florida Hospital, United Healthcare agree to 4-year contract, Orlando Sentinel  - (September 15, 2010)

Although hospitals and insurers sometimes squawk about the rate increases, the process "works quite successfully," said Robert Berenson, a health-care expert at the Urban Institute.


Mass. has fewest uninsured children,White Coat notes blog, Boston Globe - (September 15, 2010)

Statewide, 1.7 percent of children are uninsured, compared to 9.3 percent of children nationwide, the report from the Robert Wood Johnson Foundation said, based on data from 2008 analyzed by researchers at the Urban Institute. The national rate is the lowest in more than 20 years, the report says.."


Health Insurers Seeking Rate Hikes Of More Than 20 Percent In Connecticut, Hartford Courant - (September 15, 2010)

"We've done estimates," Larsen said in an interview. "Outside groups have done estimates, including The Urban Institute and Mercer, and the credible estimates come in the 1 [percent] to 2 percent range for the impact of the health care reform provisions."


Florida in top 3 for kids without health insurance, Orlando Business Journal - (September 10, 2010)

Published Sept. 3 in the organization’s Health Affairs, the study funded by the Urban Institute estimated about 7.3 million U.S. children were uninsured, according to 2008 data.


Poor economy, better outreach means more kids enrolled in KidCare, St. Petersburg Times - (September 13, 2010)

A recent report by the Urban Institute, a nonpartisan think tank, found that Florida was below average in the percentage of eligible kids — just 69.8 percent — enrolled in children's Medicaid or SCHIP.

Health Care Reform: Employees Face Greater Cost-Sharing, HealthDay.com - (September 9, 2010)

Employer-sponsored health plans cover 159 million people, or 52 percent, of all Americans, according to an analysis by the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute.


Our views: Children at risk: Brevard agencies, lawmakers should heed call on KidCare health insurance, Florida Today - (September 9, 2010)

Yet more than 700,000, or 16.7 percent of Florida children, lack insurance coverage, says a report released Friday by the Washington, D.C.-based Urban Institute.


Medical programs missing millions of kids: report, Reuters - (September 8, 2010)

Thirty-nine percent (1.8) million of eligible uninsured children live in just three states -- California, Texas and Florida, the report by the Washington-based Urban Institute Health Policy Center said. Sixty-one percent (2.9 million) of uninsured children live in 10 states, the report said.

"This new data will help us to focus our efforts and our grant funding where they are most needed," U.S. Secretary of Health and Human Services Kathleen Sebelius said in a statement. "We now have a much better sense of where most uninsured children live, and which communities may need more help."


700,000 Calif. Kids Eligible For State Insurance, Not Enrolled, KPBS (San Diego Public Radio) - (September 8, 2010)

California — A study by the Urban Institute shows some 700,000 California children who are eligible for state paid health programs are not enrolled. That's a third of the state’s 1.5 million uninsured children.


Katrina's legacy: Rethinking medical disaster planning, American Medical News - (September 6, 2010)

Hospitals in New Orleans have made many changes in response to Katrina, said Kathy A. Hebert, MD, MPH, who co-wrote a July 2006 Urban Institute report on the challenges that faced hospitals and other custodial institutions during and after the hurricane.


Push to enroll uninsured kids in health coverage under way in California, Sacramento Bee - (September 5, 2010)

The tally of 700,000 who are eligible for Medi-Cal and Healthy Families comes from a report released Friday by the Urban Institute, a health policy think tank.


Medicaid, CHIP participation second-lowest in Utah, The Money Times - (September 4, 2010)

A report by the Urban Institute established that in 2008 alone, nearly 7 million children in the US were uninsured and 5 million out of these were still entitled for low-income health insurance programs that were funded by the government.


Programs help children get health insurance, The State (Columbia, SC) - (September 4, 2010)

“As long as any child in America is without health insurance, we shouldn’t be satisfied,” Sebelius said during a webcast to discuss the Connecting Kids to Coverage Challenge. The webcast coincided with the release of a report by Urban Institute.


Utah ranks 50th in having kids insured, Deseret News - (September 3, 2010)

Utah ranks 50th in the nation when it comes to getting children into health insurance coverage programs, according to an Urban Institute report released Friday.

The report's findings were derived from 2008 Census data for all 50 states and the District of Columbia. They do not reflect the large increase in enrollment that has materialized since the economic downturn, a news release said.

The report also found wide disparity in the percentage of uninsured kids between counties and neighborhoods. For example, in Salt Lake City, the uninsured rate was 27.6 percent in 2008, while in neighboring Davis County, it was just 5.8 percent.


Obama administration says Texas must boost enrollment in CHIP and Medicaid, Dallas Morning News - (September 3, 2010)

The Obama administration today ballyhooed a new Urban Institute report that suggests a path to enrolling 5 million kids in government-sponsored health insurance who are eligible but not signed up. The report says increasing the number of Texas kids on Medicaid and CHIP is "critical" to reaching this national goal. 


Participation In Children's Health Insurance Program Varies Widely Across Country, Kaiser Health News - (September 3, 2010) 

A new study published today in Health Affairs shows that 39 percent of the uninsured but eligible kids live in three states: California, Texas and Florida. Another 22 percent live in Georgia, New York, Arizona, Illinois, Ohio, Pennsylvania and North Carolina. That's not a big surprise, because those states have more than half of all children in the country, according to the researchers at the Urban Institute, a non-partisan think tank in Washington.

Some of the poorest states had some of the highest participation rates. These included: Louisiana (88.5 percent), Arkansas (88 percent) and West Virginia (89 percent). "This shows that the highest participation rates can be achieved among a wide variety of circumstances," said Genevieve Kenney, the lead researcher on the study and senior fellow at the Urban Institute.


U.S. medical programs missing millions of kids -report, Reuters, (September 3, 2010)

Thirty-nine percent of eligible uninsured children live in just three states -- California, Texas and Florida, the report by the Washington-based Urban Institute Health Policy Center said. It added that more than half of the nation's children live in these states.


New Medicaid Enrollees Likely to Be Healthier Than Current Ones: Study, Wall Street Journal, Health blog - (August 31, 2010)

According to a new analysis by the Urban Institute, conducted for the Robert Wood Johnson Foundation, the currently uninsured and privately insured adults in that population are, on average, healthier than the adults now enrolled in the program. That suggests that people who enroll in Medicaid under health-care overhaul aren’t likely to be as expensive as current enrollees, the researchers write.."


D.C. In Front Of the Health Reform Curve, Officials Say, Kaiser Health News - (August 24, 2010)

But such comparisons involving the District and states are often problematic because the former has a smaller population than most states and is an entirely urban area. The District heavy relies on public programs to provide insurance to poor and disadvantaged residents. More D.C. residents receive public coverage -- including through Medicare, Medicaid and the Alliance -- than other areas in the country and the city government picks up a large portion of that cost, according to the Urban Institute. Approximately 32.8 percent of D.C. residents receive public coverage. Another 55 percent receive employer coverage and 6 percent access it through individually purchased plans and military, veteran and student health programs, according to the Urban Institute's 2009 DC Health Insurance Survey.."


Viewpoint: Health care bill's passage provides new day for America's children, MLive.com - (August 21, 2010)

Governors have raised concerns about new financial burdens that will be imposed on states with the Medicaid expansion included in ACA. But a new Urban Institute study finds that the vast majority of the costs will be borne by the federal government, enabling states to save money as a result. According to the study, the federal government will pay an average of 95.4 percent of the $465 billion it will cost to expand Medicaid between 2014 and 2019."


What Hospital Consolidation Means For The Cost Of An MRIKaiser Health News - (August 20, 2010)

This issue — largely left out of the health care reform debate — is gaining attention as the Federal Trade Commission continues to pursue collusion and monopoly cases, recently winning one in Maine after saying doctors colluded in merging two cardiology practices. "The federal Patient Protection and Affordable Care Act is looking for $500 billion in savings over the next decade to help pay for extending coverage to 32 million uninsured Americans. Yet it doesn't address the problem of market concentration — and may make it worse, said Robert Berenson, a physician and policy analyst at the Urban Institute in Washington D.C." Berenson and other health care experts say incentives in the new legislation for hospitals to coordinate care "could backfire by strengthening providers' bargaining leverage" (Waldman, 8/20).."


Why Baby Costs Less Down the Road in Silicon Valley, Bloomberg - (August 20, 2010)

The federal Patient Protection and Affordable Care Act is looking for $500 billion in savings over the next decade to help pay for extending coverage to 32 million uninsured Americans. Yet it doesn’t address the problem of market concentration -- and may make it worse, said Robert Berenson, a physician and policy analyst at the Urban Institute in Washington D.C.

The “unchecked” clout of hospital and physician groups in California is a “cautionary tale for national health reform,” Berenson said in a February article in the journal Health Affairs. He warned that incentives in the new legislation to improve treatment by promoting doctor-hospital alliances -- called “accountable care organizations” -- could backfire by strengthening providers’ bargaining leverage.



Healthways to manage chronic care for military, The Tennessean (August 19, 2010)

The Medicare experiment was "the broadest trial of this approach, and it failed," said Robert Berenson, a health-care analyst at the Washington-based Urban Institute and vice chairman of the Medicare Payment Advisory Commission.

"There's really no good evidence that disease management really does save money, even if the Defense Department is doing it," Berenson said.


End to COBRA subsidy means higher health insurance billsUSA Today - (August 18, 2010) 

The political problems go beyond budgetary issues. "There is a huge backlash," says Randy Bovbjerg, a health policy expert at the Urban Institute, a Washington think tank. While the COBRA subsidy was helpful to those who qualified, most of the unemployed were not eligible, he says. They did not work for a large company that provided benefits before being laid off, or they lost their job before the subsidies began. Employers with 20 or more employees are required to offer COBRA under federal law. Most states have laws that also include smaller employers. "People are mad, and people see the recovery only helping the big companies, banks and high earners."



Will the health reform law slow spending?  Modern Healthcare - (August 16, 2010)

A newly published paper by the Urban Institute says the Independent Payment Advisory Board, with the power to dictate to Congress spending targets for Medicare, may be one of the most important cost-containment tools to come out of the health reform law.

As Stephen Zuckerman, a senior fellow for the public policy not-for-profit organization, explains, the Patient Protection and Affordable Care Act gives Congress leeway on how to achieve the advisory board’s recommended savings—but they must achieve the savings. “Congress would not have the ability to ignore the IPAB recommendations in the interest of protecting provider payments,” he says.


A Prescription for Ruin, Newsweek - (August 13, 2010)

The hope is that this frees Congress to permit cuts by making it easier for them to dodge the blame. “Putting the knife in someone else’s hand will be a relief,” says Robert Reischauer, director of the Urban Institute and a former director of the Congressional Budget Office. “It will allow Congress to rant against the cuts without actually stopping them.”

“I think that’s dead right,” says Reischauer. “And when the political system is willing to assume those responsibilities, they should get them back.” But in recent years, Congress has been feckless in the face of Medicare’s spending. Repeal IPAB and you’ve restored the status quo on Medicare. That status quo was leading to federal bankruptcy. 


From Florida To Oregon, Medicare Advantage's Benefits – And Cuts – Vary, Kaiser Health News - (August 6, 2010)

Robert A. Berenson, a researcher at the Urban Institute, said that “paying (Medicare Advantage plans) 95 percent leaves plenty of room for benefit and profits.” That’s because insurers can use their clout to negotiate better deals from doctors and hospitals, and direct patients to the least expensive care, he said.


Dewhurst: New federal health care law will bust Texas' budgetDallas Morning News - (July 28, 2010)

The Kaiser Family Foundation, working with the Urban Institute, estimates that adding 1.8 million adults to Medicaid will cost Texas $2.6 million between the years 2014 and 2019, because the federal government will pick up most of the cost.


Letter: The benefits of Massachusetts' health-care systemWashington Post - (July 24, 2010)


Sparks Says Gambling Taxes Will Stabilize Medicaid in Ala. - Truth Rating: 3 out of 5,  Anniston (Ala.) Star - (July 23, 2010)

A 1997 study conducted by the Urban Institute found Mississippi’s federal Medicaid matching rate to be the highest in the country at 77 percent.



The Massachusetts plan is working -- but the American health-care system is not, Washingtonpost.com, Ezra Klein’s blog - (July 19, 2010)

The Massachusetts reforms, unfortunately, were not designed to deal with cost. They weren't even designed to improve the delivery system. There was no excise tax, no independent commission to fast-track cost controls, no efforts to generate evidence for comparative effectiveness reviews or seed the system with medical records or spark a shift toward medical homes or accountable care organizations. "The initiative was to expand coverage and that still is going very well," says Sharon Long, who is studying the reforms for the Urban Institute. "They were very successful early on and they've managed to maintain that success despite the recession. The challenge is the cost issue, which they did not tackle in the initial reform."

 

Debating The Lessons Of Massachusetts, Health Affairs Blog - (July 19, 2010)

What does the Massachusetts experience tell us about the prospects for success of national health reform? That’s the subject of an ongoing debate that relies heavily on research published in Health Affairs by Urban Institute researchers.


The Bum Rap on Mass. Health Reform,   The New Republic, Jonathan Cohn’s blog - (July 19, 2010)

According to a study that two Urban Institute researchers published this spring, the number of working-age adults reporting that they skipped care because of high costs fell from 17 percent to 11 percent in the first two years after the law took effect. The gap was even more dramatic among those eligible for subsidized insurance through the Connector--that is, people making less than three times the poverty line, or around $66,000 per year for a family of four. Among those people, the proportion skipping care because of cost fell from 27 percent to 17 percent. And that’s despite a rough leveling-off in the second year, most likely due to the fact that the recession meant lots of people were out of work and counting their pennies. When the economy rebounds, the number should decline even more.


As Massachusetts health 'reform' goes, so could go Obamacare,   The Washington Post - (July 19, 2010)

Like Obama, Massachusetts requires most individuals to have health insurance (the "individual mandate"). To aid middle-class families too well-off to qualify for Medicaid -- government insurance for the poor -- the state subsidizes insurance for people with incomes up to three times the federal poverty line (about $66,000 in 2008 for a family of four). Together, the mandate and subsidies have raised insurance coverage from 87.5 percent of the non-elderly population in 2006 to 95.2 percent in the fall of 2009, report Sharon Long and Karen Stockley of the Urban Institute.

People have more access to treatment, though changes are small. In 2006, 87 percent of the non-elderly had a "usual source of care," presumably a doctor or clinic, Long and Stockley note in the journal Health Affairs. By 2009, that was 89.9 percent. In 2006, 70.9 percent received "preventive care"; in 2009, that was 77.7 percent. Out-of-pocket costs were less burdensome.


Urban Institute touts healthcare reform’s benefits for hospitals and physicians, The Hill, Healthwatch blog - (July 19, 2010)

Insurance coverage expansions under the healthcare reform law will enable hospitals to improve the quality of care while padding physicians’ bottom lines, the liberal Urban Institute concludes in two new reports.The study authors, Robert Berenson and Stephen Zuckerman, write that hospitals stand to gain about $40 billion in new revenues by 2019 thanks to the 30 million or so newly insured individuals. After factoring cuts in payments for uncompensated care and other reductions, “most hospitals won’t see much difference to their bottom line” — especially since hospitals fall outside the purview of a new payment advisory panel’s budget cutting jurisdiction until 2019.As for physicians, the authors write, they will benefit from the coverage expansions and increased Medicaid payments for primary care services in 2013 and 2014.


U.S. Health Reform Starts to Take HoldHealthDay - (July 16, 2010)

For those who had tried to purchase individual insurance until now, there were "huge issues with trying to find coverage for people who have health problems, and that is absolutely true for children," said economist Genevieve M. Kenney, a senior fellow at the Urban Institute in Washington, D.C. "Yes, maybe you would be able to get a policy but it might exclude the very health problem that the child suffers from."


New Medicaid patients could test state's physician network, Connecticut Mirror - (July 16, 2010)

The analysis prepared by The Urban Institute, a Washington, D.C.-based, nonpartisan economic and social policy research group, estimated Connecticut's annual Medicaid caseload would grow - solely due to new enrollees eligible because of this legislation - between 114,083 and 154,664.


Healthcare reform: Few changes for seniors , UPI - (July 16, 2010)

Researchers at the Urban Institute said under the Patient Protection and Affordable Care Act the higher income-related Medicare Part B premiums -- for those with individual income of $85,000 and $170,000 for a couple are frozen from 2011-2019, resulting in more people in this income range each year subject to higher premiums providing an extra $25 billion in revenue for Medicare.


Alternative to HMOs coordinates treatment delivery, Akron Beacon Journal - (July 5, 2010)

Under the law, patients in traditional Medicare will be assigned to an ACO if their normal provider participates, said Dr. Robert Berenson, a Medicare expert at the Urban Institute, a think tank in Washington, D.C.

"I think some of us are quite skeptical," Berenson said. "It really doesn't change the fundamental incentives that every organization is working under."

Under this model, he said, there's also a concern that organizations will see an incentive to dump sicker patients to reach their targets, he said.


Health Care Model Faces Hurdles on Quality and Cost, The Fiscal Times- (June 25, 2010)

"If you want to look at it skeptically, well, this is a way to boost payments to primary care physicians, which intuitively could lead to savings elsewhere in the system, but there is not a lot of strong evidence that the savings are there," said Stephen Zuckerman, a health economist at the Urban Institute, a Washington think tank.


The appeal of repeal, The Economist(June 24, 2010)

If true, this would be fiscal insanity. A recent study by the Urban Institute, an independent think-tank that closely tracks state spending on Medicaid, reckons that this number might be too high. The biggest component of that big increase in his budget, according to Mr Daniels, will be the expansion of Medicaid required by the new law. He reckons this will cost Indiana $972m-$1.3 billion in this decade. But John Holahan of the Urban Institute reckons it is more likely to cost the state “only” $478m-$899m. And at the same time an astounding $8.5 billion-$10.1 billion in federal funding will be available for providing health care for the state’s poor: so surely, on any non-partisan reckoning, this is an investment worth making by a state.


Democratic governors defend health care overhaulReuters - (June 24, 2010)

The states' legal challenges will likely fail unless the Supreme Court takes a radical turn in interpreting the Constitution, according to an Urban Institute report issued this week. The arguments they present, though, could still blunt the law's impact, the report said.

"The other vulnerability is that the opponents' passionate legal arguments will encourage noncompliance with the individual mandate and blunt PPACA's practical enforcement," Randall Bovbjerg, an associate at the left-leaning policy research group, wrote in the report.


Congress battles as Medicare burns, Politico - (June 22, 2010)

In an interview with POLITICO, Robert Berenson — a former physician and now a senior fellow at the Urban Institute and vice chairman of the Medicare Payment Advisory Commission, an independent advisory board — stressed that he was not speaking for MedPAC but felt the situation now was “terrible” and risked undermining progress that had been made to improve the Medicare fee schedule.

“It’s very bad. Something like this will produce the kind of cynicism that will lead doctors on the fence to throw in the towel,” Berenson said. “The reality is, the payment system is getting fairer and better, but the perception that Medicare is an unreliable and politically driven payer reinforces those who want to no longer take patients.” 


Drug Spending Varies Widely By Region; Patients Are Not Primary Reason, Medscape - (June 11, 2010)

One conclusion the authors draw is that increases in drug spending apparently are not associated with offsetting savings in medical spending, or vice versa. To Stephen Zuckerman, PhD, a senior fellow in health policy at the Urban Institute, this conclusion holds implications for healthcare reform strategies.

"You could hypothesize that additional spending on medications might help physicians better manage their patients and lead to fewer hospitalizations and office visits, but [the NEJM authors] really didn't find evidence of that," Dr. Zuckerman told Medscape Medical News.


States Will Be Ground Zero for Many Changes, CQ Researcher - (June 11, 2010)

"A lot is resting on the shoulders of the states" for the success of health-care reform, says Stan Dorn, a senior research associate at the Washington-based Urban Institute, a centrist think tank.

"I'm worried about the administration side, where there's only a 50 percent federal match," says Dorn. "No state person will want to brag about hiring more state employees" since all state governments are constrained by legal requirements to balance their budgets annually,” he says. 


Massachusetts Plan, CQ Researcher - (June 11, 2010)

People using the Connector to buy insurance "have had lots of different choices of health plans, and there's been good consumer service and information," says the Urban Institute's Dorn. Furthermore, "they've been good at negotiating for low premiums" with insurers, he says.


Does Health Reform Create Winners and Losers?, CQ Researcher - (June 11, 2010)

"One big worry that I have is affordability," says Stan Dorn, a senior research associate at the Urban Institute think tank. In the 2006 coverage expansion launched in Massachusetts, the state provided "much bigger subsidies" and "much more extensive coverage" to people with incomes up to 300 percent of the federal poverty level - the group most in danger of being priced out of coverage, says Dorn. (In 2009, for example, a family of four earning about $66,000 had an income 300 percent of the poverty level.) 


Democrats in Power, CQ Researcher - (June 11, 2010)

The new law is "a much more conservative policy than was considered in the past,” says the Urban Institute's Dorn. For example, in the Clinton plan, "we were going to leave behind our employer-based coverage, ant there would have been a uniform benefit standard" for all health insurance. The Clinton proposal also included "explicit regulation of insurance premiums" to prevent them from rising too high and largely dictated what insurance benefit packages could contain, says Dorn. "This bill doesn't have any of that." 


Women face challenges in Mass health law, Boston Globe - (June 2, 2010)

Massachusetts' 2006 health law has helped reduce the number of uninsured to the lowest in the nation, but many women still struggle to pay for health care, according to a study released today by the Urban Institute and the Blue Cross Blue Shield of Massachusetts Foundation.

"Women across all demographic and socioeconomic groups reported unmet need for care because of costs and problems paying medical bills," the study concluded.

"With health care costs in the state continuing to rise rapidly," it said, "failure to take strong action to 'bend the (cost) curve' will likely result in health care costs continuing to be a burden for many women in the state."


Ready to jump in?, Modern Healthcare - (May 31, 2010)

Nearly half of the 15.6 million uninsured, nonelderly adults nationwide have at least one chronic health condition, according to the Urban Institute. In 2008, health plans denied more than 223,000 applicants for individual insurance policies, according to America's Health Insurance Plans, a trade group representing insurers.


Report on Medicaid: Gains outweigh extra costs, IndyStar.com - (May 31, 2010)

"States that go slow are going to have lower increases in spending; they're going to cover fewer people," said John Holahan, director of the Urban Institute's Health Policy Research Center and the lead author of the report.

Indiana originally estimated that nearly everyone who becomes eligible for Medicaid would sign up for it, adding about 500,000 Hoosiers to the rolls. Holahan and Weil said 100 percent participation is unrealistic. Nationally, about 57 percent of the uninsured who are now eligible for Medicaid participate.

The Kaiser report did not look at other cost and savings factors. But Holahan said there could be considerable savings to states from things such as no longer having to pay for uncompensated care.


Medicaid Costs And The New Health Law, NPR - (May 28, 2010)

Governors are complaining about the new financial burdens that will be imposed on states by a major Medicaid expansion included in the new health law. But a new study by researchers from the Urban Institute finds that the vast majority of the costs will be borne by the federal government, and some states could even save money as a result.


Health care reform's X factor, Stateline.org - (May 27, 2010)

The challenge of estimating enrollments and costs will continue. The Kaiser report mostly avoids the issue of how much states are likely to save through changes to the health care system. Although the Urban Institute’s John Holahan, a lead author of the report, says it’s likely that money saved from paying for uninsured care, payments to hospitals and other state programs that can be cut under health reform could potentially outweigh the increased Medicaid costs.

Advocates of the health overhaul say that while the law requires increased state spending on health care — at a time when states have little extra money lying around — the long-term goals and design of the program are a good deal for states. Even if they are forced to spend Kaiser’s higher estimate of $43 billion to expand Medicaid, proponents point out that the federal government is picking up as much as 95 percent of the cost for a program that’s likely to have many long-term, structural benefits for states. “It will go up a bit,” Holahan says of state spending on health care, “but it’s not a lot.”


Study: States will bear little cost of Medicaid expansion under health-care law, The Washington Post - (May 27, 2010)

And the small increase in state costs may be canceled out by savings from no longer having to subsidize the care of uninsured people, study co-author John Holahan said.

"It's absurd," said Holahan, an Urban Institute researcher, of the states' gloomy predictions. "They come out ahead. It's just crazy."


Report: Number of Kentucky Medicaid patients will surge, Kentucky.com - (May 27, 2010)

"We assume that participation rates will be higher, that there will be an aggressive outreach program," said John Holahan, director of the health policy research center at the Urban Institute.

The Kaiser researchers did not specifically ask states how they will pay the extra costs of Medicaid patients. However, Holahan said that since the federal government will pay much of the cost and states will no longer have to pay for caring for the uninsured, states will benefit by aggressively signing up Medicaid patients.

The study concluded that some states might not make efforts to enroll more citizens in Medicaid: "Some states may not aggressively implement health reform and, therefore, not see significant reductions in the uninsured."


Medicaid changes called multibillion-dollar boon for Texas, DallasNews.com - (May 27, 2010)

Rowland and John Holahan, one of two researchers at the Urban Institute who conducted the study for the Kaiser group, though, stood by their estimate that the addition of 1.8 million adults to Medicaid would cost Texas $2.6 billion between 2014 and 2019.

Holahan said Texas may be exaggerating costs of increasing provider rates because Medicaid recipients, once they see doctors, should make fewer trips to emergency rooms.


Medicaid expansion won't sock states: Kaiser, Modern Healthcare - (May 26, 2010)

John Holahan, director of the health policy center for the Urban Institute and an author of the study, said the research excluded potential savings to state subsidies for care for the uninsured, which would likely offset additional spending for adults newly enrolled under Medicaid expansion, he said. “Every single state and many localities now spend a fair amount of money to provide for the uninsured,” he said. “Much of the need to do that will go away.”


Medicaid Pain Might Be Less Than Governors Claim, NPR, Shots blog - (May 26, 2010)

"The increases in state spending are pretty small compared to the increases in coverage and relative to what states would have spent if there had been no reform," said Urban Institute researcher John Holahan, the study's lead author, at a briefing on the issue.

In fact, Holahan says, that's probably an underestimate. With so many more people covered, states will be able to cut back on other money they now spend on things like free health care for people who don't have insurance — something the study wasn't able to take into account.

"I think if we had been able to account for that, that we would show that the savings to states from no longer having to share as large a burden as they do now for uncompensated care would probably be greater than their new obligations for medicaid spending," he said.


Study: Health care reform a good deal for California, other states, San Jose Mercury News - (May 26, 2010)

In a joint study released Wednesday, the Kaiser Family Foundation and Urban Institute examined the cost to states of expanding Medicaid, one of the main vehicles in the reform law to cover the uninsured. The law will expand the federal health care program for the poor (known as Medi-Cal in California), to those earning up to 133 percent of the federal poverty line, or $14,400 for an individual. Medi-Cal rules vary, but generally they cover families who make up to 106 percent of the poverty level.

The Kaiser/Urban Institute report did not offer a comparable annual figure. But it estimates that from 2014 to 2019, as the reform law is ramping up, California could bear additional costs from $3 billion to $6.5 billion over that six-year period. The range depends on the percentage of people who end up enrolling in the program.


Big Gains for Young People in Health Law, The New York Times - (May 24, 2010)

And over time, it may become less acceptable to go without health insurance, said Linda Blumberg, a senior fellow at Health Policy Center at the Urban Institute.  “It’s going to take time because the world doesn’t turn on a dime,” Dr. Blumberg said. “But I do believe the country is going to begin to shift culturally in a way that people are going to understand that the expectation — the norm — is that people are supposed to have health coverage.”


FACT CHECK: Tax cut math doesn't add up for some, Associated Press - (May 19, 2010)

Consider small businesses: "The idea here is to target the credits to a relatively low number of firms, those who are low-wage and really quite small," said economist Linda Blumberg of the Urban Institute public policy center.

On paper, the credit seems to be available to companies with fewer than 25 workers and average wages of $50,000. But in practice, a complicated formula that combines the two numbers works against companies that have more than 10 workers and $25,000 in average wages, Blumberg said.

"You can get zero even if you are not hitting the max on both pieces," Blumberg said.


Groups step up with funding for health care plan, New Haven Register - (May 19, 2010)

The grants will underwrite the technical support needed and will allow SustiNet to hire Stanley Dorn of the Urban Institute to oversee the effort.


Don't like your diagnosis? Maybe you should move, Reuters - (May 12, 2010)

Differences in spending may simply reflect regional differences in health, a team from George Mason University and the Urban Institute in Virginia reported in a separate study.

"Our study shows that an individual's health explains almost one-third of the difference in Medicare spending per beneficiary between the highest and lowest cost areas," Stephen Zuckerman of the Urban Institute's Health Policy Center said in a statement.

Zuckerman said conventional wisdom about large, unexplained geographic differences in Medicare spending overstate the problem and could wrongly reward or penalize certain areas. 


Urgent Changes Needed To Prepare Doctors To Care For Aging America, Medical News Today - (May 6, 2010)

"As Medicare funds are intended to enhance the care of Medicare beneficiaries, the logic of prioritizing training for chronically ill older patients is compelling," said Dr. Berenson, a fellow at the Urban Institute. "Another policy option is to extend Medicare graduate medical education funding to non-hospital clinical training sites, such as nursing homes," added Dr. Leipzig, the Gerald and Mary Ellen Ritter Professor and vice chair of education in the Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai School of Medicine.


Health Reform, Medicare Advantage, and Care for America’s Seniors, The White House Blog - (April 27, 2010)

Insurers offering the plans could pressure health providers to lower their prices, McGlynn said. Also, Senate Democrats and the White House “did some smart things” to mitigate the effect of the Advantage cuts in the final version of the health law, said Robert A. Berenson, a former Medicare official now at the Urban Institute, a research foundation in Washington.

The law lets Advantage plans operating in areas where Medicare’s costs are lower than private insurers’ costs be paid more than the government program, said Berenson, who served in the Clinton administration. Plans where Medicare’s costs are higher than private insurers’ costs would get less.


Medicare Advantage May Weather Cuts Under New Law (Update1), Bloomberg.com - (April 23, 2010)

Insurers offering the plans could pressure health providers to lower their prices, McGlynn said. Also, Senate Democrats and the White House “did some smart things” to mitigate the effect of the Advantage cuts in the final version of the health law, said Robert A. Berenson, a former Medicare official now at the Urban Institute, a research foundation in Washington.

The law lets Advantage plans operating in areas where Medicare’s costs are lower than private insurers’ costs be paid more than the government program, said Berenson, who served in the Clinton administration. Plans where Medicare’s costs are higher than private insurers’ costs would get less.

“To the extent some plans can’t make it, they probably don’t deserve to make it,” Berenson said. “This is competition, I think. There should be plenty of room for good plans.”


Experts Say Connecticut Already Leading in Implementing Health Reform, Public News Service - (April 12, 2010)

Stan Dorn, senior fellow with the Washington-based Urban Institute, says that for example the federal law provides $5 billion in funding to subsidize coverage for early retirees.

"In order to access these funds, an employer needs to implement measures that slow the growth of health care costs for the chronically ill. Responding to the SustiNet law, the comptroller is already meeting this requirement."

Dorn adds that Governor Jodi Rell has made Connecticut the first state in the country to implement improved health coverage for poor single adults...

"And has done it in a way that promises to bring in matching federal dollars to substitute for state dollars, therefore saving state taxpayers of Connecticut tens of millions of dollars."


Health Care Advocates Turn An Eye Toward Informational Campaign, CTNewsJunkie - (April 12, 2010)

Stan Dorn, senior research associate with the Urban Institute, highlighted a number of them.

Some of the best known parts of federal of law that go into effect quickly, Dorn said, is the reduction of the Medicare donut hole, young adults up to age 26 can be added to their parents policy, and slowing health care cost growth for the state’s existing Medicaid populations by creating health care delivery system reforms with federal dollars.

And because of SustiNet, “The state is poised to go far beyond many of its counterparts, elsewhere in the country, in implementing reform quickly,” Dorn said.


Reform may mean profit for Delaware, delawareonline - (April 11, 2010)

"States, at least state governments, come out very well under reforms," said John Holahan, director of the Health Policy Research Center at the Urban Institute. "I think the claims that states are going to have to put up a huge amount of money is way overblown."


Health care law changes reimbursement system, PostStar.com - (April 11, 2010)

The success of the ACO concept may hinge on patient perception, wrote Kelly Devers and Robert Berenson in 13-page analysis prepared for the Urban Institute and the Robert Wood Johnson Foundation.


More Medicaid Pay For Some Doctors, But Will It Last?, NPR - (April 6, 2010)

In states like Texas, for example, where doctors currently receive about 33 percent less to treat a Medicaid patient than a Medicare patient, a jump in payment by one-third would be a big deal, says Stephen Zuckerman, a health economist at the nonpartisan research institute, the Urban Institute. "It would be hard to visualize if that happens and providers begin to accept Medicaid patients that you're going to then see in 2015 a 33% cut in those fees -- but that is clearly what would happen if you read the legislation literally."


Critics Debate If New Health Law Will Help Uninsured, NPR - (April 5, 2010)

Stephen Zuckerman, a health economist at the Urban Institute, says it’s not just Iowa where Medicaid underpays; it’s a problem in lots of states.  “There are fewer Medicaid enrollees that get access to mainstream physicians in large part because physicians can choose whom they want to treat and with Medicaid fees at the bottom of the barrel, physicians are less likely to take patients with that coverage.”


True or false? Top 7 health care fears, msnbc - (April 2, 2010)

Even experts who support the change concede that the impact of the cuts could be evident. Robert Berenson, a scholar at the Urban Institute and former Medicare official, said some Advantage plan members will notice skimpier benefits, "but the Republicans have really exaggerated that this will wipe out the Advantage plans."


Open Enrollment: How do you get 30 million Americans to sign up for health insurance? With great difficulty. Newsweek - (March 29, 2010)

But many of the administrative tasks fall to individual states: creating exchanges; raising awareness; deciding on enrollment processes; building an enrollment infrastructure, both physical and technological; and making all of it easy for consumers to use. "It's an aggressive timeline," says Genevieve Kenney, a health-policy analyst at the Urban Institute, of the 2014 deadline. "But we're not going into it blind."

"Its nonsexy stuff," Kenney says of the enrollment processes. "But if coverage is your goal, and this legislation does reflect that belief, [then] all the evidence we have shows the importance of creating good systems to support enrollment."


The Five Keys to Health Reform's Success or Failure, Time - (March 25, 2010)

There's merit in moving slowly, however, says Linda Blumberg, a health policy expert at the Urban Institute, a nonpartisan think tank. "It could be very disruptive without a lot of gain if you're wrong. It makes sense to approach this stuff cautiously." The same may be true of comparative-effectiveness research, which is funded in the reform legislation and on which many economists and policy experts are pinning their hopes. The idea here is that the research — hard data about which treatments work more efficiently than others — will be adopted as standard protocol.


5 key things to remember about health care reform, CNN - (March 25, 2010)

Starting in 2014, the new health care reform legislation makes it illegal for any health insurance plan to use pre-existing conditions to exclude, limit or set unrealistic rates on the coverage an individual or dependent can receive.

In the meantime, if you have a pre-existing condition, starting in 90 days you should be able to join a national high-risk pool, according to Linda Blumberg, a senior fellow at the Urban Institute. She also recommends finding out whether your state has an existing state high-risk pool. Here is contact information for the 35 states that have high-risk pools from the National Association of State Comprehensive Health Insurance Plans.


Last-Minute Medicare Deal Shows Challenge Of Curbing Costs, NPR - (March 24, 2010)

Stephen Zuckerman, a senior fellow and health economist at the Urban Institute, said he was surprised to see the additional funding for low-cost hospitals since hospitals in the Midwest do not have "access issues" and the bill was trying to reduce Medicare spending. 

"The question is whether low-cost hospitals should be rewarded with higher payments or whether high cost hospitals should be penalized with lower payments," Zuckerman said.


McCollum's Medicaid myths: Under new law, Florida could come out ahead., The Palm Beach Post - (March 24, 2010)

"No state has to have a Medicaid program. It's just silly to say that there's a constitutional violation of an unfunded mandate when the federal government is simply putting federal Medicaid dollars on the table and attaching conditions to the states that use those dollars," said Stan Dorn, a lawyer and senior fellow at the Urban Institute. "There's way too much hype and spin, and I just wish people would calm down and look in a careful way at the facts."


Last Minute Deal On Medicare Highlights Dilemma On Curbing Costs, Kaiser Health News - (March 23, 2010)

Stephen Zuckerman, a senior fellow and health economist at the Urban Institute, said he was surprised to see the additional funding for low-cost hospitals since hospitals in the Midwest do not have "access issues" and the bill was trying to reduce Medicare spending.

"The question is whether low-cost hospitals should be rewarded with higher payments or whether high cost hospitals should be penalized with lower payments," Zuckerman said.


First wave of health-care changes will target insurers with new rules, The Washington Post - (March 23, 2010)

"In terms of the way providers are affected, it's probably not as big a change as it should have been," said John Holahan of the Urban Institute. "But you have the structure to deal with that in place, going forward. . . . If premiums continue to skyrocket, even with subsidies, insurance will be deemed unaffordable, and the whole thing will unravel."


Unemployed, But Not Uninsured, Newsweek - (March 23, 2010)

There are a couple of things that will happen quickly that may or may not be useful for people who are unemployed or who are on the fringes. The bill will be significant for people that have health problems. Right now, the practice in the private health-insurance industry is something called "rescission." That means that once somebody files a claim that is relatively significant, the insurance companies often try to find some error on your original application, even if it wasn't fraud, and then make your plan null and void. That practice would be outlawed immediately under the reform.


Health Care: Who's Not Covered?, NPR - (March 22, 2010)

Late Sunday night, House Democrats approved a health care bill that will extend medical coverage to millions of Americans. The bill will reach as many as 32 million people — but it won't cover everyone. Host Melissa Block talks to Linda Blumberg of the Urban Institute to find out who's not covered and what will happen to them.

Dr. BLUMBERG: The biggest part of that group is going to be unauthorized immigrants who are excluded from the reforms. They won't be eligible for financial assistance or for coverage through the Medicaid program. And they'll make up about a third of that uninsured group.


Leukemia patient runs up against insurance cap, The Chicago Tribune - (March 22, 2010)

"This guy's situation is not incredibly unique," said Stephen Zuckerman, a health economist at the Urban Institute, a nonpartisan policy analysis group.

Strict income and asset requirements make many people ineligible for Medicaid, a state and federal health program, or a hospital's charity care program. 

Hospitals are required to treat patients only in emergency situations. That means the University of Chicago Medical Center was within its rights to refer Rudd somewhere else.


Opinion: America Desperately Needs Reform, AOL News - (March 18, 2010)

Every other economically advanced country provides its people with the peace of mind that comes from knowing that, no matter what, families are guaranteed affordable, essential health care. To provide American workers with that same peace of mind, the health care reform legislation now being considered does three things:

Medicaid covers the poorest uninsured.

Low-wage workers and their families whose incomes are too high for them to qualify for Medicaid but too low to pay for coverage on their own receive subsidies to help them buy private insurance.

Insurance companies are forbidden from discriminating against consumers with pre-existing conditions.


Physician groups, hospitals seen driving health care costs in California, American Medical News - (March 17, 2010)

"What we are seeing here is the haves and the have-nots," said Robert Berenson, MD, article co-author and a fellow at the Urban Institute.

More stringent enforcement of existing antitrust laws would not have an effect, because antitrust law focuses on local market concentration, and this power extends across regions, Dr. Berenson said. "They're not doing anything illegal."


States Weigh Taxes To Help Fund Medicaid—And Raise Federal Contributions, Kaiser Health News - (March 17, 2010)

Congress doesn’t appear eager to block the taxes, said Stephen Zuckerman, a health economist at the Urban Institute in Washington. "Who’s at fault here?" he asked. "The federal government knows it’s going on and allows it."


Research Roundup: Evaluating Health Bills, Attitudes About Uninsured, Improving Emergency Rooms, Medical News Today - (March 15, 2010)

Urban Institute: The Cost Of Uncompensated Care With And Without Health Reform - This report analyzes various health bills. "The cost of uncompensated care will fall from $62.1 billion in 2009 to $46.6 billion in 2019 under the Senate bill, and to $36.5 billion in 2019 with the House bill. Without reform, the cost of uncompensated care will increase to between $107 and $141 billion in 2019, depending on growth in the economy and health care costs. ... Without health reform, the number of uninsured and the amount of uncompensated care will grow substantially. This will translate into increased pressure on state and local government to finance the growing cost of the uninsured" (Holahan and Garrett, 3/9).


Obama's illusions of cost-control, The Washington Post - (March 15, 2010)

A study by the Robert Wood Johnson Foundation found that the insured accounted for 83 percent of emergency-room visits, reflecting their share of the population. After Massachusetts adopted universal insurance, emergency-room use remained higher than the national average, an Urban Institute study found. More than two-fifths of visits represented non-emergencies. Of those, a majority of adult respondents to a survey said it was "more convenient" to go to the emergency room or they couldn't "get [a doctor's] appointment as soon as needed." If universal coverage makes appointments harder to get, emergency-room use may increase.


Health Care: Road Closed, Danger Ahead!, The Huffington Post - (March 15, 2010)

Today, as part of the 9th annual Cover the Uninsured Week, the Robert Wood Johnson Foundation released a new report that warns of the dangers still ahead of us -- and our health care system -- if we don't change direction. The analysis, conducted by researchers at the Urban Institute, shows that without significant reform to the current health care system the number of uninsured Americans could grow by 10 million people in just five years. Spending on government health care programs for the poor will balloon, more than doubling by 2020. For employers who continue to offer health insurance benefits, an increasing amount of the costs would come out of workers' pockets. At the same time, individuals and families would face higher out-of-pocket costs for premiums and health care services.


We Might Remember These as the ‘Good Times’ in Health Care, The Wall Street Journal - (March 15, 2010)

The uninsured could reach more than 67 million in 10 years, according to the Robert Wood Johnson Foundation, which paid for the study conducted by the Urban Institute. Read the study and related data here.

“The bottom line is that we are likely to see a significant deterioration in who has health insurance coverage in this country, coupled with untenable increases in private and public spending,” an Urban Institute researcher said.


Democratic leaders working to win over abortion opponents for health-care reform, The Washington Post - (March 5, 2010)

Abortion rights groups and health-care analysts now are predicting that, under the Senate language, few plans would cover abortion because the requirement of two payments would be cumbersome for insurers and objectionable to customers.

"There will not be abortion coverage in the exchanges. There just won't be," said Linda J. Blumberg, a health policy analyst at the Urban Institute.


Chest Scan Costs $550 to $3,232 in Opaque Market for Radiology, Bloomberg.com - (March 4, 2010)

“These billing records show that the order of magnitude of markups is wildly excessive,” said Robert Berenson, a physician and fellow at the nonprofit Urban Institute in Washington, who reviewed some of Foley’s hospital and insurance records.

“Insured patients basically don’t care -- they are rarely responsible for paying more than a nominal amount of the bill,” Berenson said. “It is between the providers and the insurers, and the providers have the upper hand.”


Myth Diagnosis, The Atlantic - (March 2010)

Even Democratic politicians made curiously little of the plight of the uninsured. Instead, they focused on cost control, so much so that you might have thought that covering the uninsured was a happy side effect of really throttling back the rate of growth in Medicare spending. When progressive politicians or journalists did address the disadvantages of being uninsured, they often fell back on the same data Klein had used: a 2008 report from the Urban Institute that estimated that about 20,000 people were dying every year for lack of health insurance.


The Cost of Doing Nothing on Health Care, The New York Times - (February 26, 2010)

While estimates vary, the number of people without insurance is expected to increase by more than a million a year, said Ron Pollack, the executive director of Families USA, a Washington consumer advocacy group that favors the Democrats’ approach. The Urban Institute, for example, predicts that the number of uninsured individuals will increase from about 49 million today to between 57 million and 66 million by 2019. The Democrats’ plan is expected to cover as many as 30 million individuals who now are uninsured.

“I think we’ll just see the decline of public services,” said John Holahan, the director of the Health Policy Center at the Urban Institute.


Deaths Rising for Lack of Insurance, Study Finds, The New York Times - (February 26, 2010)

An earlier study by the Institute of Medicine estimated that 18,000 people died prematurely in 2000 because they lacked insurance; the Urban Institute updated that figure to 22,000 in 2006. The new study, by liberal advocacy group Families USA, applied the same methodology used in the previous reports to drill down and calculate, on both a national and state-by-state basis, the latest figures.

“The bottom line is that if you don’t get a disease picked up early and you don’t get necessary treatment, you’re more likely to die,” said Stan Dorn, a senior fellow at the Urban Institute and the author of the organization’s earlier study.


Hospital Clout Spurs Higher California Health Costs, Bloomberg.com -  (February 25, 2010)

“Health insurers have been squarely in the crosshairs, blamed for the high cost of private insurance while the role of growing hospital and physician market power has escaped scrutiny,” Robert Berenson, a study co-author and researcher at the Washington-based Center for Studying Health System Change and the Urban Institute, said in a statement. “Provider power is the elephant in the room that no one wants to talk about.”

President Barack Obama met today with Democratic and Republican members of Congress on a health-care proposal that focuses on restricting the insurance industry’s clout. Berenson, who worked on Medicare policy for President Bill Clinton, said putting a leash on insurers may not be enough.


Obama's Plan Favors Senate Over House, NationalJournal.com - (February 23, 2010)

There would be fewer new enrollees with the preferable federal matching rate in states that already cover more people under the program. "Because of the current match rate structure, a larger share of federal dollars would go to the South and West so the share of state spending is lower than the share of new enrollees in these regions if eligibility is expanded to 100 percent or 150 percent [federal poverty level] for adults. For example, in an expansion to 150 percent FPL, the South is expected to account for 49 percent of the new enrollees but 44 percent of the new state spending," the Urban Institute's John Holahan wrote in a December report for the Kaiser Commission on Medicaid and the Uninsured.


Obama offers new health-care reform proposal, The Washington Post - (February 23, 2010)

The proposal arrives in advance of Obama's bipartisan health-care summit on Thursday. But his formal adoption of an approach so aligned with the efforts of congressional Democrats acknowledges that the overhaul will draw little to no Republican support, and that the main challenge lies in retaining the support of Democratic lawmakers.

"It doesn't strike you as a scaled- down thing that's not supposed to have enemies," said John Holahan of the Urban Institute, who is a proponent of comprehensive legislation. "They just went all out."


Obama's new healthcare plan unlikely to get GOP backing, The Miami Herald - (February 23, 2010)

President Barack Obama on Monday launched a last-ditch effort to revive healthcare legislation that's unlikely to gain Republican support but may restore Democratic momentum for the bill by placing the president squarely at the center of the messy process of drafting legislation.

"It sends a clear signal what he's comfortable with,'' said Stephen Zuckerman, a senior fellow at Washington's Urban Institute, a research group.


What's New in Obama Plan? Not So Much, AOL News - (February 22, 2010)

"It isn't a wimpy proposal," said John Holahan, health policy director at the Urban Institute, a nonpartisan think tank. "It seems to have put together a package that would be reasonably close to what the House wanted as fixes to the Senate bill."


Do We Really Want the Status Quo on Health Care?, The New York Times - (February 18, 2010)

The United States Public Interest Research Group calculated last year that without reform, insurance premiums for those with employer-provided health care would nearly double by 2016. Also last month, the Urban Institute applied its computer model of health insurance costs to a scenario in which there is no reform, and this is what it found:

“Over the next decade in every state, the percent of the population that is uninsured will increase, employer-sponsored coverage will continue to erode, spending on public programs will balloon, and individual and family out-of-pocket costs could increase by more than 35 percent,” it said. It added that the number of uninsured Americans could reach as many as 65 million in another decade.


Debating Whether Health Insurance Saves Lives, Kaiser Health News - (February 16, 2010) 

Klein also posts an interview with the Urban Institute’s Stan Dorn, who authored a study (pdf) on health insurance and mortality dismissed by McArdle.  Dorn argues, “McCardle [sic] erred by presenting the Kronick study as the gold standard for research on this issue to the exclusion of all studies published since 1994 that go against her argument.”


All you ever wanted to know about the research on health insurance and health -- and more, The Washington Post - (February 16, 2010)

I think I've said quite enough on the question of whether health-care insurance reduces the risk of death. But one of the first things I did when looking into the subject was call Stan Dorn, the author of the Urban Institute study (pdf) that estimated 18,000 people died in 2006 because they didn't have health-care insurance. At the time, he said he was writing a response of his own, and would be in touch when he finished. Last night, he sent it along. It follows in full, and serves as a good introduction to the literature on this topic.

Testifying to Congress last year on behalf of the IOM, John Ayanian, a professor of medicine and health care policy at Harvard Medical School, reaffirmed, “Uninsured adults are 25 percent more likely to die prematurely than insured adults overall, and with serious conditions such as heart disease, diabetes or cancer, their risk of premature death can be 40 to 50 percent higher.” The conclusion that uninsurance increases risk of death by 25 percent was the basis of IOM’s 2002 finding of 18,000 deaths resulting from a lack of health coverage as well as our 2008 updating of IOM’s calculations.


Individual mandate: A sticking point in the healthcare debate, Chicago Tribune - (February 15, 2010)

Linda Blumberg, a health economist and senior fellow at the Urban Institute, a policy think tank in Washington, D.C.:

"For comprehensive healthcare reform to work, we have to have some way to broadly spread the cost of those with high medical needs, and this can either be done through the tax system or an individual mandate. The mandate is one useful and effective strategy.

"Under the House and Senate healthcare bills as passed, insurance companies would be required to take people on as customers regardless of preexisting conditions. If there were no individual mandate included in the legislation, this would create a situation where people would be likely to wait until they had a health problem diagnosed before they applied for insurance. That would cause premiums to increase and make coverage increasingly unattractive to people who are young and healthy. In order to make coverage affordable in the absence of a mandate, we would have to subsidize the program so that insurers did not charge sicker people higher premiums.


Washington isn't getting anything done about skyrocketing health costs. In Weld County, they're tired of waiting, The Greeley Tribune - (February 14, 2010)

By 2019, most Americans' out-of-pocket health care spending is expected to grow to almost double what they spend now, and employers' shares will more than double in the next several years, according to a report last August from the Urban Institute.


Firming Up the Argument, The Atlantic - (February 13, 2010)

I see the argument for using easier-to-measure subgroups in an attempt to isolate causality.  But here's the thing:  you cannot say, well, aggregate data isn't very good for capturing causality, and also cite the figures from the Urban Institute, or Himmelstein et. al. as if they had some meaning.  Those data are far worse than the Medicare data, because at least the Medicare data gives you a natural experiment, and it doesn't try to isolate "the uninsured" on the basis of their insurance status on a single day.  Either it's reasonable to infer causality from large and noisy data sets, or it isn't.

Since I think that the Urban and/or Himmelstein figures are reliable, and at least 60% of the uninsured will be covered by the new plans, I expect that mortality rates among those under 65 will begin a discontinuous fall by late in this decade.  I expect them to drop by at least 10,000 (1.5%) and very possibly by 22,500 (3.5%), or even more, by 2025.


Lower Medicare Fees Do Not Increase Volume of Patient Care, Study Finds, HealthCanal.com - (February 11, 2010)

Jack Hadley, professor and senior health services researcher in George Mason University’s College of Health and Human Services, along with co-authors James Reschovsky of the Center for Studying Health System Change (HSC), Catherine Corey of the New York City Department of Health and Mental Hygiene, and Stephen Zuckerman of The Urban Institute, analyzed thousands of physicians and their Medicare insurance claims to investigate volume-offset behavior, the belief that physicians respond to lower Medicare fees by increasing service volume to make up for potential lost revenue.

“In recent years, Medicare fees have fallen after accounting for inflation, while overall physician costs and volume of physician services have grown. Although suggestive of volume-offset behavior, national trend data do not necessarily reflect how physicians respond to variations in specific Medicare fees. Our analysis isolated this relationship by controlling for other factors that also influence service volume,” Hadley said. 


Medicare Cost-Saving Moves Can BackfireHealthDay - (February 9, 2010)

Dr. Robert A. Berenson, a senior fellow at the Urban Institute in Washington, D.C., and a member of the Medicare Payment Advisory Commission, which advises Congress, said there is great concern that fee-for-service incentives are causing physicians to over-recommend services or over-induce patient demand.

CMS does not experiment with physician payment rates to induce shifts in care from the hospital to the outpatient setting, as the authors suggest, he explained. The 2005 payment change likely responded to urologists' requests for an update of rates that were found to be undervalued, he said.

"The whole statutory basis for how to pay physicians is to determine what the underlying resource costs are for producing the service, whether or not it's a good value," Berenson explained. "And so some of us have actually recommended that CMS should have the authority to do just what those authors suggested, but CMS doesn't have the authority to do that."




What Happens If Nothing Happens to Health Care?, Wall Street Journal - (February 4, 2010)

"Failure to enact health reform will result in increasing numbers of people without health insurance because fewer employers will offer it and many employees will not be able to pay the cost of plans that are available," predicts Stephen Zuckerman, a health economist at Washington's Urban Institute think tank.

"For people not offered employer coverage, many will not be able to get coverage due to pre-existing conditions that insurers won't cover or because premiums simply won't be affordable. Even people with coverage will find costs becoming a greater financial burden," he said.


States Cutting Back Special Programs For Uninsured, Kaiser Health News - (February 2, 2010)

“There will be no reason for states to pay for this themselves,” says John Holahan of the Urban Institute, a nonpartisan think tank in Washington.


A new cure for healthcare reform, The Miami Herald - (February 1, 2010)

But there's a problem with that, said Robert Berenson, a physician who is a fellow with the Urban Institute. Trying to insure a few more people without providing something close to universal coverage is "a slippery slope.''

By banning preexisting clauses, "only sick people would sign up for insurance,'' Berenson said. Well persons would be less likely to waste their money on coverage. That would mean that either insurance rates would be enormously high or insurers would go bankrupt.

"So to do away with preexisting, you have to have some kind of mandate that people must have insurance,'' so that well persons could contribute to the pool of funds insurers could draw on, Berenson said. "And that means you're back to full reform.''


Massachusetts voters back their universal health coverage, The Statesman - (January 22, 2010)

The legislation would set a single standard for Medicaid eligibility, about $28,000 or $33,000 for a family, and the federal government would pay almost the entire cost of newly eligible people. That means that states with looser standards would continue to pay as much as half the cost for a broad swath of people that in other states would be paid for almost entirely by the federal government.

 "It's really striking," said John Holahan of the Urban Institute. "The real beneficiaries of this are the states in the South and the West who are opposing health care reform."


Unexpected lessons from Massachusetts, Marketwatch.com - (January 22, 2010)

John Holahan, director of the Health Policy Center at the Urban Institute in Washington, agreed. "That essentially means people from other states are supporting this Massachusetts reform."

Such a large-scale change is less of a long shot now, Holahan said. If health reform dies this year, within a decade there will be demand at least for Medicare as an option, with income subsidies similar to what's in the current bills -- and the potential for Medicare for all isn't out of the question either, he said.

 "I almost think you'd have to because of the budget implications and the health implications and financial pressure on health-care institutions," Holahan said. "If the uninsured rate goes to 60, 70 million over next decade, that's an awful lot of people who can't afford to pay."


Health reform would weigh on state, The Daily Democrat - (January 18, 2010)

John Holahan, a health care expert at the Washington, D.C.-based Urban Institute, agreed that it's "inherently unfair" for the federal government to pay different shares of each state's health care expansion costs and said it's bound to create a bureaucratic maze.

"For every new enrollee in each state, they're going to have to check: Did they qualify under the old rules or the new rules?" Holahan said.


State stands to gain from health reform, Santa Fe New Mexican - (January 16, 2010)

In a conference call this last week, Dorn said enrollment issues can be "technical and boring" but may be the key to health-insurance reforms taking hold and improving lives. "There is a long history of health insurance expansion not meeting its goals," he said.

Automatic enrollment that would allow individuals to check a box on IRS tax forms if they want their income information to be considered for eligibility into Medicaid. If they qualify on income, families can be enrolled or sent enrollment forms. "If the government already has the information, why not use it to determine eligibility," Dorn said.


What if All 50 States Get Ben Nelson's Medicaid Deal?, Time - (January 15, 2010)

The current Medicaid-expansion proposal would cost the Federal Government about $395 billion from 2010 to 2019 under the Senate bill or about $425 billion under the House bill. The state share of the expansion, in contrast, would be $26 billion or $34 billion. Moving the state costs into the federal column, as Nelson is now suggesting, would increase the cost of legislation, which is already close to the $900 billion limit set by President Obama. Then again, House and Senate leaders are currently negotiating all sorts of adjustments for a merged bill, and any new Medicaid costs could be part of that calculation. "Having the Federal Government pay the complete thing is not that big a deal," says John Holahan, an economist who has studied the Medicaid expansion extensively and who is also director of the Health Policy Research Center at the nonprofit, nonpartisan Urban Institute.


Mind the Details, or Medicaid Coverage Expansion Will Falter, Say Bingaman, Dorn, CQ HealthBeat News - (January 15, 2010)

“No matter where or how that form is filed, eligibility for all subsidy programs is determined automatically without any need for the applicant to complete additional paperwork. The relevant government agencies work together behind the scenes to determine eligibility seamlessly and invisibly to the consumer. A consumer can seek subsidized coverage without completing a full application,” the report said. “Each applicant has the option to simply provide identifying information and request a determination of eligibility based on information in government hand, including income tax data.”

The idea in the overhaul legislation now pending on Capitol Hill should also be to allow existing data in government hands to be used to determine eligibility, Bingaman and Dorn said. Applicants should be able to request that an eligibility determination be based on the use of that data, they added.


‘Cadillac’ tax on hatchback care?, The Boston Globe - (January 15, 2010)

“There’s no question that it’s going to be easier to get to those thresholds in some of the higher-cost states,’’ said Stephen Zuckerman, a health economist at the Urban Institute, a Washington think tank. If employers cannot negotiate better rates from insurers, he said, “Over time, more and more plans will be exposed to this Cadillac tax.’’


Cardiologist on front lines of medical-fee battlePhilly.com (January 13, 2010)

The new fee schedule has nothing to do with health-care reform, but Stephen Zuckerman, a health economist with the Urban Institute, said more disputes such as this were likely. Congress has promised cuts in Medicare spending as part of reform. When Medicare decides it is overpaying for certain services, "the people who provide this particular service will scream." 

Zuckerman said spending on nuclear stress tests per Medicare beneficiary doubled between 2000 and 2006. Such growth, he said, was often a sign that the tests were "financially attractive" to providers.


No silver lining, ModernHealthcare.com - (January 11, 2010)

Despite a tentative economic turnaround in 2009, continued layoffs pushed unemployment to 10%. “States clearly aren't out of the woods yet,” said Stephen Zuckerman, a health economist at the Urban Institute.

Zuckerman described the state relief reflected in the CMS figures as a “quite intentional” bid to shore up the safety net and said the agency's snapshot of health spending amid the recession highlighted the need for reforms.

“I don't think the slowdown in health spending reduces the pressure of health reform from the standpoint of trying to control costs,” said Zuckerman, who also noted the rise in healthcare spending as a share of the economy. “The need to control costs is as strong as it was despite the one-year slowdown in spending growth.”


Health reform could endanger CHIP funds, Anchorage Daily News - (January 9, 2010)

The Children's Health Insurance Program provides government insurance for children in families not poor enough to qualify for traditional Medicaid but not well off enough to be able to afford private insurance. It is financed jointly by states and the federal government.

Medicaid and CHIP combine to cover an estimated 31 percent of all children nationally, says a December report from the Urban Institute's Health Policy Center.


Health-care overall would have immediate effects, The Seattle Times - (January 5, 2010)

More money for community health centers. Immediate help for the uninsured. No more lifetime limits on coverage.

Under the health-care legislation that's moving through Congress, these and other benefits would take effect quickly and should produce a noticeable impact on consumers, according to many independent analysts and Democrats. 

"This would be a substantial package that could probably be quite helpful," said John Holahan, director of the health-policy center at Washington's Urban Institute, a research group.


Mayo Clinic Bridles at Medicare Payments, Bnet.com - (January 4, 2010)

In a Bloomberg article, Dr. Robert Berenson of the Urban Institute is quoted as saying that some primary-care physicians can afford to do without Medicare “because there is an unlimited demand for their services.” In areas where private health plans pay much more, Medicare looks like a poor payer, he adds.


Health care overhaul: Critics on left, right unite against mandateChicago Tribune - (January 4, 2010)

Linda Blumberg of the Urban Institute says much of the public's resistance stems from still-sketchy details about how the new insurance exchanges that would likely be established for those without job-related coverage would operate. People who earn just over 100 percent above the federal poverty line would become eligible for Medicaid -- and those up to 400 percent would qualify for federal subsidies.

Blumberg cites Massachusetts as a success story. The state enacted its own insurance mandate in 2006. About 96 percent of residents were insured by the end of 2008 -- although the state's penalties for violating its mandate are higher than those in the Senate's bill.


Program for Children Has Uncertain FutureThe New York Times, Prescriptions blog - (January 3, 2010)

"Attention must be paid to the possibility that some children who lose CHIP coverage could fall through the cracks and become uninsured," Genevieve M. Kenney and Allison Cook wrote last month in a brief prepared for the Urban Institute, the Washington research group.


Opponents of a health insurance mandate mobilizeLos Angeles Times - (January 2, 2010)

Linda Blumberg, a researcher with the Urban Institute, said much of the public's resistance stemmed from sketchy details about the new insurance exchanges, which would be established so that people without job-related insurance could buy coverage. People who earn just over 100% above the federal poverty line would become eligible for Medicaid -- and those earning up to 400% of the poverty line would qualify for federal subsidies to help defray the cost of insurance.

"There's a lack of information about what they're going to pay and what they're going to get," Blumberg said.


Senate health-care bill would still leave millions uninsuredThe Washington Post - (January 2, 2010)

"If you're at 84 percent and you are going to 94 percent, you picked up roughly two-thirds of the problem, which is big," said John Holahan, director of the Health Policy Center at the liberal Urban Institute, referring to the percentage of legal U.S. residents who will have health insurance under the Senate plan. "If the economy comes back, you can pick up a good chunk of the rest. Most European countries don't get 100 percent -- the data I've seen is always 98 or 99 percent."


Americans would feel varying effects from health billUSAToday.com - (December 27, 2009)

Both proposals would let small companies choose to buy insurance through "exchanges," online marketplaces in which employees could pick from a range of private plans. That would let businesses increase risk pools and reduce administrative overhead by buying coverage alongside other small companies, said the Urban Institute's Linda Blumberg.

"Small employers are just not efficient purchasers of health insurance coverage," Blumberg said. "What these bills do is they really try to make progress."


Senate and House in search of health-care compromiseThe Washington Post - (December 24, 2009)

"There are hundreds of thousands of decisions that need to be made as these things are being put into place that affect access and costs in a very significant way," said Linda Blumberg of the Urban Institute. "There's a lot at stake here, and we need to be defaulting on the side of uniformity."


No clear answer to costs of coverage in health billStatesman.com - (December 24, 2009)

Linda Blumberg, an economist and a senior fellow at Washington's nonpartisan Urban Institute, said that, under the Senate bill, people buying coverage through small group or private plans could see lower premiums. Administrative costs, according to the Congressional Research Service, run between 30 and 35 percent of benefits paid out. The bill would restrict those costs to 20 percent, and they could end up even lower because of changes in the way coverage would be sold.


 

Health coverage mandate doesn't guarantee compliance, USA Today - (December 21, 2009)

"If you get too many young and healthy people who slip through, all the insurance market reforms start to unravel and the whole health bill unravels," says John Holahan of the Urban Institute's Health Policy Research Center.

Yet Congress risks a political backlash if penalties are too steep, particularly among those who earn too much to qualify for subsidies, Holahan says.


Health-policy experts say there is little basis for Sen. Nelson's concerns about Medicaid expansionThe Washinton Post - (December 19, 2009)

States such as Nebraska "have to come up with the extra money [for their slight share for the newly eligible] so you can view it as a burden, but on the other hand, a ton of federal dollars are coming in to pay for these people, so it's an economic gain in that sense," said John Holahan of the Urban Institute. "This is a really ridiculous thing for anybody to complain about....The bottom line is, Nebraska comes out great on this."


Amid the Reform Crossfire, Experts Offer Reality CheckBnet.com - (December 17, 2009)

Government subsidies have enabled many of the 7 million people who have lost their jobs during the recession to buy COBRA coverage, but most will become uninsured after their COBRA eligibility expires. And while federal stimulus funds have temporarily enabled states to maintain Medicaid coverage at current levels, the experts point out, “many states will cut their Medicaid programs as soon as the ARRA funding ends. The Urban Institute predicts that in the absence of reform, the costs of uncompensated care will double in 45 states over the next 10 years, and the number of uninsured could grow by more than 30 percent in 29 states.” During the same period, without the kind of cost controls that the reform measure would initiate, Medicare will go broke, the authors note.


Harkin health care figure off; nearly 8,000 lose insurance every dayThe Iowa Independent - (December 16, 2009)

What they found was that the 14,000 figure was no longer true. The number of people who lose their insurance has fallen to a still sizable 7,784 per day, based on a model developed by Urban Institute health care scholar John Holahan.

Holahan and his co-author, using a baseline of 4.6 percent unemployment in 2007, calculated that 2.6 million people would lose coverage if the unemployment rate climbed to 7 percent; 3.7 million if it went to 8 percent; 4.8 million at 9 percent; and 5.8 million at 10 percent.  The estimates took into account people who lost their jobs but then switched to a spouse’s plan or extended their coverage through COBRA, the federal law that guarantees people who lose their job can still get continued health coverage.

Applying Holahan’s calculations to the actual rise in unemployment from November 2008 to June 2009, we found that the number was right around the 14,000 people per day that [President Barack] Obama cited. We checked with health care experts, and they, too, agreed that the 14,000 number was just about right.

When extended out through November, though, the number falls. Since January, unemployment has risen from 7.6 percent to 10 percent, meaning 2.6 million jobs have been lost so far in 2009, according to Holahan’s calculations. Dividing 2.6 million by 334 days means 7,784 people lost insurance every day.


Medicare 'buy-in': A bargain or burden?USA Today - (December 13, 2009)

• Benefits. Under Medicare, cost-sharing by beneficiaries is not capped for catastrophic illnesses, something often included in private plans, says Tim Waidmann of the Urban Institute, a non-partisan think tank. That's one reason many Medicare beneficiaries buy Medigap policies.


Of OPM role in a reformed health-care system, some are fans, some are definitely notThe Washington Post - (December 11, 2009)

The FEHBP "has run arguably very well for a long time," said the Urban Institute's Randall R. Bovbjerg. And Walton Francis, a health economist who writes an annual FEHBP consumer guide, said, "OPM is really competent...They can do the job."


A quick vote favors Harry Reid’s causeLas Vegas Sun - (December 11, 2009)

Stephen Zuckerman, a health economist at the Urban Institute, sees promise in the overall deal, particularly with the Medicare expansion, if it sticks.

“I think this is really kind of a clever compromise,” he said. “I don’t know if it can hold.”


The five biggest myths about health reformMarketWatch - (December 10, 2009)

"The distinction between who's delivering health care and who's paying for health care is routinely confused and distorted," said Stephen Zuckerman, a health economist at the Urban Institute's Health Policy Center in Washington. Medicare, for example, is a government-financed program, but private doctors make the clinical decisions and deliver the care.

"Government-run health care is like the Veterans Administration, where the government owns the hospital, employs the physicians and finances the care," Zuckerman said.

The bottom line: "More care is going to be financed by government, but more care is not going to be provided by government," Zuckerman said.

"While not everyone gets everything, there's a very high volume of care that's provided in the U.S., and there's very little in the bill that would likely change that," Zuckerman said. "Rationing is one of the more inflammatory words that gets used that has no basis beyond what currently happens."


If 'public option' is no longer an option in Senate bill, then what?The Washington Post - (December 10, 2009)

"I don't know what it does beyond provide some political cover for somebody," said Robert Berenson of the Urban Institute. "It'll be the same insurance companies applying to the national exchange as would be in the state exchange."

His colleague John Holahan says the new national nonprofit plans would accomplish one of the public option's goals: providing consumers with more choices, especially in markets dominated by one or two insurers. To further goad insurer behavior, the Senate deal would also require that insurers pay out 90 percent of the revenue they collect in premiums on reimbursements for medical care -- a much higher rate than many now pay out.

But the plans would not address the other, and in Holahan's mind more crucial, goal of the public option: exerting pressure on doctors and hospitals, especially in places where providers dominate the market. "If your view is that the problem is not having enough insurers, then it would help. But if you think the problem is about not having enough leverage over providers, then this doesn't work," he said.

"The whole Medicare thing raises 100,000 questions," Holahan said.


Government-Run Health Care? It's Already HereSphere.com - (December 9, 2009)

"The government has a pretty substantial role, no doubt," said John Holahan, director of the Urban Institute's Health Policy Center. And most are happy with the care they receive.

"People are very satisfied with Medicare," said Holahan, citing numerous surveys. "If you begin to talk to veterans about giving up (VA health care) and getting private insurance, they go ballistic."

Federal income-tax subsidies for health care, including the hotly debated exclusion of employer-provided health insurance from taxes, reached $186 billion last year, Holahan wrote in a paper with Stan Dorn last year. That exemption helped 61 percent of those under 65 pay for their health care.

Indeed, "only 5 percent of the insured population in the United States does not receive some kind of government subsidy, either directly or through a tax benefit," Holahan and Dorn wrote.


Lieberman riles many with role in health debateThe Washington Post - (December 8, 2009)

But Lieberman has maintained that the public option alone represents a cost to the government. "He keeps saying over and over that we can't afford the public option, but the question is whether we can afford the subsidies," said John Holahan of the Urban Institute.


Think tankThe Washington Post, Ezra Klein's blog - (December 7, 2009)

30) The Urban Institute has the best overview I've read of the public option, both the one that advocates want and the compromises they're likely to get.


Profile: How Could Healh Care Reform Affect You?Online NewsHour - (December 7, 2009)

Beyond those facts, though, how analysts see Resnick's case varies by ideological outlook. Linda Blumberg, a health policy researcher at the Urban Institute who generally favors many aspects of the reform legislation, says that it will provide significant advantages for small employers. Right now, even just shopping for coverage is a major burden for small business owners, she says.

"They don't have a benefits manager, most likely," she says. "They have to spend a lot of time, and worry, 'Am I getting the best deal?'"

The exchange would for the first time provide a structured marketplace where employers and individuals could compare different options, she says, and evaluate plans at comparable levels of coverage.

She also says the plans offered in the exchange are likely to have significantly lower administrative overhead costs than current plans, which must spend a lot of money marketing to many small firms.


Team of Ten’s Goal: A Not-Quite-Public PlanThe New York Times, Prescriptions blog - (December 6, 2009)

In an August 2009 report, the Urban Institute, a nonpartisan policy research group highlighted the potential appeal of using the federal employees health plan — or the F.E.H.B.P. — as a model for a broader overhaul of the nation’s health insurance system.

“Politically, the program as a model for reform has appeal across the spectrum,” the report said in its introduction. “Conservatives like the program’s reliance on private health plans and market competition. Liberals like the prospect of expanding to everyone the F.E.H.B.P.’s large-employer-style benefits, community rating, and close oversight of insurer pricing.”

The report also contains some warnings about trying to expand the federal employees’ plan to the general public. “It does not seem to be wise simply to open the existing F.E.H.B.P. to non-federal enrollment nor feasible to precisely replicate the F.E.H.B.P. and its national approach outside the context of federal employment,” the report said.


All Harry Reid Wants for Christmas Is Health Care: Albert HuntBloomberg - (November 30, 2009)

The only way to get any Republican -- Maine’s Olympia Snowe and perhaps a couple others -- is to drop the public option and accept a so-called trigger in which a government plan takes effect only if health-insurance companies don’t meet certain targets on cost and coverage. Liberals say this would be a sellout to the insurance industry. Actually, the Urban Institute, a well-regarded Washington-based research group, said in a report last week that a serious trigger would be more effective than the pallid public option in the Reid bill.


Disparity exists between Medicare spending upstate vs. New York CityDemocrat and Chronicle - (November 29, 2009)

An across-the-board cut in Medicare payments to entire regions isn't likely, according to Stephen Zuckerman, a health economist at the Urban Institute.

"That would penalize all providers in those areas and the patients equally," Zuckerman said. "It may be that all the providers are not responsible for high spending. I think the Institute of Medicine study is going to try and sort out the issue."


Senate debate to address inequality in Medicare costs, Press and Sun-Bulletin - (November 28, 2009)

An across-the-board cut in Medicare payments to entire regions isn't likely, according to Stephen Zuckerman, a health economist at the Urban Institute.

"That would penalize all providers in those areas and the patients equally," Zuckerman said.

"It may be that all the providers are not responsible for high spending. I think the Institute of Medicine study is going to try and sort out the issue."


Paper: Trigger best option for reformPolitico - (November 25, 2009)

The paper, from the Washington-based Urban Institute, offers a fresh look at the whole public option debate, casting the issue as “one of fiscal conservatism” — more about containing health costs than extending benefits to the uninsured.

“I would rather have a hard trigger to a strong public plan than settle for a weak plan now that is doomed to fail,” Robert Berenson, one of the three authors, told POLITICO. And this staggered approach, he argued, could also allow more time to learn from the promised experimentation in new payment systems and the comparative-effectiveness research.

“If we need to trigger a public option because health care costs are continuing to rise out of control,” he said, “a good one in five years would be able to learn from the results of these pilot programs and apply the lessons learned.”

The ideas in the Urban Institute paper could be controversial in themselves. But given the political situation, the paper is highly relevant, both because it rethinks the public option debate from the standpoint of cost containment — a goal for moderates — and because it builds on Snowe’s trigger approach with what some Democrats might welcome as a harder, more cleanly defined alternative.

John Holahan and Stephen Zuckerman, two economists at the Urban Institute, co-authored the paper with Berenson, an institute fellow who oversaw Medicare expenditures for the last years of the Clinton administration. A trained physician, Berenson now serves on the Medicare Payment Advisory Commission, or MedPAC, and emphasized that he was speaking only for himself and not the commission.

“An advantage of using growth in national health expenditures (NHE) is that the data are regularly and consistently reported and are directly related to the purpose of a public option … to reduce health spending growth,” the authors write. “Because of annual variations, the trajectory of NHE might be constructed on a rolling-average, perhaps three year basis.”

In this context, the paper notes that major health industry stakeholders set a goal earlier this year of slowing the growth in spending by a 1.5 percentage point, a one-fifth reduction in the growth rate. The specific targets would have to be adjusted to reflect the passage of reform measures expanding coverage. But the authors argue that this background “provides a strong rationale for tying the triggering event to failure to meet a criterion based on the growth in national health care spending per capita.”

“Taking a strong public option off the table may be necessary to enact reform,” the authors concede in their conclusion. “But it will, at a minimum, increase government costs. In addition, it will eliminate the potential payer with the largest market power from exerting cost containment pressure on providers.”


Health care bills would raise taxes well before changes roll out, The Miami Herald - (November 25, 2009)

"You want to fully finance these reforms, so there's no reason not to start raising money," said Linda Blumberg, senior fellow at Washington's Urban Institute Health Policy Center, a center-left research group.


Health Reform's Impact on Premiums: Winners, Losers And, For Many, A Question MarkKaiser Health News - (November 25, 2009)

To be sure, without passage of any legislation, insurance premiums for employers and individuals are projected to continue to rise faster than inflation for the foreseeable future. As a result, more employers, especially small ones, would be likely to drop coverage, while others would continue to raise the amounts workers pay toward premiums and out of pocket costs, a study by the Urban Institute found. Under current law, the Commonwealth Fund estimates that the average cost of a family plan offered by employers, large and small, would approach $24,000 by 2020, up from about $13,000 now.


How to blend health billsThe Palm Beach Post - (November 24, 2009)

"The Urban Institute predicts that in the absence of reform, the costs of uncompensated care will double in 45 states over the next 10 years, and the number of uninsured could grow by more than 30 percent in 29 states," said a recent article in The New England Journal of Medicine. "Voting for the status quo may be politically tempting, but it won't stop the steady erosion of coverage in the United States … When many people lack insurance, everyone's access to care is compromised."


JPS plan would use Medicaid loophole to gain more federal moneyStar-Telegram - (November 22, 2009)

Those efforts, while seen by some as abuses at the federal level, are legal and often help healthcare providers capture revenue needed to provide more care to Medicaid and charity patients, said Teresa Coughlin, a senior fellow at the Urban Institute, a Washington, D.C.-based nonprofit that conducts research on economic and social policies.

She said JPS’ effort to bring in additional federal money is "clever."

"I’m sure the way they are doing it is legal, even though it goes against the spirit of the UPL arrangement," Coughlin said. "They are trying to make private nursing homes into quasi-public agencies to circumvent the regulations that say there has to be two UPL payments to public and private nursing homes. It’s smart."

She said loopholes in the system allow for arrangements such as the one JPS is proposing.

"If you’re a Texan, you want your state to be clever so that another state like Ohio doesn’t capture those dollars," Couglin said. "But it certainly is the kind of thing that gives Medicaid a bad name as a program out of control."


Reid pushes for votes on health-care billThe Washington Post - (November 20, 2009)

"This is an example of a weak version of the public option, and it raises the question: Why are we doing this at all?" said John Holahan, director of the Health Policy Research Center at the liberal Urban Institute. "If your goal is cost-containment and lower government subsidy costs, this isn't working, and the CBO is telling them that."


Primary-care doctor crunch offers no quick fixMarket Watch - (November 19, 2009)

"We have an undersupply of physicians willing to be generalists, and that's largely primary care but not just primary care," said Robert Berenson, a fellow at the Urban Institute. "There aren't enough general surgeons either."


Democrats' family feud could sink U.S. health-care reformThe Globe and Mail (Canada) - (November 19, 2009)

“There are lots of different revenue options and they all have strong constituencies that will fight to the death to stop them,” noted Linda Blumberg, a senior fellow at the Washington-based Urban Institute's Health Policy Center.


Business owners want change in health care, but differ on what kindQuad-City Times - (November 18, 2009)

But the current system is inherently unfair, countered Linda Blumberg, a senior fellow and economist with the Urban Institute, a nonpartisan economic and social policy research organization based in Washington, D.C. The virtual monopolies held by a small number of insurance providers and massive, consolidated hospital systems make it impossible for small-business owners to get a good deal, she said.

"We have a situation where we don’t have competitive health insurance markets today," she said. "What happens is big, consolidated health systems know that the big insurer in town can’t sell their product if their system is not included, and the insurer cannot ask them for decreased rates. With no competitive networks in most metro areas, this means you’ve got two big gorillas and instead of butting heads, they shake hands and pass the cost on to consumers."

A public option, Blumberg said, has strong potential for increasing competition.

"If you take a public option and put it in place, then it can impose lower rates on hospital systems," she said. "With strong incentives from providers to participate, then what you’ve got is a lower-cost competitor in many of these markets. We anticipate, then, the private insurers will now have a real competitor to deal with and can go back and negotiate with providers to get them to lower payment rates."


Health Overhaul Sparks Debate On Future Of Children's Health ProgramKaiser Health News - (November 17, 2009)

According to preliminary estimates from the Urban Institute, about 60 percent of children in CHIP would, along with their parents, receive coverage in the exchanges. Children in families with incomes up to 150 percent of the federal poverty line - about $33,000 a year for a family of four - would go into an expanded Medicaid program. In addition, the House bill would require states that now cover CHIP children through their state Medicaid programs to continue to do so, regardless of a family’s income.

If CHIP enrollees moved into exchanges face higher co-payments for doctor’s visits and prescriptions, their families might not enroll in the exchanges or use the benefits, said Stan Dorn, senior research associate at the Urban Institute. "The research in pretty clear: With low-income families if you charge more per visit people go without necessary services because they just can’t afford it," Dorn said. "The benefits would be there in theory but not in reality because it’s not affordable to them."


Dems’ Health Bills Keep Medicaid Funding Flaw IntactThe Washington Independent - (November 17, 2009)

"From time to time, we’re going to have these economic downturns," Stan Dorn, senior health policy researcher at the Urban Institute, said last week during a kids’ health forum on Capitol Hill. "Rather than react in the same panicked way every single time, is there a way we can rethink how we structure the underlying program?"

Dorn endorsed that approach, arguing that such a mechanism would "provide automatic counter-cyclical relief so that when state conditions decline, federal help is forthcoming, and when state conditions improve, federal help retracts."

"Not only would that help states," Dorn added, "it would mean that federal dollars, which are in short supply, ... would be much more closely targeted to need."

In the eyes of many experts and advocates, even if the House reimbursement changes don’t pass as part of the final bill, the expansion of Medicaid represents a step in the right direction. "As bad as Medicaid reimbursement is, it’s better than zero," Dorn said. "For low-income folks, it will certainly be better than being uninsured."


Socialist Nightmare Might Make U.S. HealthierBloomberg.com - (November 17, 2009)

As the health-care debate moves to the Senate, before the pundits start waving the specter of socialism again, it’s useful to take a look at a study for the Robert Wood Johnson Foundation and the Urban Institute.

"In light of the fact that the United States spends twice as much per person on health care as its peers, those who question the value for money obtained in U.S. health expenditures are on firm footing," the authors concluded. "Faced with the evidence, one might well ask why it is that assertions of the superiority of U.S. health care are so common."


House health bill includes Medicaid relief for statesThe Washington Post - (November 16, 2009)

John Holahan, a Medicaid expert at the Urban Institute, said that if it had not come up in the course of health-care legislation, it probably was only a matter of time before Congress would have had to address the end of Medicaid stimulus funding.

"When we got into 2010, there was going to be a lot of talk about a need for more stimulus. I guess maybe to avoid that they put it in here," Holahan said. "It was going to come up somehow, we're going to be looking at high unemployment and swollen Medicaid rolls beyond 2010," he said.


Hospital profits plunged in '08, but for different reasons than expected: AHAModern Healthcare - (November 16, 2009)

Given the magnitude of economic upheaval in 2008, Urban Institute Senior Fellow Stephen Zuckerman said hospitals seemed to have done well in weathering the recession, apart from the massive investment losses, which had already begun to turn positive again in 2009.

"You look at this picture, it doesn't look that dramatic to me," Zuckerman said.

"Hospitals have always been pretty creative. They've faced financial challenges in the past, and have been able to reorganize the ways they do things and adjust their staffing," Zuckerman said. "You can't approach this in terms of thinking that hospitals' costs are a given and their margins only fluctuate as revenues fluctuate. In fact, the expenses that a hospital incurs are very much in their power to change."


Experts: CHIP Repeal Threatens Kids’ CareThe Washington Independent - (November 13, 2009)

Stan Dorn, senior health policy researcher at the Urban Institute, said there are certain advantages to scrapping CHIP. Both Medicaid and exchange plans, for example, would never require congressionalreauthorization - a process CHIP is subjected to every few years, he pointed out. But due to CHIP’s affordability, Dorn said "it’s clear" that kids "are much better off" under CHIP than they would be under private exchange plans.

"It’s not even a close question," Dorn said during a children’s health care forum on Capitol Hill Friday.

Studies suggest Dorn’s concerns are valid. One analysis, conducted by Watson Wyatt Worldwide, an actuarial research firm, found that families living between 175 and 225 percent of the federal poverty level pay just 2 percent or less of treatment costs under CHIP. Under the proposed exchange plans, researchers found, those same families would pay up to 35 percent of their children’s health costs.


S. Florida seniors' coverage may be cut, Miami Herald- (November 13, 2009)

Local congressional leaders are battling for regional protection, but Robert Berenson, a healthcare specialist with the Washington-based Urban Institute, warns that the result won't make everyone happy. ``I'm not saying nobody will feel any pain over this.''

``There's a real geographic food fight on this,'' says Berenson, with different regions having much different interests.

Berenson, of the Urban Institute, believes such bidding could cause the Miami HMOs to come in at 80 percent of the fee-for-service average or perhaps even lower.

``We just need to have a level playing field,'' says Berenson, to make up for the George W. Bush administration, which increased the benefits to the HMOs. ``The insurers right now are making a very handsome profit.''

Berenson is concerned that competitive bidding for Medicare HMOs has never been tried before. He would like to see local demonstration projects before the bidding began.

``I would be surprised if the Senate language holds,'' because the health insurance industry will be battling to stop it.


The Role Young Americans Play in Health Care ReformNightly Business Report - (November 13, 2009)

GERSH: While many important details are being worked out, health care reform will mean big changes for 20-somethings. To begin with, they would be required to buy insurance or pay a fine. Right now one in three are uninsured. Subsidies would offset some of the cost and the premiums would be set so younger workers pay between $2,000 to $3,000 a year. That's roughly one half to one quarter of what older workers would pay. In essence, with more young people buying insurance, their parents will be paying somewhat less. The reason for that, says health expert Stephen Zuckerman is simple.

STEPHEN ZUCKERMAN, SR. FELLOW, THE URBAN INSTITUTE: The group that is having the greatest affordability problems right now are older individuals who are not yet eligible for Medicare.


More criticism of McCarthy's vote on reform, The Bakersfield Californian - (November 11, 2009)

A recent Urban Institute report indicates that unless we enact changes now, those who manage to keep their coverage will pay an even heftier price over the next 10 years, with individual and family spending on health care increasing in California by 46 percent by 2019. Nationally, up to 57 million Americans could find themselves uninsured, including nearly 9 million in California by 2019. And this, according to the report, is the best-case scenario.


Letters, 11/11: Remember the troopsJournalStar.com - (November 11, 2009)

Recent statistics from the American Journal of Public Health and the Urban Institute indicate that nearly 200 Nebraskans will die in 2010 simply because they lack health insurance. Yet all of our congressional representatives oppose meaningful health care reform that would save those lives.


Should Older People Pay More for Health Insurance?The Wall Street Journal - (November 10, 2009)

The big health-care bills in Congress would still allow variation, but the range would be capped. Under the House bill, insurers could charge older people twice what they charge younger people. The Senate bill could allow a ratio of 3 to 1, the WSJ suggests; this Urban Institute report from last month cites congressional proposals for caps as high as 5 to 1.

For example: Under a 2-to-1 ratio, a 20-year-old could pay $2,965 per year and a 60-year-old could pay $5,930 per year, the Urban Institute estimates. Under a 5-to-1 ratio, the 20-year-old’s premium could fall to $1,884 per year, while the 60-year-old’s could rise to $9,420.


Healthcare reform bill wouldn't end higher premiums based on ageThe Los Angeles Times - (November 9, 2009)

"There's no argument that healthcare spending for older adults is substantially higher than younger adults," said Linda Blumberg of the Urban Institute, a Washington think tank that has studied the matter. "The issue is how we want to distribute those costs."

For example, according to a recent Urban Institute study, if the age-rating ratio were set at 2 to 1, a typical 58-year-old policyholder would pay about $5,900 a year for health insurance. If the age rating were 4 to 1, the premium could jump to $8,650.

But Blumberg says young people are more likely to benefit from the government subsidies to buy insurance that will be offered to those who make incomes slightly above the federal poverty level, reducing the overall cost to them.

Meanwhile, depending on the ratings, older people could have both higher costs and higher out-of-pocket expenses because they are more in need of services.

"It really is a double whammy as you get older," Blumberg said.


D.C.'s 'Failure To Launch' National Health Care PolicyRasmussen Reports - (November 8, 2009)

As health care expert Steve Zuckerman of the Urban Institute noted, putting young adults on their parents' policies mean more premiums for insurers to cover a group that has pretty low claims.

"It's a way to get people to have coverage, but without the federal government picking up the tab," noted Zuckerman. But that does not mean there is no cost -- only that employers or employees will have to pay the added cost.

This is where a proposal by the Senate Finance Committee, chaired by Sen. Max Baucus, D-Mont., to sell low-premium, high-deductible "young invincibles" policies to young adults comes in handy. As Time Magazine reported, such policies "do not constitute full coverage." But if crafted correctly, Zuckerman told me, "the young-invincibles plans could be a good option."


House passes health insurance reform bill on close vote, 220-215The Kansas City Star - (November 7, 2009)

"It’s pretty significant," said John Holahan, director of the Health Policy Research Center at the nonpartisan Urban Institute, speaking about the House bill. "Nobody’s going to get a bill that they like every aspect of. It would do the country a lot of good."


Age-Rating: Arcane Issue to Effect Costs for Young, Middle-AgedThe Baltimore Sun - (November 7, 2009)

"There's no argument that healthcare spending for older adults is substantially higher than younger adults," says Linda Blumberg of the Urban Institute, a Washington think-tank that has studied the matter. "The issue is how we want to distribute those costs."

For example, according to a recent Urban Institute study, if the age-rating ratio were set at 2 to 1, a typical 58-year-old policy-holder would pay about $5,900 a year for health insurance. If the age rating were 4 to 1, the premium could jump to $8,650 a year.

But Blumberg argues that young people are more likely to benefit from the government subsidies to buy health insurance that will be offered to those who make incomes slightly above the federal poverty level, reducing the overall cost to them.

Meanwhile, if the rating bands are extreme, older people will have both higher costs and higher out-of-pocket expenses because they are more in need of services. "It really is a double whammy as you get older," Blumberg said.

Younger people, she argues, should pay a greater share of the expense, knowing that eventually they will take advantage of the same framework. "If they have to pay a little bit more now in the future, they're going to reap the benefits of knowing they have stable coverage at an affordable price that they can plan for," Blumberg said.


National health care reforms will impact college students’ coverageThe Columbia Spectator - (November 6, 2009)

These figures are unsurprising given the confidence young people have been shown to have in their health. A June 2008 report by the Urban Institute, a Washington, D.C.-based think tank, showed that 70 percent of adults aged 27 to 64 strongly believe health insurance is necessary, while only 48 percent of those aged between 19 and 26 do.

International study shows UK GPs rate improvements to their health service highestGuardian News - (November 5, 2009)

In a speech to the Urban Institute in Washington, Burnham said radical challenges facing the NHS: "will mean spending less in hospitals and more closer to the patient's home. It will mean changes to services on a scale not seen before in its 61-year history, which will raise another difficult public debate.


NHS targets imply "lack of trust in staff"Nursing In Practice - (November 5, 2009)

"Targets drove the system hard and were the right thing to do," said Mr. Burnham, speaking to public policy think tank the Urban Institute. "But we have come to learn that the top-down approach can only take you so far.


Unhealthy America, The New York Times - (November 4, 2009)

Yet another study, cited in a recent report by the Robert Wood Johnson Foundation and the Urban Institute, looked at how well 19 developed countries succeeded in avoiding "preventable deaths," such as those where a disease could be cured or forestalled. What Senator Shelby called "the best health care system" ranked in last place.


Finding a healthy compromise, Highland Ranch Herald - (November 2, 2009)

Young adults are uninsured for a variety of reasons. According to a 2008 study by the Urban Institute, young adults are less likely to work for employers who offer coverage; they may not qualify for public programs such as Medicaid; and even the leanest private insurance plans may be too expensive when combined with student loan payments and credit card debt.


Lieberman: The ExplanationThe Washington Independent - (October 28, 2009)

Researchers at the Urban Institute this year described the trend, starting with the observation that "insurer and hospital markets are increasingly dominated by large insurers and provider systems."


Barbour’s Medicaid Letter a Half-Truth?Jackson Free Press - (October 28, 2009)

And though Barbour may condone dodging the potential price increase of health-care reform now, ducking the overall price increase of health care in the future will be more difficult without some form of reform. In 10 years, the number of people without health insurance will increase by more than 30 percent in 29 states, according to a study by Washington D.C.-based think tank The Urban Institute.


Jobless lose healthcare coverage, tooThe Cheiftain - (October 28, 2009)

Families USA released the numbers recently in the report "One-Two Punch: Unemployed and Uninsured." The report is based on a model created by economists at The Urban Institute.


Health Care Pools: Let Youth Jump, Or Push Them?NPR - (October 27, 2009)

But the insurance industry is leaving out a critical element, says Linda Blumberg, a researcher at the Urban Institute. She says the current health overhaul bills all provide subsidies for lower income Americans, and "the young adults tend to be lower income, so they really are buffered a great deal from the full impact."

Blumberg is worried more about middle-income older Americans - those between 55 and 64 years old. Discounts for younger people mean "surcharges" for older ones - and those older adults are less likely to qualify for a government subsidy.

"More than half of individuals in that 55- to 64-year-old age group with incomes between 400 and 500 percent of the federal poverty level would have household health care financing burdens of 20 percent," she says.

What Blumberg's saying is that my mom - before she retired - would have ended up spending 20 percent of her income to buy health insurance. And because she earned too much to qualify for a government subsidy, she would be - as she says - "up a creek."


A Closer Look at the UninsuredNational Review Online - (October 26, 2009)

After adjusting for the Medicaid undercount, Urban Institute researchers John Holahan, Allison Cook, and Lisa Dubay determined that in 2004, fully one-quarter of the nonelderly uninsured were eligible for Medicaid or CHIP, and another 19 percent belonged to families earning 300 percent or more of the FPL. Nearly three-quarters (74 percent) of uninsured children were eligible for Medicaid or CHIP (as were 28 percent of uninsured parents), and another 15 percent had family incomes equal to 300 percent or more of the FPL. This means that only 11 percent of uninsured children were both ineligible for government coverage and living in families with incomes below 300 percent of the FPL. These children - the 11 percent - were disproportionately Hispanic (42 percent), and the vast majority (77 percent) belonged to families earning between 200 and 299 percent of the FPL.

To be sure, estimates of how many Americans are "voluntarily" or "involuntarily" uninsured will fluctuate depending on methods and assumptions. The Urban Institute study - conducted for the Kaiser Commission on Medicaid and the Uninsured (KCMU) - designated 300 percent of the FPL as the affordability threshold for insurance coverage. Economists June and Dave O’Neill of Baruch College believe a more appropriate threshold is 250 percent. The O’Neills calculate that in 2006, roughly 43 percent of all uninsured individuals between the ages of 18 and 64 had family incomes greater than this level - and thus were "voluntarily uninsured," because they appeared to have "enough disposable income to purchase health insurance."

Whether we use 250 percent or 300 percent as the affordability line, those uninsured by necessity, rather than by choice, constitute a significantly smaller group than 46 million. Their numbers shrink even more when we remove noncitizens. A KCMU/Urban Institute analysis notes that in 2008, 20 percent of the nonelderly uninsured were not American citizens, and nearly half (46 percent) of all nonelderly noncitizens lacked health insurance.

Which brings us to the much-ballyhooed "free rider" dilemma. There is no question that uncompensated health care received by the uninsured has contributed to escalating costs throughout the system; but the magnitude of that contribution remains unclear. A recent KCMU study conducted by Urban Institute researchers Jack Hadley, John Holahan, Teresa Coughlin, and Dawn Miller estimated that in 2008, uncompensated care represented nearly two-thirds of the dollar amount of all uninsured care. But the same study also found that uncompensated care accounted for only 2.2 percent of America’s total health-care spending. "Between 1986 and 2005," it noted, "the share of [hospital] expenses going to uncompensated care remained remarkably steady, with a mean of 6 percent and a range from 6.4 percent in 1986 to 5.4 percent in 2002."


Small Group Health Carriers Draw Fire At HearingNational Underwriter - (October 20, 2009)

Linda Blumberg, a senior fellow at the Urban Institute, Washington, testified at the hearing that only about 36% of employers with fewer than 10 workers offered health benefits in 2008, compared with almost 99% of employers with 1,000 or more workers.

At employers where at least half of the workers earned low wages, only 18% of the smallest employers offered health benefits in 2008, compared with 98% of the large employers with high concentrations of low-wage workers, Blumberg said.

The gap is growing, because most large employers have kept their health benefits programs, but employers with fewer than 10 workers were 10% less likely to offer health benefits in 2008 than in 2000, Blumberg said.

The National Health Insurance Exchange system proposed in H.R. 3200, the House health bill, would help small employers, by helping them get standardized plans without the kinds of underwriting rules that now prevail, Blumberg said.

The exchange system would prohibit preexisting condition exclusion periods, limit the difference between the rates charged for the oldest insureds and the youngest, and prohibit insurers from considering health status, gender or industry of employment when setting rates, Blumberg said.

The health exchange system also could cut administrative costs, including marketing costs, Blumberg said.

She cited Congressional Budget Office estimates that administrative costs account for just 7% of premiums for the largest groups and up to 30% of premiums individuals and small groups.

"For example," Blumberg said, according to the written version of her testimony, "insurers typically pay agent commissions of 10% of the first year’s premium in the small-group market."

In Massachusetts, that state’s health insurance exchange pays agent commissions equal to just 1.3% to 3.3% of premiums, Blumberg said.


Finance reform bill would tax higher-premium health plansAmednews.com - (October 20, 2009)

Stephen Zuckerman, PhD, an economist at the Urban Institute, said the excise tax definitely would encourage workers to limit their health spending. But he said instituting the tax is a much more indirect way of doing so than is limiting the tax exclusion.


Lawmakers to Fight for Rural Hospitals Despite Budget Concerns On ReformKaiser Health News/Politico - (October 19, 2009)

Some experts say that the waiver process led to a subversion of the intent of the 1997 legislation, which was to create a small number of critical access hospitals in isolated areas to stabilize patients and then transfer them to larger hospitals. "Over time, it's become clear that the concept has changed, so it looks like almost any rural hospital is being considered as a critical access hospital, with no longer the expectation the patient will be transferred," said Robert Berenson, a former Medicare official who is now at the Urban Institute.


Medicare pricing gets new look; RUC process revisitedAmerican Medical News - (October 19, 2009)

But Robert A. Berenson, MD, a commission member and senior fellow at the Urban Institute, warned that fixing the fee-for-service system should not be ignored as such new options are examined.

"You've got to keep working on fee for service, because those other things will take a long time to develop," Dr. Berenson said. "What I heard was a general agreement that while you're working on more fundamental reforms, you also need to get prices right, and there was concern expressed about what happens when you get prices wrong."


Lawmakers to Fight for Rural Hospitals Despite Budget Concerns On Reform, Kaiser Health News - (October 19, 2009)

Some experts say that the waiver process led to a subversion of the intent of the 1997 legislation, which was to create a small number of critical access hospitals in isolated areas to stabilize patients and then transfer them to larger hospitals. "Over time, it's become clear that the concept has changed, so it looks like almost any rural hospital is being considered as a critical access hospital, with no longer the expectation the patient will be transferred," said Robert Berenson, a former Medicare official who is now at the Urban Institute.


Studies: Alabama system is unhealthyMobile Press-Register - (October 19, 2009)

That second study - titled, "The Cost of Failure to Enact Health Reform," and produced by the Urban Institute — takes no position on the overhaul bills moving through Congress, but assumes that the status quo remains in place.


Health bills target young-old cost gapThe Washington Times - (October 18, 2009)

"It works both ways," said John Holahan, director of the health research center at the Urban Institute. "They're disadvantaged with the more you move away from [the current price] rating, but more advantaged with income subsidies."


Why Doesn't Bredesen Ever Talk About the Cost of Not Fixing Health Care?Nashville News - (October 18, 2009)

A new study by the Health Policy Center at the Urban Institute, a pro-reform group, breaks it down state by state, and it isn't pretty. According to the report's worst-case scenario, the number of people without insurance would increase over the next decade by more than 30 percent in 29 states, including Tennessee, and businesses would see their premiums double in 27 states, again including Tennessee.


Insuring young adults takes center stage in health care debateThe Mercury News - (October 17, 2009)

While 31 percent of young adults (ages 19-29) have no insurance, only 17 percent of adults ages 30-64 are uninsured. Young adults comprise about 18 percent of the adult population but make up 28 percent of the overall uninsured adult population, according to the Urban Institute.


Cost is too high if we fail to enact reformEast Valley Tribune - (October 16, 2009)

When it comes to health care, the status quo is failing American families. Too many insurance company denials. Suffocating costs. Too many uninsured. But if Congress fails to enact reform, things won’t just stay the same - they’ll get worse. And a recent report released by the nonpartisan Urban Institute underscores just how much worse things will get for our state.

The Urban Institute report indicates that unless we enact changes now, those who manage to keep their coverage will pay an even heftier price over the next 10 years, with individual and family spending on health care increasing by 23.8 percent in Arizona by 2019. Nationally, up to 57 million Americans could find themselves uninsured. And this, according to the report, is the best-case scenario. In Arizona alone, delaying health care reform would hit our communities hard, with the estimated number of uninsured in Arizona skyrocketing to 1.64 million.


Push for Healthcare Reform, Human Resource Executive - (October 16, 2009)

There are two problems with this scenario. First, it's not that likely employers will discontinue administering healthcare plans. An evaluation of the results of the Massachusetts pay-or-play requirement for employers after two years of the program showed a net increase in employers providing coverage, even though the penalty to drop it was very modest, according to a study released in September by the Urban Institute.


Staggering health price hikes loom, Triangle Business Journal - (October 16, 2009)

The Urban Institute, a nonpartisan social and economic research organization, analyzed growth and spending trends and estimated best-, intermediate- and worst-case scenarios for health-care costs if the health-care system remains as it is.


An ailing picture of health care in TexasHouston Chronicle - (October 15, 2009)

Not only does the Lone Star State lead the nation in its uninsured population, adults and children alike, but the percentage of residents without health coverage could balloon from 27.5 percent to as much as one-third of the population in the next 10 years, a new study by the Robert Wood Johnson Foundation and the Urban Institute predicts.

Texas minorities are hit hardest. Eight of the 15 U.S. congressional districts with the highest rates of uninsured residents are in Texas, according to a new Urban Institute analysis, and all have substantial Latino or African American populations.

What's more, the studies find that health care in Texas is not deteriorating as rapidly as in most other states. Over the next decade, according to the new Robert Wood Johnson Foundation/Urban Institute study, Florida, battered by recession and real-estate woes, may threaten the Lone Star State's dubious distinction as the leader in uncovered residents.


State survey: 97.3 percent insured, 171,000 uninsured, stark disparitiesSharon Advocate - (October 15, 2009)

The survey of 4,910 Massachusetts households, conducted by the Urban Institute between March and June, comes with a 1.54 percent margin of error.

Sharon Long, one of the Urban Institute researchers who authored the survey, said the report shows "remarkable stability" between 2008 and 2009. Long noted that disparities in insurance rates for Hispanic, low-income and disabled residents are mirrored across the country.


13,200 Mainers Lost Health Coverage In 2009 Due To Increased UnemploymentMedical News Today - (October 15, 2009) 

The Families USA report "One-Two Punch: Unemployed and Uninsured," is based on a model created by economists at The Urban Institute. The Institute's formula shows that for every percentage point increase in the seasonally adjusted unemployment rate, the percentage of uninsured working-age adults grows by 0.59 percentage points.


State survey finds 97% with health insurance, Martha's Vineyard Times - (October 15, 2009)

The survey of 4,910 Massachusetts households, conducted by the Urban Institute between March and June, comes with a 1.54 percent margin of error.

Sharon Long, one of the Urban Institute researchers who authored the survey, said the report shows “remarkable stability” between 2008 and 2009. Long noted that disparities in insurance rates for Hispanic, low-income and disabled residents are mirrored across the country.


BUREAUCRATIC ACTIVISM IN NEVADA: Regulating child care out of financial reach, LasVegas Review-Journal - (October 15, 2009)

For low-income parents especially, according to the Urban Institute's groundbreaking National Child Care Survey, quality most often had to do with whether providers are warm and loving, reliable and experienced with children. Highest quality, here, often means a trusted relative.


What Congress Plans for the Young and UninsuredThe New York Times - (October 14, 2009)

Another big hurdle is convincing this age group that coverage is even necessary — that they are not invincible, after all. Less than half of those aged 19 to 26 strongly agree that health coverage is necessary, according to a June 2008 Urban Institute survey (pdf). The Finance Committee bill tries to compensate for this attitude by levying a penalty: $750 by 2017 against all Americans, including young adults, who choose to go without health insurance.


Most in Mass. still rely on employer for insuranceAssociated Press - (October 14, 2009)

The telephone, Internet and mail survey, conducted between March and June by the Urban Institute, found more than 97 percent of state residents are now insured. The margin of error was plus or minus 1.5 percentage points.


Job Losses Add 28K Uninsured In State, The Hartford Courant - (October 14, 2009)

The projections used a formula developed by the Urban Institute to measure loss of coverage based on the rising unemployment rate.


Health insurance coverage rates holding steady, Boston Globe, White Coat Notes blog - (October 14, 2009)

The study, conducted by the Urban Institute on behalf of the state's Division of Health Care Finance and Policy, indicated that roughly the same number of people had health coverage through work this year as last year, despite widespread layoffs.


Study: Cost higher if health reform fails, study saysHouston Chronicle - (September 29, 2009)

“People worry about losing what they have now, but they need to remember that what they have now is likely to change,” said Bowen Garrett, a senior researcher with the Urban Institute's health policy center, which conducted the study for the foundation. “Many who have employee-sponsored insurance will lose it as health care costs go up, and those fortunate enough to keep their plans will pay higher out-of-pocket costs or earn smaller wages as employers decide whether to cut on wages or benefits.”


Study shows Minnesota has a lot to lose if efforts at federal health care reform failPioneer Press - (September 29, 2009)

"People may think they have health coverage now and that they're happy with it. The problem is, the status quo is changing," said Bowen Garrett, a senior research associate with the Urban Institute who led the study. "Many people who have coverage through their employers now may lose that coverage. Those that continue to have coverage will pay more out of pocket."

Garrett said his projections underestimate the number of uninsured in Minnesota if the general assistance medical program is cut as scheduled next year. However, the projections would then overestimate the growing cost of the state's Medicaid budget. In the worst case, the report predicts Minnesota's Medicaid spending would increase from $3.8 billion in 2009 to $8.6 billion in 2019.

One advantage for Minnesota is the number of people employed by large companies, which are able to maintain their benefits, Garrett said. In the worst case, the share of Minnesotans with employer-based health coverage would drop from 66 percent to 61 percent. In the best case — assuming an uptick in employment and the economy — that number would remain stable.


Study: Without health care reform, cost would be substantialABC15.com - (September 29, 2009)

The study, commissioned by the Robert Wood Johnson Foundation along with Health Policy Center at the Urban Institute, states that by 2014 the number of Arizonans without insurance will increase by nearly 25 percent.


Going Red Over Health CareRealClearPolitics - (September 24, 2009)

"It's not a nationally uniform problem," says Steve Zuckerman, senior fellow at the Urban Institute and an expert on Medicaid. Because there has to be a greater improvement in coverage in the South and West, Zuckerman says, "there will be a geographic redistribution."

The low rates of coverage in the South and West result from low rates of employer-based insurance, Zuckerman says. Meanwhile, these states are also less likely to have tried to close the gap with Medicaid. They historically have imposed tight income restraints and other eligibility barriers to the joint federal-state program for low-income people. In Texas, a working parent must have an annual income below 27 percent of the federal poverty level -- that amounts to $5,953.50 for a family of four -- in order to qualify for Medicaid, according to the Kaiser Family Foundation.


Baucus Aims to Increase Affordability in Senate Health Care PlanPBS.org, Online NewsHour - (September 22, 2009)

But Linda Blumberg, a health economist at the Urban Institute think tank, says that the amendments don't go far enough, because the combination of premiums and out-of-pocket costs is still too high.

Blumberg believes those numbers don't hit the affordability bar.

"These are improvements that [Baucus has] made, but in my opinion we can do more. There doesn't seem to be a strong political will for spending more money, and that's what you need to do."


Health insurer tax not what it seemsCNNMoney.com - (September 22, 2009)

"That's going to be built into the base price," said Steve Zuckerman, a senior fellow in health care policy at the non-partisan Urban Institute.


Young, Invincible — and the Key to Health-Care ReformTIME Magazine - (September 22, 2009)

While the Senate Finance Committee's bill would not allow insurers to annually cap benefits, many health-policy experts warn that the young-invincible policies do not constitute full coverage. "If you're sick, you're not going to want this policy," says Linda Blumberg, a health-policy analyst at the Urban Institute. The only health services that would be covered before a young invincible reaches his deductible would be preventive care, which would only be partially paid for. A bronze policy, by contrast, would cover 65% of total health-care costs, while covering 100% of preventive care.

Still, convincing a critical mass of young adults to sign up for health insurance may not just be a question of affordability. In a June 2008 survey by the Urban Institute, just under half of Americans age 19 to 26 said they "strongly" agreed that health insurance is needed, compared to 70% among the entire population. In other words, the real challenge might be getting young invincibles to understand they're not actually invincible.


Massachusetts leads health coverage - CensusCNNMoney.com - (September 21, 2009)

Overall, "there are a lot of pieces to the state variation," said Sharon Long, senior fellow at the Urban Institute's Health Policy Center. She said that Medicaid eligibility standards vary widely from state to state, with Massachusetts being more "generous" than most.

She said that areas with lots of educated people tend to have lower percentages of uninsured, since they tend to seek out jobs that offer insurance. Also, some areas might have corporate employers that offer insurance, while others do not.

"If you've got large manufacturing populations and large firms, they offer health insurance coverage," Long said. "If you have a small business-based economy, they're less likely to offer it. Retail firms are less likely to offer it."

Nationwide, the average percentage of the uninsured was 15.4% in 2008, or 46.3 million, according to Turner of the Census Bureau. The uninsured population rose from 45.7 million in 2007, but percentage was unchanged at 15.4%, she said.


Baucus Plan Ignores Republicans and DemocratsThe D.C. Writeup - (September 17, 2009)

Republicans do not want the government to mandate insurance because it places an additional burden on young healthy Americans who do not need an extensive insurance package. Democrats insist that young Americans are imperative to funding the plan, hoping that the additional costs to young Americans will help pay for the increased need for older and sicker Americans. Younger Americans will face a minimum of $100 a month for the most basic coverage some insurance experts suggest; strapping a significant new expense to many Americans just starting out in the work force. Linda J. Blumberg, a health care expert from the Urban Institute says that requiring people obtain insurance is merely a “mechanism for financing health care reform.”


CBO: Baucus healthcare plan would cut deficitChristian Science Monitor - (September 16, 2009)

That healthcare reform could actually save money doesn’t surprise some observers. “It’s not hard to imagine,” says John Holahan, director of the health policy group at the Urban Institute. “You can easily get there.”


Health care: Ron Wyden's cost concernsThe Oregonian - (September 16, 2009)

That would amount to more than $700 a month for a family of four making $66,000 a year -- significantly more than most people at the same income level now pay, according to research conducted by Linda Blumberg, a senior fellow in the Health Policy Center at the Urban Institute. Families earning less than 300 percent of the poverty level also would be eligible for assistance with deductibles and other out-of-pocket expenses, but families who earn more would be on their own.

"That group does spend in the neighborhood of 12 percent of their income. But it's not just the premium. It includes out-of-pocket spending," Blumberg said, adding that the Baucus plan "is going to be somewhat of a wakeup call."


Reform Bill Will Address GOP FearsThe Washington Post - (September 15 2009)

That would amount to more than $700 a month for a family of four making $66,000 a year -- significantly more than most people at the same income level now pay, according to research conducted by Linda Blumberg, a senior fellow in the Health Policy Center at the Urban Institute. Families earning less than 300 percent of the poverty level also would be eligible for assistance with deductibles and other out-of-pocket expenses, but families who earn more would be on their own.

"That group does spend in the neighborhood of 12 percent of their income. But it's not just the premium. It includes out-of-pocket spending," Blumberg said, adding that the Baucus plan "is going to be somewhat of a wakeup call."


Private health system failing its peopleKnoxville News Sentinel - (September 14, 2009)

Yet, under the present privately run health system — the greatest in the world, proponents claim — lack of insurance causes tens of thousands of deaths every year. The Urban Institute put the number at 22,000 fatalities in 2006, and more and more people are losing insurance every day.


Democrats Target Federal Subsidies for Medicare's Private PlansKaiser Health News - (September 9, 2009)
Robert Berenson, a senior fellow at the Urban Institute and a Medicare official during the Clinton administration, said Medicare Advantage patients would be affected by the cuts.

"They will feel pain," he said of Medicare Advantage members. "We need to reduce the overpayments, but to say no one will experience any pain is exaggerating."


Think Tank Round-Up: 30 Percent EditionThe American Prospect, Tapped blog - (September 8, 2009)

There is no government health care takeover. Today, the Urban Institute addressed claims that health care reform would result in a "government takeover" or "socialized" medicine. “Rather than expand government’s role …current proposals leave the practice of medicine firmly in private hands,” the study affirmed. At a time when passions over the future of health care are running high, the study cautions us to form our own opinions, but not our own facts. The study debunks conservatives’ warnings of a government take-over by confirming that proposed reforms are non-radical uses of competition and regulation to expand and improve coverage. – PL


A prescription for bipartisanshipTimes Union - (September 8, 2009)

Regardless of the divisive tone, Congress and the administration cannot afford to get sidetracked. More than one out of seven Americans do not have health insurance. In the absence of meaningful near-term reform, the Urban Institute estimates that an additional 20 million Americans could be without health insurance by 2019. Every day that goes by without action creates more uncertainty, fear and risk.


A health care reform Q&AThe News Journal - (September 8, 2009)

None of the proposals under consideration should be described as socialized medicine, said Stan Dorn, a senior research associate with the Urban Institute, a nonpartisan public policy institute in Washington, D.C. Each includes the creation of insurance exchanges, which are intended to give Americans more options -- nearly all of them through private insurers.

"What's being discussed today is even further from government-run health care," said Dorn, who co-wrote a health policy paper last year on whether the country was headed toward socialized medicine. "What's being discussed today is mostly private. The key point is giving individual consumers choice."


The Problem with Consumerism in Health Care, The 30,000 Foot View, Seattle Post Intelligencer, The Health Retort blog  - (September 8, 2009)

A 2009 review by the Urban Institute of how quality in U.S. compares to other countries concluded "U.S. health care is not pre-eminent on quality."


Health Compromise Floated Before Obama SpeechThe New York Times - (September 8, 2009)

"The idea of a stripped-down benefits package for people who have a good income and choose not to buy health insurance makes a lot of sense," said Stan Dorn, a senior research associate at the Urban Institute. "But a catastrophic insurance policy does not make sense for lower-income people, because they cannot afford medical care short of catastrophic expenses. A catastrophic policy does not cover routine care."


 

"This is definitely going to be a change. It's not health care as usual," said Stephen Zuckerman, a health economist in the Urban Institute's Health Policy Center in Washington.

Safety net hospitals may need help raising money to spruce up and modernize to become more competitive with private hospitals, Zuckerman said. But they won't disappear.

"The capacity they provide to the system is going to be needed," Zuckerman said. "I don't think the rest of the system is ready to absorb the patient population the public hospitals now serve."


Something must be done, The Washington Times - (September 6, 2009)

Delaying action makes the problem worse. A recent Robert Wood Johnson Foundation study by the Urban Institute shows that if the system is not reformed, within 10 years the cost to American businesses for their workers' health care could double.


Obama Ready to Stress Areas of Health AgreementCQ Politics - (September 6, 2009)

A recent Urban Institute analysis projects the uninsured population could swell as high as 57.7 million by 2014 and 65.7 million by 2019 if health costs continue to outpace wage growth. The biggest increase would be among middle-income individuals and families who won’t be able to cover out-of-pocket expenses or those who are dropped from employer plans. Businesses that still can afford to cover workers would be hit with steep premium increases, forcing many to lower wages. Taxpayers will shoulder an added burden, as government expands public safety-net programs like Medicaid and the Children’s Health Insurance Program.


Families, nation wrestle with end-of-life care, Detroit Free Press - (September 6, 2009)

A report released this summer by the Washington, D.C.-based Urban Institute, citing research that as much as 30% of Medicare spending is in the last year of a patient's life, concluded that even a modest reduction of 5% in end-of-life costs -- perhaps by increasing the number of people with advance care directives -- could save the cash-strapped program $90.8 billion in 10 years.

Dr. Robert Berenson, an author of the Urban Institute's study, said friends warned him not to include end-of-life care savings in the report because it would "sound like rationing."


Let's reset the tone in the healthcare debate, The Miami Herald - (September 4, 2009)

Regardless of the divisive tone, Congress and the administration cannot afford to get sidetracked. More than one out of seven Americans do not have health insurance. In the absence of meaningful near-term reform, the Urban Institute estimates that an additional 20 million Americans could be without health insurance by 2019. Every day that goes by without action creates more uncertainty, fear and risk.


Whatever Happened To the Uninsured?Kaiser Health News - (September 3, 2009)

When one sees conservative religious groups beginning to mobilize against health reform because they genuinely believe opposition is "pro-life," it is not an indictment of those groups’ compassion. Rather, it reflects the failure of reform advocates to communicate the stories of real pain suffered day in and day out by neighbors in their own communities. It is a cruel irony that the Urban Institute estimates that 400 Americans die each week because of lack of access to care, yet the imagination of the public has been inflamed by the prospect of "death panels" falsely alleged to be set to deny care to the elderly.


Hospital CEO: Decline in reimbursements linked to higher health premiumsWLOX.com - (September 3, 2009)

Marchand cited a report put out recently by the Urban Institute. It said that of the 45 million uninsured in this country, about 6 million are illegal immigrants, 20 million are childless adults in generally good health, and the other 16 million are parents and children.


The Fix Is In, Slate.com - (September 2, 2009)

Fundamentally, the entire payment model of American health care drives medical centers, doctors, and hospital managers to push for more fancy procedures at the expense of primary care doctors. How'd we get here? Since 1992, Medicare has depended almost entirely on the American Medical Association for guidance on how relative values should be set. In a devastating critique published in the Annals of Internal Medicine, scholars from the Urban Institute and the University of California-San Francisco explained that Medicare uncritically accepted 95 percent of the AMA's recommendations, which are formulated by the group's Relative Value Scale Update Committee, or RUC.


Healing of health care returns to congressional agendaGreen Bay Press-Gazette - (August 31, 2009)

Consolidation among insurance companies and health-care provider markets already has diminished competition in regional markets, said Linda Blumberg, a senior fellow in the health policy center of the Urban Institute in Washington, D.C.

"There's a misperception that it's going to mess things up for competition, but we don't really have competitive markets," Blumberg said. "What you see is the vast majority (of markets) are dominated by a small number of insurers."

The public plan would most likely have to offer rates between what Medicare currently sets in its benefits and what commercial insurance sets to successfully lower overall health-care costs, Blumberg said.

"Private rates are on average more than 30 percent of Medicare (rates), so there's a lot of room in between that you can set the rates for" in a public plan, Blumberg said. "What we've learned from Medicare is that private plans can compete with public plans. The enrollment in Medicare Advantage has grown over the years and continues to grow." However, much of this depends on how the final legislation defines who is eligible for the private-public insurance exchange, Blumberg said.

For example, assuming that only small businesses, the self-employed, low-income families and individuals were allowed to join the plan with a standard benefit package, Blumberg's research estimates that about 92 million Americans would use the exchange, and 47 million would enroll in the public plan. But those details have yet to be hashed out in any one proposal before Congress, meaning all numbers predicting public enrollment are just estimates.


Editorial: Don't settle for triageAsbury Park Press - (August 30, 2009)

A 2008 mortality study in the journal Health Affairs found the U.S. had the highest rate of deaths among 19 countries from conditions that could have been prevented or treated successfully. The Urban Institute released a study this month that found the U.S. performed better than other advanced nations in some areas and worse than in others. The study noted that only 45 percent of Americans thought the U.S. had the world's best health care.


Insurers Poised To Gain From from Health Care Reform, The Hartford Courant - (August 30, 2009)

"They could do very well. What's being proposed is universal or near-universal health care coverage provided through private health insurance plans," said Linda Blumberg, a health policy analyst at the nonpartisan Urban Institute in Washington, D.C. "It would give them a stable pool of insured with less turnover and potentially more enrollees." Federally mandated health insurance, besides bringing more participants to the private insurers, would cut down on administrative costs, Urban Institute's Blumberg said. Just the fact that insurers wouldn't have to assess and rate applicants based on how much they would need medical care would cut down on administrative costs, she said.

"Even without the public plan, some of this would take place," she said.

Marketing costs also would be lower because the marketplace or "exchange" where plans would be offered to individuals and small businesses would shoulder some of the marketing costs, Blumberg said. Blumberg said insurance companies will adapt to the new health care environment regardless of the outcome.

"The big ones that have the vast majority of the market will innovate and become more efficient and provide better care," Blumberg said.


Health care: Young people lack insurance, but also interest in doing something about itChicago Tribune - (August 30, 2009)

But Genevieve Kenney, a health economist at the Urban Institute, a nonpartisan Washington think-tank, disagrees.

"I think many more uninsured young adults stand to gain from health care reform than stand to lose," Kenney said, citing plans in Congress to provide subsidies for low-income people -- many of whom are young -- to purchase insurance. "That's a major step forward for young adults who are poor or near poor," Kenney said.


Taxes too heavyHerald Times Reporter - (August 29, 2009)

One of those things on my plate today is a recent study by the Urban Institute that suggests taxing high-fat foods would make us healthier, or at least provide more money for health care if we decide not to forego those higher-priced burgers and super-sized fries. The study, posted on the Urban Institute's Web site, is called "Reducing Obesity: Policy Strategies from the Tobacco Wars." You guessed it, a main premise is that higher taxes reduced smoking and it'll work for unhealthy food, too. The study points out that:

40 percent of Americans will be obese within the next 10 years if current trends continue;

The obese and overweight suffer chronic illness, poor health and more than 100,000 preventable deaths each year;

Obesity creates more than $200 billion in annual health-care spending, about half of which is borne by taxpayers; and

Private health insurance premiums for non-obese workers are nearly $26 billion higher annually due to obesity-related costs. The Urban Institute's faulty conclusions are accompanied by other outlandish suggestions, like adding traffic-light nutrition labels to the front of food packages and banning advertisement of fattening food in the mass media.


Kennedy: Health Care Loses a ChampionBusinessWeek - (August 27, 2009)

"He had been an absolutely tireless, imposing figure in the efforts to get health care passed over the years," says Linda Blumberg, a health-care analyst with the Urban Institute.


Editorial: All about that public optionThe Standard-Examiner - (August 27, 2009)

Proponents of the public option say that's nonsense, and fear-mongering to boot. A public option plan, they say, will create much-needed competition in the health care industry and force private insurers to lower their rates. In fact, a study by another public policy institute, the Urban Institute, says that taxpayers would save between $224 billion and $400 billion over 10 years with a public option. And they also counter The Lewin Group's assertion that 122.9 million Americans would lose private health insurance with a Congressional Budget Office study that places the figure at a much-lower 9 million.


Down Economy Leaving More Kids Uninsured, WINKnews.com - (August 27, 2009)

Urban Institute


Editorial: World’s Best Health CareThe New York Times - (August 26, 2009)

The emptiness of those claims became apparent recently when researchers from the Urban Institute released a report analyzing studies that have compared the clinical effectiveness and quality of care in the United States with the care dispensed in other advanced nations. They found a mixed bag, with the United States doing better in some areas, like cancer care, and worse in others, like preventing deaths from treatable and preventable conditions.


McCaskill: Health Care Reform Will Reduce CostKMBC-TV  - (August 25, 2009)

The repayment rate, she said, is too low to cover the real costs of treatment. That is one reason she favors health care reform. But an Urban Institute report, released in June 2009, casts some doubt on that assertion.

"Children could gain or lose," states the report, "Depending on how health care is changed."


When Compromise Is KeyExecutive Healthcare magazine, Q3 2009 issue

Reformation of the American healthcare system is not a new concept for Robert Berenson, who has been publishing work on physician payment and healthcare cost containment since 2003. He tells EHM about the need for compromise between private and public payers.


Healthcare insurers get upper handLos Angeles Times - (August 24, 2009)

"The insurers are going to do quite well," said Linda Blumberg, a health policy analyst at the nonpartisan Urban Institute, a Washington think tank. "They are going to have this very stable pool, they're going to have people getting subsidies to help them buy coverage and . . . they will be paid the full costs of the benefits that they provide -- plus their administrative costs."


Competition lacking among private health insurers, The Associated Press- (August 23, 2009)

A study by the Urban Institute public policy center estimated that a public plan could save taxpayers from $224 billion to $400 billion over 10 years by lowering the cost of proposed subsidies for the uninsured, while preserving private coverage for most people.

"Right now, there's no incentive for insurers or big hospital groups to negotiate with each other, because they can pass higher payments on through premiums," said economist Linda Blumberg, co-author of the report. "A public plan would have the leverage to set lower payment rates and get providers to participate at those rates."

"The private plans would come back to the providers and say, 'If you don't negotiate with me, you're going to be left with only the public plan.'" Blumberg continued. "Suddenly, you have a very strong economic incentive for them to negotiate."


Calls to tax junk food gain ground, Los Angeles Times - (August 23, 2009)

A report this summer from the Urban Institute said such taxes are needed to ensure that rising obesity rates don't cause the average American life expectancy to fall for the first time in history.


Editorial: Public option is critical to reform, The Denver Post  - (August 23, 2009)

Publicly run insurance would almost certainly spend less on administration than private insurance. A study by the Urban Institute puts Medicare and Medicaid administrative costs at about 5 percent, while private plans spend about 12 percent.


Junk food tax idea gaining acceptanceUnited Press International - (August 23, 2009)

The Urban Institute claimed in a report this summer that rising obesity rates could cause the American life expectancy to fall for the first time in history.


Why is health care reform a financial issue?Examiner.com - (August 23, 2009)

Job loss due to the recession is a major contributor to the growing ranks of the uninsured. The Urban Institute estimates that the number of uninsured could grow to as many as 66 million American by the year 2019.


Reform is neededDaily Herald - (August 22, 2009)

The Urban Institute claims about 22,000 people a year die in the United States each year for lack of health care. Some of these are people who reject treatment, but everyone has also heard stories of deaths which resulted from insurance companies refusing to pay for a transplant or other expensive procedure.


White anger fueling health care debateMercury News  - (August 22, 2009)

"I think the people who are probably most concerned about any changes relating to health care reform are moderately satisfied, willing to keep the status quo in place," said health economist Stephen Zuckerman, a senior fellow at the nonpartisan Urban Institute's Health Policy Center in Washington, D.C. "And it is the case that minority populations tend to be uninsured, so they have more to gain from reform."


The Best Paper You'll Read TodayThe Washington Post Ezra Kleins blog  - (August 21, 2009)

Elizabeth Docteur and Bob Berenson offer whether American health care really is the "best in the world."


Editorial: Weighty mattersHouston Chronicle - (August 20, 2009)

We're bulging and the problem is growing: Since 1960, the number of American adults classified as obese has nearly tripled, from 13 percent to 35 percent, according to a study for the Urban Institute reported by columnist Rick Casey in last Sunday's Chronicle ("A ‘fat tax' for Texas? Chew on it," Page B1, Aug. 16).


What is wrong with health care reform?, St. Louis Post-Dispatch - (August 19, 2009)

The non-partisan Urban Institute published a study last year showing at least 137,000 people in the U.S. died from 2000 to 2006 because they lacked health insurance, including 22,000 in 2006 alone. Far from setting up "death panels," health care reform will save lives.


Obama faces new dispute over subsidy for Medicare, The Baltimore Sun - (August 19, 2009)

"Some beneficiaries will be dislocated," said Robert Berenson, a physician and health care policy analyst at the Urban Institute. "This is not painless."


Navigating health plan options after a job lossMsnbc.com - (August 17, 2009)

For the average worker, COBRA is a better choice than policies available on the open market because you don’t have to pay an agent fee, you don’t have to search for a new policy, and you can keep your existing health care providers, maintained Randall Bovbjerg, senior fellow for the Health Policy Center at The Urban Institute.


Soda makers: Don't tax our soft drinks, USA Today - (August 17, 2009)

A report last month by the Urban Institute, a non-profit research group, does not single out soft drinks. It proposes to tax all fattening foods, including chocolate, based on a British model that calculates a food's nutritional value against its calories. It suggests using part of the $500 billion raised over a decade to reduce the cost of fruits and vegetables and increase food stamp allotments.

"If you want to eat food that makes you obese, that's your right," but you should help pay the societal costs, says co-author Stan Dorn. He says a tax could help low-income people by paying for health care and healthier foods.


Health reform's biggest threat: expanding waist linesAlbany Times-Union - (August 17, 2009)

Obesity is causing "death and illness on a massive scale," according to a new study by University of Virginia and Urban Institute researchers.


Industry battles proposals to tax sugary sodas, San Francisco Chronicle - (August 17, 2009)

A broader tax on junk food could raise $500 billion over 10 years, University of Virginia scholars Carolyn Engelhard and Arthur Garson and the Urban Institute's Stan Dorn said in a recent study.


The Health Care Debate just got Personal, The Minneapolis Star-Tribune - (August 17, 2009)

The Christian Century magazine current issue (Aug. 25, 2009) reports that, "The Urban Institute estimates that 22,000 Americans die each year for lack of health care." It goes on to say "15 percent of the [U.S.] population is uninsured, and 24 percent say they have gone without care because of cost." In the next paragraph it reports that "The U.S. spends twice as much of its GNP on health care as do European countries, while getting worse results".”


What Do We Know About Health Reform?CBS News - (August 16, 2009)

"The Urban Institute estimates that as many as 66 million Americans could be without health insurance in 2019," Oberlander said.


Health coverage for all, and what that meansLos Angeles Times - (August 16, 2009)

Probably. Many younger people and healthy people choose not to get coverage. Some 4.5 million of the uninsured make at least four times the federal poverty level -- or $43,320 a year for an individual and $88,200 for a family of four -- according to an analysis by the Urban Institute and the Kaiser Commission on Medicaid and the Uninsured. The analysis estimated that 15 million of the uninsured are below the federal poverty line of $10,830 for an individual and $22,050 for a family of four.


Illegal Immigration Enters the Health-Care DebateThe Wall Street Journal - (August 15, 2009)

The role illegal immigrants play in U.S. health-care costs is "one hot button that no one wants to touch," says Stephen Zuckerman, an economist at the Urban Institute, a nonpartisan think tank in Washington.


Why the rancor of health care debateThe Buffalo News - (August 15, 2009)

And 46.5 million Americans have no insurance -- a number that's growing by more than 15,000 a day, according to a calculation by Urban Institute health care scholar John Holahan.


Hispanics in New Orleans are hurting for health care, The Times-Picayune - (August 15, 2009)

In addition to the language barrier, a lack of medical insurance poses a challenge, for medical providers as well as patients. It is a national problem: According to an analysis of 2008 census data by the Kaiser Commission on Medicaid and the Urban Institute, Hispanics comprise 15 percent of the population but make up 32 percent of the total uninsured population in the United States. And health officials say such numbers ring true in New Orleans.


A System that Kills Many to Enrich the Few, Binghamton Press & Sun-Bulletin - (August 14, 2009)

In 2002 the Institute of Medicine released a study estimating that 18,000 Americans had died during 2000, as a result of not having health care. More recently, the Urban Institute employed the IOM's methodology, accounting for the rise in the ranks of the uninsured, and adjusted the number upwards: 22,000 in 2006 (urban.org). This means that since the 2003 invasion of Iraq, enough American citizens to fill a city the size of Allentown, Pennsylvania or Midlands, Texas have bitten the dust, simply because they did not have access to timely and appropriate health care. This would never have happened in any of the world's other industrialized democracies, who guarantee their citizens access to necessary health care as a basic right.


Getting aboard a health plan -- it's time to throw a lifeline to 60 million Americans, Chicago Tribune - (August 14, 2009)

Accordingly, 22,000 people died in 2006 because they lacked health insurance, according to research by the non-partisan Urban Institute.


Editorial: Taxing fat food, Frederick News Post - (August 14, 2009)

How severe is the national obesity problem? A few simple statistics tell the tale. According to the nonpartisan Urban Institute, by 2015 -- only 5 1/2 short years away -- 40 percent of American adults will be obese. As for kids, 20 percent of them are obese right now.


Editorial: Stop distortion: There's no 'death panel', Des Moines Register - (August 14, 2009)

More living wills could help prevent spending on care patients don't want - and save health dollars. "A 5 percent reduction in end-of-life costs would save Medicare 1.25 percent. This would amount to $6.4 billion in 2010 and $90.8 billion over 10 years," according to a study by the Urban Institute, a nonpartisan research center.


Something sane to read on end-of-life questions, Michael Tomasky’s Blog on The Guardian’s Web site - (August 13, 2009)

"People are getting overtreated at the end of life," said Robert Berenson, a former Medicare official in the Clinton administration and a fellow at the Urban Institute. "This would save money and improve the fidelity to people's wishes."


The Real Death Panels, RealClearPolitics.com - (August 13, 2009)

Using the same methodology combined with Census Bureau estimates of health coverage, the Urban Institute concluded that the incidence of death among the uninsured was enormous. Between 2000 and 2006, the last year of that study, the total number of dead was estimated to have reached 137,000 -- a body count more than double the number of casualties in the Vietnam War.


End-of-Life Provision Loses FavorThe Wall Street Journal - (August 13, 2009)

The Urban Institute, a nonpartisan research center, found that the government could save $90.8 billion over 10 years by better managing end-of-life care. The savings would result from training aimed at discouraging doctors from providing care simply because they would get paid for it, and from having teams at hospitals help terminally ill patients manage their pain once they chose to stop treatment, among other things.

The institute's report, issued last month, concluded that much end-of-life spending isn't sought by patients and goes against their families' expressed preferences.

"People are getting overtreated at the end of life," said Robert Berenson, a former Medicare official in the Clinton administration and a fellow at the Urban Institute. "This would save money and improve the fidelity to people's wishes."


Congress' dangerous search for more health care 'value'New York Daily News(August 12, 2009)

The Urban Institute found that many low-income people seek regular medical care only when they are old enough to get coverage through Medicare. By then, their health problems may be entrenched and much more expensive to treat.


Democrats Take Aim at Medicare Private Plans, The Washington Independent - (August 12, 2009)

“They’ve decided they don’t want to open a two-front war,” said Robert Berenson, senior fellow at the Urban Institute who headed Medicare’s payment and managed care division in the late stages of the Clinton administration.


How many Americans are uninsured?, Associated Press - (August 11, 2009)

All those numbers are out-of-date. Taking into account the effects of the recession, with widespread job losses cutting into employer-provided health care - more than 5 million jobs have been lost since last August - researchers at the Urban Institute and elsewhere estimate that the present-day number of uninsured is closer to 50 million. That's the number used by the Congressional Budget Office.


Stimulus money to fight obesity a wasteFort Worth Star-Telegram - (August 10, 2009)

The Urban Institute and the University of Virginia released a July report advocating the aggressive tactics that cut the U.S. cigarette smoking rate by more than half: excise taxes on junk food; graphic nutrition and caloric product labeling; and restrictions on advertising and marketing.


Ad Industry Gears Up for Battles With WashingtonBroadcasting & Cable - (August 10, 2009)

A recent study by the Urban Institute suggests that that there should be a tax on snack foods and more restrictions on food marketing to battle obesity, which the government calls a growing health crisis.


Letter, 8/8: We need health reform, Journal Star - (August 8, 2009)

"Over the next three weeks, 143,000 will lose their health insurance -Health Affairs/Families USA … 53,507 will file for bankruptcy because of medical bills - American Journal of Medicine … 1,265 people will die because they have no coverage - Institute of Medicine/Urban Institute."


Real health reform must include a public optionThe Press Democrat - (August 8, 2009)

Most importantly, a public plan based on Medicare would provide competition that is lacking in the insurance markets. A recent Urban Institute study found that concentration in the insurance and hospital industries has created markets that “by and large are simply not competitive.”


Sometimes, the smart decision is to bite the bullet, Edmonton Sun - (August 8, 2009)

"Obesity," argue the authors of the Urban Institute's report, "is widely recognized as one of the country's leading public health problems. The obese and overweight experience chronic illness, poor health, and more than 100,000 preventable deaths each year. For the average affected individual, obesity has a much greater impact on health status and health care costs than either smoking or heavy drinking."

In fact, the institute calls for "aggressive public policy initiatives" similar to those piled onto the tobacco industry.

Aside from a punitive tax, the institute also wants "graphic, simple labels" on junk-food packages spelling out the products' nutritional value. It also wants nutritional info on restaurant menus, including at fast-food joints.

The report also calls for marketing limits on fattening food.

But along with corrective sticks, the institute is proposing some carrots, too.

The report suggests some of the money collected be used as subsidies to lower the price of healthy foods like fruits and vegetables, an impediment to reducing obesity among lower income classes.

The institute acknowledged it would cut into the money allotted to health care, but argued it would also take pressure off the system by keeping more people healthy.


Disagreement Over Public Plan Among Dems Straining Party UnityKaiser Health News - (August 7, 2009)

-At the left-leaning Urban Institute, experts say "a public plan is essential to fiscal responsibility in a country where health-care spending has soared to $2.4 trillion per year."


Health Care Reform: An Online Guide - If you want to keep up, you must know these web sites, Slate.com - (August 6, 2009)

 "Is The Public Plan Option a Necessary Part of Health Reform?" Yes, argue John Holohan and Linda Blumberg of the Urban Institute. They predict the insurance industry "would survive at about the same size but be more efficient and more effective in controlling health care spending."


Democrats Wrestle Over Chances of a Public OptionThe Washington Post - (August 6, 2009)

Many experts, such as Linda Blumberg and John Holahan at the Urban Institute, say a public plan is essential to fiscal responsibility in a country where health-care spending has soared to $2.4 trillion per year. A public option such as that proposed by House Democrats, with prices initially set at 5 percent above Medicare rates but well below private insurer rates, would inject competition into markets that are now oligopolies: An American Medical Association study found that a single insurer controls more than half the market in 16 states and a third of it in 38 states.

"We know [insurers and providers] have the ability to lower costs, but if there's no incentive, what motivates them?" Blumberg said.

"If you say we're not going to fight over this, then where is the cost containment?" Holahan asked.


Health care debate: How many actually uninsured?, The Associated Press - (August 5, 2009)

All those numbers are out-of-date. Taking into account the effects of the recession, with widespread job losses cutting into employer-provided health care — more than 5 million jobs have been lost since last August — researchers at the Urban Institute and elsewhere estimate that the present-day number of uninsured is closer to 50 million. That's the number used by the Congressional Budget Office.


Reducing Obesity: Policy Strategies from the Tobacco WarsYouth Today - (August 3, 2009)

The first challenge for the 100-plus people who flowed into Urban Institute's Washington offices last week to talk about a new study on strategies to combat obesity was to keep their hands off the cookies, sugary snack squares and soda laid out on a table for the lunch-time panel discussion. The irony alone might have been worth an extra mile on the treadmill that night, but most went with the vegetable wraps, tuna sandwiches, fruit and even water.

The event was built around a new institute study that seemed to raise hope: "Ousting Obesity: Strategies from the Tobacco Wars." You'd think the successful efforts over the past decades to reduce tobacco use would offer some lessons to combat overeating.


Ad Audit: Conservatives For Patients' Rights "Squeezes" The TruthKaiser Health News - (August 3, 2009)

ACCURACY: Although CPR lists individual sources for each statement in the ad, the facts are largely taken out of context, come from biased industry groups or have been discredited. "There's absolutely nothing here that's right. It's unbelievable," says John Holahan, director of the Health Policy Research Center at the Urban Institute, a nonpartisan think tank.

Holahan says that number could turn out to be right, but it likely will be less. "There are all kinds of proposals out there, and [the cost] depends on the design choices, including how generous it is in terms of benefits and subsidies, what savings they can get out of Medicare and Medicaid and whether there's a public plan." And, a soda tax is just one of many proposed revenue-raisers, including a cap on the tax deductibility of insurance premiums, a tax on the wealthy and an alcohol tax.

Holahan points out that an increase in the federal deficit means spending money without raising taxes. "It's almost impossible to both say that you're going to raise taxes by $600 billion and increase the deficit by $1 trillion—that means there's no savings at all anywhere. That can't be right."

The study finds that even with an individual mandate, eliminating all risk assessment would increase premiums by around 95% but does not include an explanation of how the numbers were derived. But Holahan says that, in the absence of health reform, premiums are "almost guaranteed" to grow 95% over a 10 year period.

Holahan says "there are a lot of people who wouldn't be able be able to come into the public plan at all," including those who are eligible for Medicaid or who are already covered under most employer-provided plans.


Fighting for a COBRA subsidyLos Angeles Times - (August 3, 2009)

There's little news so far on how successful an appeal might be. "Federal agencies reporting on the subsidy requests and appeals have only just begun reporting their data," says Stan Dorn of the Urban Institute, an independent social and economic health policy group. The organization will be assessing the appeals process later this year with funding from the Commonwealth Fund, a private health research think tank, and the California Healthcare Foundation.


Geisinger becomes national model for better health careThe Times-Tribune - (August 2, 2009)

One of the things that sets Geisinger apart even among integrated health care systems around the country is particularly good for the communities where it functions, according to Dr. Robert Berenson, a health care expert and fellow at the Urban Institute. The nation's best integrated systems are still challenged by the difficulty of merging the ideals of personalized, community-based medicine with the sophistication of large organizations.

"I think Geisinger, as much as any organization in the country, is able to somehow merge the decentralized, patient-friendly notion of the community doc with the organizational advantages of an organization," he said.

They are also concerned with the negative impact their success might have on community hospitals in the regions where Geisinger has spread its practice sites, he said.

"It's obviously better for patents and it's better for the nation's health care system," Dr. Berenson said, "but the business model for hospitals is to keep beds full."


Desperately seeking a health-care cureMcClatchy Newspapers  - (August 1, 2009)

"I think a lot of these issues are not well understood, and when you don't understand something, you're more susceptible to interest-group pressures," said John Holahan, the director of the Urban Institute Health Policy Research Center.

 

Health advocates work to raise candy consciousnessWinston-Salem Journal - (August 1, 2009)

The medical costs of obesity in the United States are staggering -- $147 billion annually, according to a new CDC study. Another new study, from the University of Virginia and the Urban Institute, put the price tag higher -- $200 billion a year. That report also said that health-insurance premiums for non-obese workers are $26 billion a year higher because of the medical costs of the obese.

Clearly, we've got to do something. The Virginia-Urban Institute study proposes a 10-percent tax on fattening foods that it says will raise $500 billion in revenue over 10 years. If combined with a subsidy to lower the price of fruits and vegetables 10 percent, the net revenue still would be more than $350 billion over the period, according to the authors. They are Carolyn L. Engelhard, Arthur Garson Jr. and Stan Dorn. Engelhard and Garson are at Virginia, where Garson is former dean of the university's medical school. Dorn is at the Urban Institute.

The CDC report doesn't mention higher taxes, but it cites the success of the tobacco-control model in other areas. Among the recommendations: restricting what's sold in vending machines in schools and other public facilities as well as limiting advertisements of less-healthy foods and beverages. The Virginia-Urban Institute study proposes more aggressive strategies, including stronger warning labels on fattening foods.


Jubilant Democrats Move Ahead, But Still Face Many Obstacles on ReformKaiser Health News - (July 30, 2009)

Others were more restrained. An agreement among a small group of senators or a House committee, "doesn’t mean that these proposals will sail through the House or the Senate," said Urban Institute president Robert Reischauer.

"There is no issue harder to deal with" than health care, he added, nothing that it makes up one-sixth of the national economy, impacts the livelihood of millions of people, and "affects all Americans in a very personal kind of way."


Gov't plan can coexist with private insuranceThe Associated Press - (July 29, 2009)

As if to underscore how such estimates can vary, the Urban Institute public policy center also ran calculations -- and came up with different numbers. The Urban Institute estimated that about 47 million people would sign up for the public plan, if companies with fewer than 50 workers were allowed to join.


Report Shows Single Payer Least Costly for NYS, WNYC Radio - (July 29, 2009)

The report by the Urban Institute seems to favor a public-private partnership with existing health insurance companies that it says would bring down exorbitant rates for individual health coverage plans.


Backers: Single pay plan viableAlbany Times Union - (July 29, 2009)

It was released jointly by Health Commissioner Richard Daines and acting Insurance Superintendent Kermitt Brooks, and conducted by the Urban Institute, a nonpartisan public policy think tank based in Washington, D.C.

The Urban Institute studied four basic types of reform approaches, ranging from a single-payer system to a market-based strategy that relies on deregulation and tax credits. Three of these types of reforms, the report's authors argue, would achieve universal coverage, while the market-based approach would leave more than 13 percent of New Yorkers uninsured.

The report found that, although the single-payer plan would achieve the greatest savings, it would also have by far the highest cost to government: more than $21,000 per newly insured New Yorker annually.


Group Offers Four Key Ways U.S. Can Fight ObesityCBSNews.com - (July 28, 2009)

Taxes should be combined with other aggressive policy interventions, as well as community outreach programs, to bring down obesity rates by changing what people eat, according to a new report from the Urban Institute and the University of Virginia. Just as the popularity of smoking declined dramatically over decades, the researchers say, using policy to bring down obesity rates could be effective but would take a generation of work.


Taxing the fat in your foodCNNMoney.com  - (July 28, 2009)

More than 25% of the increase in medical costs between 1987 and 2001 is attributable to obesity and obesity-related conditions such as hypertension and diabetes, according to a new report from the non-partisan Urban Institute.

All told, 9% of health spending last year -- or more than $200 billion -- was spent on obesity-related costs, according to Urban Institute. Half of that bill was footed by taxpayers through Medicare and Medicaid.

To relieve that burden, the authors suggest $180 billion of the revenue raised be used to subsidize low-income families' purchase of fruits and vegetables and to otherwise make healthier foods available to them.

Stan Dorn, one of the authors and a senior research associate at the Urban Institute, noted that one study shows that states that already tax sodas and snack foods are much less likely to rank among states with the highest growth rates in obesity.

And that's just with a very limited tax on specific kinds of fattening foods, Dorn said. When a tax is limited to specific unhealthy foods, studies show that consumers tend to reduce consumption of the taxed product but then switch to other unhealthy foods that aren't taxed.

The authors of the Urban Institute study say a tax alone would not be sufficient to reduce obesity rates. They also recommend measures such as bans on advertising fattening foods to children and more explicit labeling on fattening foods.

"It's a multi-pronged approach," Dorn said.

They also concede, however, that enacting a tax on fattening foods would be a long and uphill battle, given the powerful interests involved in food production.


Senate group's health care plan omits key options, The Associated Press  - (July 28, 2009)

The Urban Institute public policy center also ran calculations and produced different numbers. It estimated that about 47 million people would sign up for the public plan, if firms with fewer than 50 workers were allowed to join.


Tough love for fat people: Tax their food to pay for healthcare, Booster Shots, the Los Angeles Times health blog  - (July 27, 2009)

As evidence of this new "get-tough" strategy on obesity, they may well cite a study released today by the Urban Institute titled "Reducing Obesity: Policy Strategies From the Tobacco Wars."

And although 40 U.S. states now impose modest extra sales taxes on soft drinks and a few snack items, the Urban Institute report suggests that a truly forceful "intervention" -- one that would drive down the consumption of fattening foods and, presumably, prevent or reverse obesity -- would have to target pretty much all the fattening and nutritionally empty stuff we eat: "With a more narrowly targeted tax, consumers could simply substitute one fattening food or beverage for another," the reports says.


Holes in the safety net: Medicaid falls short just as some need it mostMSNBC.com - (July 27, 2009)

Medicaid reimbursement rates can be as much as 40 percent lower than those for private insurance, according to John Holahan, the director of the Health Policy Research Center at The Urban Institute, a Washington think tank.


Opinion: AccountabilityThe Frederick News-Post - (July 27, 2009)

The size of the disabled older population who will need assisted or nursing home care will grow by more than 50 percent between 2000 and 2040, according to the Urban Institute.


Fat Tax Could Be Panacea for Health ReformForbes.com - (July 27, 2009)

According to a study released Monday by experts at the Urban Institute and the University of Virginia, a 10% excise or sales tax on fattening foods could raise $522 billion over the next 10 years. A 20% tax could raise $937 billion. Among its other uses (like paying down the deficit), that money could be used to defray the costs of health care reform or to curb the rise in obesity.

The Urban Institute-U.Va. study is based on a model used by the British government that uses a numerical scale to determine whether a food's vegetable content, fiber and protein outweigh its calories, saturated fat, salt and sugar.

The authors of the Urban-U.Va. study also note that a tax on fattening foods would be regressive; however, they suggest that the revenue raised could be used to subsidize health care for the poor or to help them gain access to healthier foods. In addition, they say the government's efforts to limit Americans' tobacco use provide a good model to curb obesity.


From Waterloo to Shiloh for Obama?The Politico - (July 23, 2009)

Elliott Fisher and Robert Berenson are trained physicians who practiced medicine for about 20 years each before moving into more academic or government positions. Fisher is now the director of The Dartmouth Institute for Health Policy and Clinical Practice, whose studies of Medicare expenditures from one region to the next have become a big part of this year’s health care debate. Berenson, now a senior fellow at the Urban Institute, was a top Medicare administrator in the late ’90s and was recently appointed to the Medicare Payment Advisory Commission, which makes policy recommendations to Congress regarding the health care program for the elderly.

In separate interviews with POLITICO, both men said this window could be used to experiment with new ideas to contain costs. And Berenson suggested that Congress and the White House could even “call the bluff” of providers in the health industry who had promised voluntary savings.

“Put everything they promised in the bill. Require them to achieve some targets, and if they don’t do it, here are some things that will happen,” Berenson said. “Lay out the whole regime that lets CBO know that you have a backup if the private volunteer effort doesn’t succeed.”


Mass. has lessons for health care debateUSA Today - (July 23, 2009)

Quality has been an issue, too. Because more people have insurance, some doctors and safety-net hospitals are overwhelmed. A study by the non-partisan Urban Institute found one in five adults in the state have been turned away by a doctor's office or clinic.


W&L professor examines impact of public plan on health reform, The News Leader - (July 21, 2009)

He has written or is writing monographs on legal issues in health care reform for a number of other organizations including the National Academy of Public Administration and National Academy of Social Insurance, the Fresh Thinking Project, the Urban Institute and New America Foundation and Academy Health.


Costs of NY health care reform detailedCrain’s New York Business - (July 21, 2009)

The Paterson administration released a key report that evaluates the cost and coverage implications of four health reform proposals. The long-awaited report, written by the Urban Institute, was commissioned by state legislators to provide a road map to expanding health insurance coverage to include the 16% of New York residents who are uninsured.


Like car insurance, health coverage may be mandatedDelaware News Journal - (July 20, 2009)

"There's no doubt that to be acceptable, it has to be regarded as fair and that you're not requiring people to buy insurance that's not affordable to them," said John Holahan, the Urban Institute's health policy center director.


Clock ticking on health reform, report saysChattanooga Times Free Press - (July 16, 2009)

As unemployment rates climb, many people are losing employer-sponsored health insurance along with their jobs, Mr. Pollack said. According to the Urban Institute, for every 1 percent increase in the unemployment rate, there is a 0.59 percent bump in the number of uninsured adults under 65, he said.


When I'm really old, put me on that ice floeLos Angeles Times - (July 14, 2009)

This is strikingly underscored by an Urban Institute estimate that in 2006, more than 22,000 Americans died because they lacked medical insurance, and 137,000 died between 2000 and 2006. Thousands more have struggled on with a reduced quality of life.

According to Linda J. Blumberg and Karen Pollitz with the Urban Institute, exchanges could be successful if administered appropriately and if designed to carry out functions not currently performed in the health care sector: negotiating directly with private insurers on health plans, establishing minimum coverage standards, subsidizing health insurance premiums, providing plan comparison tools, and facilitating enrollment - all with the aim of streamlining information into a centralized location.


Liberals Brace For Fight Over Scope Of Health LegislationKaiser Health News - (July 13, 2009)

"There are a lot of tough choices ahead," said Linda Blumberg, an economist and health policy expert at the Urban Institute. "Truthfully, we know a lot about how to do health care reform and do it well, and what levels of coverage are affordable. But the key is how willing are we to raise the money to do the things we recognize we need to do. That’s very much a political-will issue."


Health benefit tax could fund coverage expansion, Indianapolis Star - (July 12, 2009)

But because lawmakers are looking at multiple options - including taxing benefits of higher-income earners only, or taxing plans a certain level above the average - it's hard to tell who the main losers would be, said Stan Dorn, a senior research associate with the Urban Institute.

Dorn has looked at ways Congress could structure the tax to take into account such factors as geographic differences in health care costs and the fact that some employer-provided premiums are higher because of the age of their workers or the number of their employees.

"I don't think it would be simple," Dorn said of devising an equitable tax, "but I think it would be feasible."


Job seekers putting health benefits firstChicago Sun-Times - (July 11, 2009)

For every 1 percentage point increase in the nation's unemployment rate, an estimated 1.1 million Americans become uninsured, according to the Urban Institute Health Policy Center, which analyzes trends and causes of change in health insurance coverage. The nation's unemployment rate is 9.5 percent.


Exchanges May Play Key Role In An Overhauled Health SystemKaiser Health News - (July 10, 2009)

About 200,000 people have obtained policies through the Connector. Based on a study by the Urban Institute, the state says 97 percent of residents have insurance, the highest percentage in the nation.

If bigger is better, then a national exchange would in theory have more clout than a series of state or regional exchanges. An exchange also would have more marketplace leverage if it negotiated prices on behalf of consumers, according to a report last April by Linda Blumberg, a senior fellow at the Urban Institute’s Health Policy Center and Karen Pollitz, a professor at Georgetown University.


What's at stake with a public health-plan optionMarketWatch.com - (July 9, 2009)

Even in a conservative scenario, a public plan option would save the federal government an estimated $17.4 billion in 2010 and about $224 billion within the first 10 years of reform, according to a report from the Urban Institute.

That's why cost containment is the major reason for including a public plan option in comprehensive health reform, said Linda Blumberg, senior fellow at the Urban Institute.

"The idea is to catalyze competition in these markets where we don't see it today and provide a lower-cost option for individuals to buy," she said.

Another reason is to provide an alternative for people who've had bad experiences with private health plans, Blumberg said.

"If we're going to require everyone to have coverage, it's very important that every individual have an option they feel comfortable with, especially those with health-care needs," she said.

One of the criticisms of the public plan option -- that it would have artificially low premiums -- is inaccurate, Blumberg said.

"The only way you have artificially low premiums is if you support the costs of a public plan with general revenue," she said. "That's not what we're talking about."


Health tax is in flux. Now what?CNNMoney.com - (July 9, 2009)

In the end, lawmakers may have to be more aggressive about cost containment or finding other revenue raisers, said Linda Blumberg, a senior fellow at the Health Policy Center of the Urban Institute.

"If you take something off the table, you've got to find something to fill the hole," she said, adding that since no option will be universally popular, lawmakers will have to be willing to make tradeoffs.

Critics say sin taxes would disproportionately tax low- and middle-income families. But Blumberg noted that they are the same groups that would benefit a lot from health reform. "They'll come out ahead with what they're getting versus what they're paying," she said.

Another possibility might be raising everyone's income tax rates by, say, 1%, Blumberg said.

Given how sensitive lawmakers were on the issue of the charitable contributions, however, they could exclude them from the new rule, Blumberg said. But mortgage interest and other popular itemized deductions would still be subject to the limit.


Mass. healthcare system a model for Washington?Reuters - (July 8, 2009)

The Urban Institute, a Washington think tank, found in a recent review that from 2006 to 2008, access to care rose so that 91 percent of adults in the state had a usual care provider, up from 86 percent in 2006.

But the group also found evidence it was getting harder to see some specialists or get follow-up care.

The Urban Institute's Sharon Long said the Massachusetts model was the most widely-cited example to date in the debate over a national system. "Clearly people are looking at it as a successful model," she said of Massachusetts, though she cautioned the state must still show it can control costs.

She noted it was also an example of all the interested parties -- industry, insurers, hospitals, patient groups and politicians -- managing to negotiate a lasting deal.

That's an important lesson for Washington, she said. "People must feel like they're getting enough gains in the system from the process, and that they're not hurt badly enough that they'll step away," she said.


New at the mall: The health-care storeMarketplace - (July 8, 2009)

Linda Blumberg, a senior health policy fellow at the Urban Institute, says these stores don't address the real reason why so many people are uninsured. She says it's not because they don't know where to shop.LINDA BLUMBERG: They do nothing to make coverage more affordable for those who are modest income, and they do not address any of the barriers to coverage that exist for those that have significant health-care needs.


Administrative Costs in Health Care: A PrimerWashingtonpost.com - (July 7, 2009)

2. Another week, another study http://www.urban.org/publications/411915.html showing that a public insurance option would save money and improve quality in the health-care system. This one comes from the Urban Institute.


Thousands Of Bay Staters Still Without Health InsuranceWCVB TV (Boston) - (July 6, 2009)

For those who do struggle with medical debt, numbers show healthcare reform isn't helping everyone. A recent study by the Urban Institute shows almost 18 percent of Baystaters have problems paying medical bills, up from 16.5 percent in 2007.


Editorial: Covering the uninsured: A cost that pays, Los Angeles Times - (July 6, 2009)

That's why it's important to promote competition while imposing insurance mandates, starting by creating one-stop shopping exchanges where people can compare and purchase policies that meet a minimum standard for coverage. Although it's a lightning rod for critics, the idea of the government establishing public insurance plans to vie with private ones for subsidized policies is worth exploring. It's a potential counterweight to the power wielded by a single healthcare provider or insurer in too many communities, a recent Urban Institute study contends.


Our view on health care: 'Public option' offers best way to curb medical costsUSA Today - (July 4, 2009)

Opponents who rail against "government run" health care seem not to have noticed that government already directly covers about a third of Americans through Medicare, Medicaid, military and veterans care. Though not without flaws, these are hugely popular programs that provide coverage for less than private plans can. According to the Urban Institute, Medicare and Medicaid spend about 5% on administration compared to 12% in private plans. The simplest version of a public plan, the one that would not create a big new bureaucracy, would allow people to buy into Medicare at cost.


‘Rationing’ Health Care: What Does It Mean?The New York Times, Economix blog - (July 3, 2009)

A 2008 peer-reviewed study by researchers at the Urban Institute found that health spending for uninsured nonelderly Americans is only about 43 percent of health spending for similar, privately insured Americans. Unless one argues that the extra 57 percent received by insured Americans is all waste, these data imply rationing by price and ability to pay.


What A Tax On Health Benefits May Mean, The Wall Street Journal - (July 2, 2009)

When it comes to raising money for an overhaul, no other strategy comes close. The tax exclusion for employer-sponsored health benefits is set to reduce federal tax revenues by an estimated $3.5 trillion between 2010 and 2019, according to the Urban Institute. No draft legislation calls for raising that whopping sum through total elimination of the tax exclusion. But capping it above a certain threshold to shore up a fraction of its potential value has bipartisan support, even though any kind of tax increase remains politically sensitive.

Workers with job-based health insurance have enjoyed a tax exclusion for the full value of those benefits. The value of the tax exclusion is greater for higher-income workers, who tend to have richer employer benefits compared with lower-income workers, who are much less likely to have job-based health insurance, according to an analysis from the Urban Institute.

In the first year of having a cap on the tax exclusion, the impact would be minimal across three of the policy options being discussed on Capitol Hill, said Lisa Clemans-Cope, lead author of the Urban Institute report.

"The bite is very small in the first year," Clemans-Cope said. "In 2010, the change in after-tax income for those who have an increase is less than 1%."


Will The Health Care Crisis Cooperate With Health Insurance Co-OpsNightly Business Report - (July 1, 2009)

BATE: But health care expert Linda Blumberg says that misses the point. She says there has been so much consolidation among insurance companies and providers that we need to catalyze competition and only a public plan has the size to do that.

LINDA BLUMBERG, HEALTH ECONOMIST, URBAN INSTITUTE: Big is better in terms of leverage in the market, in terms of getting provider payments down and really looking for efficiencies and pushing insurers, the private insurers as well, to create efficiencies in their systems.


Medicaid: True Or False?, Kaiser Health News - (July 1, 2009)

3. Medicaid provides bare-bones coverage compared to what’s available in the private sector.

False. "At least on paper, Medicaid has a longer list of benefits than many private plans," said John Holahan, director of the health policy center at the Urban Institute, a Washington think tank. Medicaid benefits include mental health services, transportation-to-health services, and comprehensive screenings and treatment for children. In addition, Medicaid enrollees have much lower out-of-pocket costs than people with private coverage. There are typically no monthly premiums and no, or very low, copayments.


Taxing of health care benefits on the tableLansing State Journal - (June 29, 2009)

But because lawmakers are looking at multiple options - including taxing the benefits of only higher-income earners or taxing plans a certain level above the average - it's hard to tell who the main losers will be, said Stan Dorn, a senior research associate with the Urban Institute.

Dorn has looked at ways Congress could structure the tax to take into account such factors as geographic differences in health care costs and the fact that some employer-provided premiums are higher because of the age of their workers or the number of their employees.

"I don't think it would be simple," Dorn said of devising an equitable tax, "but I think it would be feasible."


A Tail Wags The Dog on Health ReformThe Washington Post - (June 28, 2009)

John Holahan and Linda Blumberg of the Urban Institute, thoughtful advocates of a public option, have a new paper outlining a public plan that would pay providers either 10 or 20 percent more than Medicare rates; by contrast, private insurers now pay about 30 percent more. They argue that private insurance would not "be eradicated" under this approach -- the strongest and most efficient private insurers would survive, they say -- but would lower costs to compete. Consequently, the government would have to pay less in planned subsidies to help lower-income Americans obtain insurance, saving an estimated $224 billion over 10 years if prices were 20 percent more than Medicare rates and almost $400 billion if prices were at 10 percent above the Medicare level.

But they end with a cautionary note: "It is important to recognize that the cost containment potential of a public plan rests fully in its ability to leverage the power of the federal government as health care purchaser to encourage provider participation and reduce prevailing payment rates. Without taking advantage of that strength, the cost containment potential of the public plan option . . . would be tremendously weakened."


Is a 'public plan' the fix for health insurance? A government-sponsored rival to private insurers dominates the debateMSNBC.com - (June 26, 2009)

John Holohan, the director of the Health Policy Center at the Urban Institute, a non-partisan Washington think tank, said "having a competitor to private plans, under a fair set of market rules, will provide more choice and place substantial cost containment pressure on the health care system."

But Holohan said in an interview with msnbc.com Wednesday that "the public plan is probably going to get sicker than average people" signing up for it. "There are an awful lot of people who have had health problems and have had bad experiences with insurance companies. And they will probably gravitate toward the public plan. So the public plan has some things going against it, too."

Holohan told the House Ways and Means Committee in testimony Wednesday that because it would attract sicker than average people "the public plan could have somewhat higher premiums as a result."

He also said, "A public plan should be compensated if it ends up with populations with higher medical needs."


Diagnosing the problemLos Angeles Times - (June 22, 2009)

There is a moral dimension to this problem: People incapable of obtaining health insurance are less likely to get care when they need it, and more likely to die from a preventable illness. A 2002 study by the Institute of Medicine found that the uninsured had a 25% higher "mortality risk" than the insured, leading to about 18,000 more deaths in 2000 than would have been expected had everyone been covered. The Urban Institute updated that research last year, raising the toll to 22,000 in 2006.


The $64,000 Question: Can Health Care Be Paid For Without Breaking the Bank?Kaiser Health News - (June 22, 2009)

By lowering the threshold in that manner, lawmakers potentially would leave out about 4.6 million people, says John F. Holahan, director of the Urban Institute’s Health Policy Research Center.


Bringing Down the House: The sobering lessons of health reform in MassachusettsSlate.com - (June 23, 2009)

According to an Urban Institute estimate, the number of uninsured residents quickly fell from 13 percent to 7 percent following the law's passage.


No health care? Expect a requirement to get it, The Associated Press - (June 22, 2009)

"There’s no doubt that to be acceptable, it has to be regarded as fair and that you’re not requiring people to buy insurance that’s not affordable to them," said John Holahan, the Urban Institute’s health policy center director.


Reimbursement lags behind inflation: reportModern Physician - (June 22, 2009)

While some states have increased their Medicaid reimbursement rates for primary-care and obstetric services, in general, rate increases did not keep up with the rate of inflation between 2003 and 2008, according to a recent report from the Washington-based Urban Institute and published on the Web site of the journal Health Affairs.


Obama's Health Care ClaimsNewsweek  - (June 18, 2009)

But the claim is disputed. A 2008 report conducted by researchers from the Urban Institute for the nonpartisan Kaiser Family Foundation examined the first Families USA study, and found its claims to be unconvincing. They concluded: "[W]e are highly skeptical that the high and growing cost of private insurance is strongly related, if at all, to the amount of uncompensated care delivered by private providers or to the growing number of uninsured people."

Jack Hadley, the lead researcher on the KFF study, told us that to assume that the insured end up paying for all uncompensated care is "clearly an exaggeration." According to KFF, the amount of uncompensated care that providers could shift to the privately insured is much less, only $8 billion, not the $42.7 billion Families USA said could be passed on to premium payers in 2008. The KFF number is less than 19 percent of Families USA's, and by our figuring that implies a per-family increase in health insurance premiums of less than $200 a year, not $1,000.

Adding in taxes and health care costs changes the story. According to Hadley, "The savings that will accrue from covering the uninsured will be primarily in the form of lower taxes to pay for government-funded uncompensated care, not lower premiums for private insurance. These savings are a legitimate potential source of funding to help pay for expanded insurance coverage." The Kaiser study found that insured adults "spend about $350 per person through taxes, donations, and payments for private health care and private insurance to subsidize care received by the uninsured." That's close to Families USA's estimate of the average cost to insured singles. Kaiser didn't give a per-family estimate, but a $350 per person cost is generally consistent with a cost of $1,000 per family.


A Selection of Recent Studies And SurveysKaiser Health News - (June 18, 2009)

The Urban Institute: Health Care Reform for Children with Public Coverage: How Can Policymakers Maximize Gains and Prevent Harm?

Though "universal coverage has the potential to increase access to care and improve the health and well-being of uninsured children and adults," "the effects of health care reform on the more than 25 million children who currently have coverage under Medicaid or the Children’s Health Insurance Program (CHIP) are less clear."

"Increased parental coverage will help these children since many have uninsured parents with unmet health needs. However, proposals to move these children into a new health insurance exchange could make them worse off through the potential loss of benefits and legal protections and possible exposure to higher cost-sharing; alternatively, if reimbursement rates are higher in the exchange than paid under Medicaid and CHIP, children's access to providers could improve (Kenney and Dorn, 6/09)."


Bogus number?Marketplace website - (June 17, 2009)

A study two years ago by Urban Institute scholars found that 19 percent of the uninsured in America, or roughly nine million people, were in households earning more than three times the poverty level, which the study broadly defined as income high enough to afford unsubsidized insurance. About two-thirds of this group was childless adults who only needed insurance for themselves.


Health Care Rationing Rhetoric Overlooks RealityThe New York Times - (June 17, 2009)

The uninsured still receive some health care, obviously. But they get less care, and worse care, than they need. The Institute of Medicine has estimated that 18,000 people died in 2000 because they lacked insurance. By 2006, the number had risen to 22,000, according to the Urban Institute.


Covering All Uninsured In U.S. Will Be Very Costly, CBO Signals, Investor’s Business Daily - (June 16, 2009)

"It doesn't make a lot of sense - they get so few people covered but it costs so much. It seems way too high," said John Holahan, director of the Health Policy Center at the liberal Urban Institute. He suggested that covering all the uninsured would cost $1.5 trillion-$1.7 trillion.


Will the Public Plan Make or Break Health Reform?, Time - (June 16, 2009)

"Insurers have consolidated," says Linda Blumberg, an economist and health care expert at the Urban Institute.

"Similar things have happened in the provider community. In a lot of areas, insurers will tell you they have no negotiating power with providers and they're held over a barrel. [A public plan] would force insurers and providers to negotiate with each other, which they aren't doing today."

Still, in order to shake up the system, a public plan would need to have enough doctors and hospitals participating as part of its network. Many Democrats believe that would only happen if providers were forced to accept its patients, most likely as a condition of participating in Medicare, an idea that the AMA and others reject out of hand. Yet, as Blumberg points out, for all the conservative scare stories about government health care, "the people with the most choice are the people who are in the traditional Medicare program...[with access to] a huge network of providers because of market power."


Will the Health Industry Derail Obama's Reforms?, The Washington Post - (June 15, 2009)

LINDA J. BLUMBERG

Senior fellow at the Urban Institute; adviser for health policy in the Office of Management and Budget, 1993-1994

Sustaining comprehensive health care reform will require not only making adequate affordable coverage available to all, but also improving the efficiency of how we deliver care. But cost containment is a political minefield. The only way to lower costs is to reduce the use of services, pay less per unit of service, or some combination of the two. Whichever the route, this means reducing the income of some of those who provide healthcare.

We know that there are efficiencies to be had without compromising quality of care. Most insurance and provider markets are simply not competitive, largely due to the consolidation in both markets in recent years. These market failures fuel the rapid growth in spending. Among other things, the presence of a public competitor, perhaps one like Medicare except it charges somewhat higher rates and offers benefits like those in typical employer plans, can catalyze competition among private insurers and lead to significant savings.

Though sensible reform would increase the insured population, offsetting cost containment-related losses, any such cost containment approach will engender opposition from the insurance and provider sectors. So it will take the collective efforts of disease-specific groups, consumer groups, labor, and business to overcome this opposition. While the chances seem better than ever before, it is still an uphill battle.


Health care mandates: How they workCNNMoney.com - (June 12, 2009)

"When I'm healthy, I help pay for the sick, and when I'm sick, then healthy people help pay for me," said Linda Blumberg of the Urban Institute.


The ‘Cost’ of Health Care ReformThe New York Times, Economix blog - (June 12, 2009)

An illustration of that approach was furnished last year by Jack Hadley and his co-authors at the Urban Institute in Washington. Using the first definition of “costs” shown above, these researchers estimated the net addition to total national health spending on the assumption that universal health insurance coverage had been fully run in by 2008.

Assuming, once again unrealistically, that universal coverage were fully achieved in 2010, after passage of health-care reform legislation this year, to what amount would the Hadley et al. estimate for 2008 have grown by 2010?


Health Care Spending Disparities Stir a FightThe New York Times - (June 9, 2009)

Research by Dr. Robert A. Berenson and Jack Hadley of the Urban Institute suggests that much of the geographic variation in health spending can be explained by differences in "individual characteristics, especially patients’ underlying health status and a range of socio-economic factors, including income.”

"Some patients may benefit from higher spending," said Mr. Hadley, who is also a professor at George Mason University in Virginia. "They could be adversely affected if they live in geographic areas where payments are cut."

Dr. Berenson, who was a Medicare official in the Clinton administration, said, "There remains too much uncertainty about the Dartmouth findings to ground public policy on them."


How Congress might tax your health benefits, Miami Herald - (June 6, 2009)

"Does it make sense to say you will pay more if a co-worker gets hit by a car?" senior research associate Stan Dorn of the Urban Institute asked during a panel discussion of the tax issue last week.

Dorn suggested another way to set the benchmark: Tie it to a measure of the policy's value: what the insurer pays for claims. The benchmark could be set at, say, policies that pay 80 percent or 90 percent of approved medical claims. Less generous plans wouldn't be taxed.


Letter: Number of uninsured is misleadingDes Moines Register - (June 6, 2009)

In "Health Care Reform Requires the T-Word," May 21 editorial, the Register persists in using the Census Bureau estimate of 45 million uninsured Americans, omitting the rest of the bureau's findings as well as those of the U.S. Department of Health and Human Services, the Kaiser Family Foundation, the Urban Institute and the Blue Cross Blue Shield Association.


The Good News Bad News Labor ReportNightly Business Report - (June 5, 2009)

DANA BATE, NIGHTLY BUSINESS REPORT CORRESPONDENT: Whether it's shopping on eBay or searching for a phone plan, Americans love a good deal. But if you decided to shop around for a health care plan today, chances are it wouldn't be easy. Health economist Linda Blumberg says that's because the health insurance market is broken.

LINDA BLUMBERG, HEALTH ECONOMIST, URBAN INSTITUTE: It's kind of the wild, wild west out there, particularly in the non-group insurance market, but also in the small group market and people who are making purchasing decisions don't have the information they need to make good choices.

BATE: Blumberg worries too little regulation could lump high risk people together, defeating the system's purpose.

BLUMBERG: The way that insurers behave is in their interest to have the lowest cost, lowest risk enrollees in their plans. The more that they can differentiate the plans that they're offering, the more they can attempt to attract individuals of different risk.


Editorial: ‘Hidden Health Tax’Bangor Daily News - (June 5, 2009)

This "tax" is made worse by the fact that those without insurance generally wait longer for medical care than those with insurance. As a result, they are sicker - and require more expensive treatment - when they do go to a doctor or hospital. In 2006, 22,000 people between the ages of 25 and 64 died because of a lack of health insurance, according to an Urban Institute report.


The moment of truthThe Economist - (June 4, 2009)

A new report from the Urban Institute, a think-tank, adds that doing nothing means the number of uninsured will grow from perhaps 49m today to 62m in a decade. Taken together, all these factors explain why there is such momentum behind health reform.


Battle #1: Taxing health benefitsCNNMoney.com - (June 4, 2009)

But judging from the issues raised by tax, budget and insurance experts at an Urban Institute forum this week, the idea is not as simple as it sounds.

"If policy makers wish to cap the amount of the employer exclusion without creating serious inequities, no perfect solution is available," Stan Dorn, a senior research associate at the institute, wrote in a paper released for the event.

Indeed, Dorn said at the forum, "health status is the primary force in setting premiums and you can't adjust for that."


Editorial: Partners vs. MetrowestThe Boston Globe - (June 4, 2009)

Still, no one can claim that the Metrowest area needs more health facilities. In fact, a study by the Urban Institute for the Blue Cross Blue Shield Foundation of Massachusetts and two other foundations found Metrowest residents have the best access to care of any part of the state.


When Being Insured Doesn’t Mean Being ProtectedCQ TODAY ONLINE NEWS - (June 4, 2009)

Restuccia and other advocates point to the benefits in the Massachusetts overhaul, where, according to a report last year from the Urban Institute, the percentage of people who are underinsured dropped from 4 percent to 3 percent. The state, which requires nearly all residents to obtain health care policies, mandates that plans meet basic standards for coverage of hospital stays and other essentials and cover preventive care without charging a deductible. The system offers three benefit packages at different costs.


High-deductible plans causing issues for health care providers, The Business Journal - (June 1, 2009)

According to the Urban Institute, about half of all enrollees with HSA-eligible plans don’t open the accounts. And patients who do have an HSA aren’t required to use the money if they receive a medical bill.


Should All America Follow Massachusetts On Health Care?, CQ Healthbeat - (May 31, 2009)

"The reforms in Massachusetts are a success, but they’re not complete yet," says Linda J. Blumberg, principal research associate at the Urban Institute. "They’re just turning to questions of cost containment. Cost containment is enormous. That’s why Massachusetts put it off. It’s really hard to do."


Editorial: Health reform goal: expanding coverage, The Republican - (May 31, 2009)

The third annual health care study was conducted last fall by the Urban Institute and funded by the Blue Cross-Blue Shield Foundation, Robert Wood Johnson Foundation and the Commonwealth Fund.

With information contained in the Urban Institute study, Massachusetts has a chance to reset the agenda. Universal coverage has shown to be achievable, but there are challenges ahead. Costs need to come down and access needs to be expanded. As Helen R. Caulton-Harris, director of the Springfield Department of Health and Human services put it, "We did the road to coverage, so now we have to do the road to access.


High Costs Put Damper on Massachusetts Insurance ProgramThe Wall Street Journal, Health Blog - (May 28, 2009)

"Unlike some of the sustained gains in insurance coverage and access, some of the early gains in the affordability of health care had eroded by fall 2008, as health costs continued to increase," write the study’s authors, Sharon Long and Paul Masi of the Urban Institute.


More Mass. Residents Have Health Coverage, But Rising Costs Remain A Problem, WBUR.org - (May 28, 2009)

But Sharon Long with the Urban Institute, which conducted the study, says more people report trouble getting follow-up care including appointments with specialists or medical tests.

"The problems were more serious for low-income adults and for adults on public coverage," Long explains. "When we look at unmet need for care, it is higher among low income, than among higher income adults."

Long says rising health care costs are eroding progress on affordable care. But Long says a special commission on health care payments shows has the potential to address that problem.


Costs snarling health overhaul, The Boston Globe - (May 28, 2009)

While the state is facing cost challenges, he said, implementation of near-universal coverage in 2006 still put consumers here in a better position than in other states. "We should be lucky enough to have those problems [nationally]," Altman said of the challenges outlined in the Urban Institute survey. "If we get to a point where everyone is insured, then we can move on to worry about the affordability of care."

The survey was conducted by the Urban Institute, a social policy think tank, and funded by the Blue Cross and Blue Shield of Massachusetts Foundation, Robert Wood Johnson Foundation, and the Commonwealth Fund.

Still, access to care is "generally good in Massachusetts and health reform made it better," said study author Sharon Long.

The affordability problems that have started to resurface, she said, can not be blamed on the state's overhaul, but on a much larger and troubling national trend.

"Healthcare costs, in general, are increasing faster than inflation," Long said.


Health costs hinder reformThe Boston Herald - (May 28, 2009)

The latest report from the Urban Institute, a nonprofit research firm based in Washington, D.C., shows that the state is making progress on its reform efforts. More people than ever before have insurance, and those people are using that insurance for regular checkups, according to the Massachusetts Health Reform Survey.


Massachusetts, Model for Universal Health Care, Sees Ups and Downs in PolicyThe New York Times - (May 28, 2009)

"Although major expansions in coverage can be achieved without addressing health care costs, cost pressures have the potential to undermine the gains," wrote the researchers, Sharon K. Long and Paul B. Masi of the Urban Institute.


Even small co-pays, The Times of Trenton - (May 27, 2009)

The Urban Institute estimated in 2008 that 22,000 adults died due to lack of health coverage.


New Data Show Failure of Reform Is Not an Option, Bnet.com - (May 24, 2009)

A new Urban Institute study reminds us that failure to achieve the right kind of healthcare reform is not an option. By 2019, the study forecasts, between 53 million and 66 million U.S. residents will be uninsured. Healthcare spending by individuals and families will rise between 46 percent and 68 percent over the next decade, the study predicts. Government costs for programs like Medicare and Medicaid will double by 2019 if there’s no action on reform.


The five biggest hurdles to health reform, MarketWatch.com - (May 21, 2009)

"You kind of need the revenue you're going to get from it," said John Holahan, director of the Urban Institute's Health Policy Center in Washington.. "It seems to me that it's something we have to do."Holahan said he favors capping the amount that's tax exempt and indexing it to health-care inflation so it slowly "bites more and more over time" instead of completely eradicating the tax exemption across the board and replacing it with a tax credit that sends millions of people into the individual market, which President George W. Bush proposed doing in 2007.

"There's a big distinction between putting a cap at 95% or 75% and indexing and eliminating the tax preference overnight and having lots of people moving out of the employer market all at once into another market that doesn't really exist," he said. "A complete elimination with a credit, that is nuts and was nuts."But comprehensive benefits push up the price, setting up old tensions, Holahan said.

"You'd probably get the biggest pushback from the left, saying everything under the sun has to be in it," he said. "And people really can't afford to spend more than a small percentage of their income on health care."

A related issue is setting limits on out-of-pocket costs based on income, Holahan said. "You've got to pick a number."


Baucus Forecasts ‘Near Universal Coverage’, CQ Healthbeat News - (May 21, 2009)

Easing Baucus’ task in putting together a financing package may be a study released Thursday pointing out that foregoing an overhaul would also add deeply to the nation’s financial burdens and strike growing numbers of middle-class Americans particularly hard (see related story in this issue). The study shows that the status quo will not be easy to defend, either, said speakers at a forum sponsored by the Urban Institute.


Health care cure seen in tax code, The Washington Times - (May 21, 2009)

Some people worry that a cap would be unfair to older workers and workers in small companies. These workers and people in high-cost areas of the country often can pay stiff premiums for plain-vanilla health insurance. But Urban Institute scholar Stan Dorn explains in an upcoming study how, by using the "actuarial value" of a plan, the Internal Revenue Service could cap tax subsidies based on the generosity of covered benefits. This would address the concern by eliminating the need for a fixed-dollar cap.


Editorial: Health care spending - These reform proposals' time shouldn't come, The Orange County Register - (May 19, 2009)

The Obama administration's approach – many details aren't yet available – is to expand health insurance to all those not presently covered and save money to cover the additional $120 billion per year this will cost (according to the Urban Institute) by reforming several medical practices.


Herb Kuhn to join MedPAC, Modern Healthcare - (May 12, 2009)

Kuhn, along with Robert Berenson, senior fellow at the Urban Institute, were both appointed as new members to the independent government body, which advises Congress on a range of care, cost and quality issues, including hospital and physician payment.

the newest appointments in a written statement. “We look forward to working with Mr. Kuhn, Dr. Berenson and the entire commission to discuss issues to ensure quality care for our nation’s frail, elderly and disabled,” Yarwood said.


Hospitals Pay for Cutting Costly Readmissions, The New York Times - (May 8, 2009)

“The hospitals who say they are penalized for doing the right thing are absolutely right,” said Dr. Robert Berenson, a policy specialist at the Urban Institute, an economic and social policy research center in Washington. “If we can’t do this, we can’t do much of anything in health reform.”


Medicaid payments to doctors rise, gap remains: study, CCH® Medicaid - (May 8, 2009)

Between 2003 and 2008, Medicaid physician fees rose a bit more than Medicare fees, but did not keep up with inflation, according to a study published on the website of the journal Health Affairs. The study was conducted by the Urban Institute in partnership with the Kaiser Commission on Medicaid and the Uninsured and the California HealthCare Foundation. The study examined states' Medicaid physician fee schedules from 2003 to 2008 and compared them to the Medicare fees during the same period. On average, combining all services, Medicaid physician fees rose 15.1 percent during the five-year period, while Medicare fees rose about 9 percent. Neither program kept pace with inflation.

In some areas, Medicaid recipients' access to care has been affected. States' concerns about the effects of fees on access were a primary reason that they increased Medicaid payments during the late 1990s and early 2000s, according to Stephen Zuckerman, a senior fellow at the Urban Institute's Health Policy Center and lead author of the study.


Single-Payer Health Care Debated at Senate Hearing, AllGov.com - (May 7, 2009)

Claiming the U.S. is the only developed nation without health coverage for all of its citizens, Baucus drew attention to a report by the Urban Institute that found that 22,000 uninsured adults die every year because they lack access to care. And in light of the current recession, the situation only grows worse by the day. “For every 1 percent increase in the unemployment rate, the number of uninsured Americans increases by 1.1 million,” said Baucus, who added that 87 million people—approximately one-third of the population—went without health insurance at some point between 2007 and 2008. “Fourteen thousand people lose their health insurance every day,” the chairman insisted.


Small-biz divided on health-care, Buffalo Business News First - (May 1, 2009)

John Holohan, director of the Urban Institute’s Health Policy Center, said a public plan “has to be part of the deal” if Congress wants to be serious about containing health-care costs. Not all private insurance plans will survive this new competition, but the best ones will, he said. Private insurers probably would provide better service and better access than a public plan, at a slightly higher cost, he said.

“A lot of people will want to be in there,” Holohan said of private plans.


In the Tanks: Debating Health Care Reform, Washingtonpost.com - (April 29, 2009)

Linda Blumberg (Urban Institute): Right now private insurers have little incentive to hold down costs; they can continue to pass on costs to purchasers. A public plan puts a competitor with a public interest in holding down costs into the marketplace, forcing the private insurers to play harder with providers and innovate on cost control in order to retain market share. 


Medicaid physician fees grew 15 percent from 2003 to 2008, Healthcare Finance News - (April 28, 2009)

BETHESDA, MD – Between 2003 and 2008, Medicaid physician fees rose 15.1 percent, closing a portion of the gap with Medicare physician payment rates, according to a study by researchers from the Urban Institute.

"Medicaid has historically paid physicians less than both private insurers and Medicare for the same services, contributing to reduced physician participation in Medicaid in some areas and raising concerns over access to care for enrollees" said lead author Stephen Zuckerman, a senior fellow at the Urban Institute's Health Policy Center. "These concerns were a primary reason that state Medicaid programs increased physician fees during the late 1990s and early 2000s."

This study, conducted by Zuckerman and Urban Institute coauthors Aimee Williams and Karen Stockley, provides the first national and state-by-state update of Medicaid physician fees since 2003. Their research was conducted in partnership with the Kaiser Family Foundation's Commission on Medicaid and the Uninsured and the California HealthCare Foundation.

"State revenue declines during the current economic crisis heighten the need to monitor this issue since many states sought to reduce Medicaid spending growth during past recessions through provider payment cuts," said Zuckerman.


Inflation outpaces Medicaid rate increases report, Modern Health Care - (April 28, 2009) 

While some states have increased their Medicaid reimbursement rates for primary care and obstetric services, in general, rate increases did not keep up with the rate of inflation between 2003 and 2008, according to a report from the Washington-based Urban Institute and published on the Health Affairs Web site.


Automated enrollment can widen access for uninsured kids, Modern Healthcare - (April 26, 2009)

Some 96% of children who receive free school lunches live in families with incomes low enough to make them eligible for CHIP or Medicaid, according to the report by Stan Dorn, an Urban Institute senior research associate.

Under CHIP, states get financial incentives to enroll more eligible children and receive bonuses for doing so. The combination of financial incentives and new eligibility tools can help boost enrollment and reduce the number of uninsured children, Dorn concluded.


DU studies cost-benefits of health care reform, The Pueblo Chieftain - (April 24, 2009)

Brown said that the study of health care reform grew out of a report by the Colorado Economic Future Panel studying long-term issues facing the state. DU was asked to set up a non-partisan program to study health care and work with the Urban Institute and the New America Foundation, which also are involved in the study. The DU center will analyze the economic aspects of reform and provide the national agencies with information specific to Colorado, Resnick said.


Kaiser: Long-term care accounts for nearly one-third of all Medicaid spending in the United StatesMcKnight's Long Term Care News and Assisted Living - (April 17, 2009) 

Nearly $195 billion (61%) of all Medicaid funding was used to cover acute care services, while another $15.9 billion (5%) went to disproportionate share hospital payments. In all, $319,676,945,585 was spent on Medicaid. The totals are based on data provided by the Centers for Medicare & Medicaid Services. Analysis was jointly conducted by the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute.


Letter: Workable health care system is out thereNorwich Bulletin - (April 11, 2009)

The proposal is Senate Bill 6600, or SustiNet. It was developed in conjunction with a team of national experts from the Urban Institute and MIT and with input from a diverse range of residents and groups, including business, labor, health care and clergy.


Laurel to the Tampa Tribune: For adding a fresh dimension to the Medicare Advantage story, Columbia Journalism Review - (April 10, 2009)   

Indeed, the health care ratings business has run amuck. J.D. Power, which rates companies and products in various industries, is one of some seventy-five businesses and government organizations that rate managed care plans and lots of other health care providers. (There are more than 175 for hospitals.) These groups, some for-profit and some not-for-profit, hope to capitalize on the push for increased consumer information, cloaking themselves in the blanket of consumer choice. But as Mullins showed, many purveyors of ratings also help themselves. “Most popular ratings are downright deceitful,” Robert Berenson, a senior fellow at the Urban Institute, told me.


My turn: More kids now eligible for LaChip, The Town Talk - (March 27, 2009)

Eight out of 10 uninsured persons come from working families. They live sicker lives and die younger than those with coverage. According to the Institute of Medicine and the Urban Institute, an estimated eighteen to twenty thousand Americans die each year because they lack coverage.


Insurance coverage falls as unemployment rises, No income means no insurance, and possibly sicker folks in the futureThe Florida Times-Union - (March 22, 2009)

But that financial help is "likely to be too small to make coverage affordable to many people who have lost their jobs," according to the Urban Institute, a Washington-based think tank.

The analysis cited an existing COBRA subsidy for job losses related to trade liberalization that has only enrolled from 12 percent to 15 percent of eligible workers. (Without subsidies, about 9 percent seek COBRA coverage.)


Report: thousands in Conn. lacked health insurance in past yearThe Bristol Press - (March 22, 2009)

The concept of each person having a “medical home” drew Mills to support SustiNet. Representing the home-care industry where it is common for caregivers to work for multiple employers, she said it is vital that any structure for medical management provides such a focal point to prevent duplication of testing and prescribing and medical records lost between providers. The “medical home” promotes healthy behavior and manages chronic illnesses while care coordination, patient empowerment and timely access to care are also essential elements. After years of comprehensive analysis of Connecticut residents’ needs, to develop SustiNet, the foundation worked with Dr. Jonathan Gruber, a health economist at MIT, and the Urban Institute, to identify its coverage and economic impact.


The Right Medicine for Healthcare ReformThe Christian Post - (March 21, 2009)

Two: sign up the more than five million uninsured Americans who already qualify for health insurance coverage through their employers. Over twenty-five percent of eligible workers are not signed up, according to the Urban Institute, and using an "opt out" system that has been successful in getting low-income workers into 401(k) plans can be used to increase the number of insured.


Oregon Considering Insurance MandateThe Bulletin - (March 19, 2009)

Massachusetts passed an individual mandate in 2006, and its state-funded insurance plan for low-income people has had higher-than-anticipated costs, according to a study by the Urban Institute, a policy research organization based in Washington, D.C.

Though costs were lower than projected in 2007, they exceeded the 2008 state budget request of $427 million by $153 million. In 2009, the Massachusetts Legislature requested $869 million to cover costs.

Though some of the costs are short term, the report found, “Massachusetts also faces a long-term cost problem,” it concluded.

 “One of the things you have to keep in mind about Massachusetts is the political calculus,” said Linda Blumberg, who co-authored the Urban Institute’s report. They decided, she said, “we want to get coverage in place, then we will figure out cost containment.”


LETTER:The Right Medicine for Health care ReformNative American Times - (March 18, 2009)

Two: sign up the more than 5 million uninsured Americans who already qualify for health insurance coverage through their employers. Over 25 percent of eligible workers are not signed up, according to the Urban Institute, and using an "opt out" system that has been successful in getting low-income workers into 401(k) plans can be used to increase the number of insured. 


When Republicans lose their principles, San Francisco Chronicle- (March 13, 2009) 

Give conservatives credit here: At minimum, this argument had a logic to it, however flawed. Sure, it is belied by data - the Urban Institute reports that private insurers spend up to 30 percent of their revenue on administrative costs (read: salaries, paperwork, etc.) while government programs spend just 5 percent, and polls show Medicare recipients are far more satisfied with their health care than those in the private system. But, in nonetheless claiming that the private sector will always outperform the government, Republicans at least presented an ideologically coherent (if fantastically inaccurate) hypothesis.


The urgency of health care reformThe Washington Examiner progressive politics blog - (March 5, 2009)

"I think there is going to be a lot of ideological argument over it," said Linda J. Blumberg, principal research associate at the Urban Institute's Health Policy Center in Washington, D.C.

"The way that we're envisioning this is more modeled after a traditional Medicare-type plan," said Blumberg, co-author of a recent Urban Institute paper examining the cost and competitive implications of creating a public insurance plan. The government would set the fees and bear the risk, she said, and the benefits package would be structured to look more like an employer-sponsored plan.

As for provider payments, Blumberg suspects that the government plan would pay doctors slightly better than Medicare does. "I think the pressures from the private market are going to help to make sure that what's being paid in the public plans is going to be sufficient to providing good quality care," she said.


White House forum to diagnose health care illsThe Associated Press - (March 4, 2009)

"This is part of a larger process of people feeling each other out," said health economist John Holahan of the Urban Institute, who was involved in a similar effort that succeeded in Massachusetts. "I imagine that a lot of what they'll say is already known. What's going to be more important is the stuff behind the scenes, which we may never know much about."


Does New Health Insurance Plan Tilt Too Much Toward Government?HealthDay - (March 4, 2009)

"I think there is going to be a lot of ideological argument over it," said Linda J. Blumberg, principal research associate at the Urban Institute's Health Policy Center in Washington, D.C

"The way that we're envisioning this is more modeled after a traditional Medicare-type plan," said Blumberg, co-author of a recent Urban Institute paper examining the cost and competitive implications of creating a public insurance plan. The government would set the fees and bear the risk, she said, and the benefits package would be structured to look more like an employer-sponsored plan.

As for provider payments, Blumberg suspects that the government plan would pay doctors slightly better than Medicare does. "I think the pressures from the private market are going to help to make sure that what's being paid in the public plans is going to be sufficient to providing good quality care," she said.


Breaking Down Obama's Health Care Cuts, BNET.com, Healthcare - (February 27, 2009)

Experts like Robert Berenson of the Urban Institute have advocated bundling Medicare payments for hospital and post-acute care for years. Yet it remains an untried approach, with uncertain savings.


Report: Maine personal income growth lacking, Bangor Daily News - (February 26, 2009)

More than 90 percent of Mainers reported having health insurance in 2007, but 19 percent of those were covered by MaineCare, the state’s Medicaid program, according to the Kaiser Foundation and Urban Institute. Nationally, 13 percent of the population is covered by Medicaid.


The "Obama Effect" On Health Care, NPR, News & Notes - (February 26, 2009)

For more on the president's plan and its possible impact, Tony Cox speaks with Robert Moffitt — director of the Center for Health Policy Studies at The Heritage Foundation — and Linda Blumberg, Senior Fellow at the Urban Institute's Health Policy Center.


Low-Cost Health Care in Howard Not an Easy Sell, The Washington Post - (February 24, 2009)

Policymakers "can't take it for granted that people will come to them," said Linda Blumberg, an economist and senior fellow at the Urban Institute's health policy center who has studied enrollment trends in federal programs. States and counties that want to offer such programs must realize that they have to devote sizable resources to recruitment, especially now that the faltering economy will mean a growing number of people who have not dealt with the public system could be looking for help, she said.


Personal health gets a shot of stimulus, MarketWatch.com - (February 19, 2009)

"The Cobra subsidy will help people keep their policies," said John Holahan, director of the Health Policy Research Center at The Urban Institute. "It will be a big lift."


Massachusetts' Health Reform Costs Too Much For Too LittleInvestor’s Business Daily - (February 19, 2009)

Sharon Long, a principal research associate at the liberal Urban Institute and an expert on Commonwealth Care, claims that "on access to care, reform has made substantial progress...But the elephant in the room is the cost, and they have not yet tackled that."

Long co-authored a 2008 study showing that program had boosted coverage by nearly 4% and by 4.8% for low-income adults.

A survey conducted by Long pegs the uninsured rate closer to 2.6%.

PNHP argues that Long's study failed to reach many non-English speaking households or those that lacked a landline phone.

But she says the study addressed those concerns.


U.S. employers expect steady rise in health costs, Reuters - (February 19, 2009)

The Center for American Progress used Urban Institute data that showed a 1 percentage point rise in the national unemployment rate causes 2.4 million people to lose employer-sponsored health coverage.


Report: 4M Americans lost health insurance since recession beganAustin Business Journal - (February 19, 2009)

The report uses estimates from Urban Institute researchers that a one percentage point rise in the national unemployment rate causes 2.4 million people to lose employer-sponsored health coverage. Of those people, 1 million rely on Medicaid or the Children’s Health Insurance Program and 1.1 million end up uninsured.


Universal health care plan gains steam, The Journal-Record - (February 17, 2009)

Galvin and several other state business leaders are encouraging business owners to take a close look at SustiNet, a public-private health care plan developed by the Universal Health Care Foundation Inc. and a team of national experts led by the Urban Institute, MIT with input from business, labor, and state health care and clergy leaders.


Report suggests shifting nursing home care to Medicare program, McKnight’s Long-Term Care News & Assisted Living - (February 16, 2009)

Moving more of the cost of care for so-called dual-eligibles - the 9 million Americans eligible for both Medicaid and Medicare - from Medicaid to Medicare could save states as much as $47 billion annually, say study authors from the Kaiser Family Foundation's Commission on Medicaid and the Uninsured, and researchers at the Urban Institute. A majority of nursing home residents fit under the “dual eligible” label.


Stimulating Jobs and Health Care Savings: 20,000 Jobs Hang in the Balance, The Huffington Post - (February 12, 2009)

In 2008, Trust for America's Health (TFAH) released a report, Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, using an economic model developed by researchers at the Urban Institute which found that for every $1 spend on proven community-based disease prevention programs, the country could save $5.60 in health care costs within five years.

The January 2009 "Maximizing the Stimulus Effect of Prevention Activities" analysis by the Urban Institute experts concluded community-based disease prevention programs by definition do not increase health care costs and have been shown to reduce health spending within short time periods. Community-based prevention programs can also have "spillover effects on the quality of life and economic vitality" in communities. The researchers also conclude that investments in community-based disease prevention programs help reduce rates of disease as well as health care costs "upstream," helping people avoid developing diseases in the first place and preventing individuals with early cases of diabetes and hypertension from developing more serious and costly complications, and that these programs not only generate short- and long-term health care savings, "but also increased productivity at school and work as the result of reduced disease."


UnitedHealth and I.B.M. Test Health Care Plan, The New York Times - (February 7, 2009)

"The purchasers want a magic bullet," said Dr. Robert A. Berenson, a health policy expert for the Urban Institute, a nonpartisan public policy group in Washington. "Every two years a new one comes along."

While Mr. Berenson says he sees promise in the medical home concept, he worries that small doctors’ offices will find it too difficult to make the necessary changes to succeed.


Editorial: SCHIP failures: Liberal malpractice, Pittsburgh Tribune-Review - (February 4, 2009)

Expanding SCHIP could make a bad situation worse by discouraging work. The Urban Institute offers an eye-opening example of the Law of Unintended Consequences:

"A single mother of two earning minimum wage in New Mexico who increased her earnings by $30,000 would find no change in her net income: She would pay an additional $4,000 in taxes and lose $26,000 in SCHIP and other government benefits," the institute concludes.


Federal leadership role for Mayo's Cortese?, Minneapolis Star-Tribune - (February 2, 2009)

The RPM Report blog puts Cortese at the top of the list of  heavyweight policy hitters in the running for the CMS job. Others under consideration include three men from Harvard, former Avalere executive Jon Blum, the Urban Institute’s Robert Berenson and Institute for Health Care Improvement’s Dr. Donald Berwick.


Does SCHIP Work?, National Review Online - (February 2, 2009)

One thing SCHIP does accomplish is to discourage work. SCHIP and similar programs create enormous disincentives to climb the economic ladder. A single mother of two earning minimum wage in New Mexico who increased her earnings by $30,000 would find no change in her net income: She would pay an additional $4,000 in taxes and lose $26,000 in SCHIP and other government benefits, according to data compiled by the Urban Institute for the federal government.


Can Stimulus Funding Help Promote Wellness?, NPR All Things Considered - (February 1, 2009)

The group's analysis is published in a report called Prevention for a Healthier America. The group collaborated with economists at the Urban Institute and experts at the New York Academy of Medicine.


35 percent increase in low-income Wisconsinites getting state-funded health care, Pierce County Herald - (January 30, 2009)

Nationally, the Urban Institute says Medicaid enrollments grow by a million people for every 1 percent increase in the unemployment rate.


Mandate could cost N.Y. jobs, Rochester Democrat and Chronicle - (January 30, 2009)

The agencies and a panel of experts held public hearings in 2007, then hired the Urban Institute to develop a "roadmap" to achieve universal coverage.

The report is expected to be out in the spring, said Health Department spokeswoman Beth Goldberg.


More relying on state health care programs, Milwaukee Journal Sentinel - (January 29, 2009)

Medicaid enrollment will likely tick higher in 2009. Each increase of 1 percentage point in the national unemployment rate is expected to increase Medicaid enrollment by 1 million people, according to the Urban Institute, a policy research institute in Washington.


Blueprints for a health care fix, Fortune Small Business  - (January 28, 2009)

Small business should remain central to that discussion, says economist Linda Blumberg of the Urban Institute in Washington, D.C.: "There is broad interest in helping small employers and their workers because so many of them are uninsured."


Federal Action Required on Healthcare, U.S. News & World Report - (January 27, 2009) 

We didn't need an election to tell us our healthcare system is broken. From declining coverage to increasing costs to escalating levels of chronic disease, our healthcare system isn't promoting our nation's health the way it should. American families bear the pain. More than 45 million Americans lack health insurance and are therefore less likely to receive timely, adequate, or high-quality healthcare. The Urban Institute has estimated that 22,000 people die each year because they lack coverage. The uninsured live sicker and die younger than people with coverage.


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