Health Policy Center, independent research for better health policy: The Urban Institute

Socialist Nightmare Might Make U.S. Healthier, Bloomberg.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 states, The 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: AHA, Modern 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’ Care, The 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 Reform, Nightly 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 troops, JournalStar.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 age, The 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 Policy, Rasmussen 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, 220-215, The 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-Aged, The 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’ coverage, The 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 highest, Guardian 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 Explanation, The 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, too, The 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 Uninsured, National 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 Hearing, National 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 plans, Amednews.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 Reform, Kaiser 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 revisited, American 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 unhealthy, Mobile 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 gap, The 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 debate, The 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 reform, East 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 Texas, Houston 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 disparities, Sharon 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 Unemployment, Medical 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 Uninsured, The 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 insurance, Associated 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 says, Houston 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 fail, Pioneer 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 substantial, ABC15.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 Care, RealClearPolitics - (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 Plan, PBS.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 seems, CNNMoney.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 Reform, TIME 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 - Census, CNNMoney.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 Democrats, The 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 deficit, Christian 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 concerns, The 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 Fears, The 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 people, Knoxville 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 Plans, Kaiser 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 Edition, The 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 bipartisanship, Times 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&A, The 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 Speech, The 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 Agreement, CQ 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 premiums, WLOX.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 agenda, Green 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 triage, Asbury 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 it, Chicago 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 heavy, Herald 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 Champion, BusinessWeek - (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 option, The 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 Care, The 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 Cost, KMBC-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 Key, Executive 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 hand, Los 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 acceptance, United 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 needed, Daily 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 debate, Mercury 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 Today, The 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 matters, Houston 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 loss, Msnbc.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 lines, Albany 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 means, Los 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 Debate, The 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 debate, The 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 Favor, The 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 waste, Fort 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 Washington, Broadcasting & 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 option, The 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 Unity, Kaiser 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 Option, The 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 Wars, Youth 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 Truth, Kaiser 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 subsidy, Los 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 care, The 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 cure, McClatchy 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 consciousness, Winston-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 Reform, Kaiser 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 insurance, The 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 viable, Albany 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 Obesity,  CBSNews.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 food, CNNMoney.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 most, MSNBC.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: Accountability, The 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 Reform, Forbes.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 debate, USA 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 detailed, Crain’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 mandated, Delaware 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 says,  Chattanooga 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 floe, Los 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 Legislation, Kaiser 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 first, Chicago 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 System,  Kaiser 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 option, MarketWatch.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 store, Marketplace - (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 Primer, Washingtonpost.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 Insurance,  WCVB 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 costs, USA 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-Ops, Nightly 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 table, Lansing 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 Reform, The 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 debate, MSNBC.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 problem, Los 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 Massachusetts, Slate.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: report, Modern 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 Claims, Newsweek  - (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 Surveys,  Kaiser 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 Reality, The 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 work, CNNMoney.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 Reform, The 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 Fight, The 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 misleading, Des 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 Report, Nightly 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 truth, The 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 benefits, CNNMoney.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. Metrowest, The 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 Protected, CQ 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 Program, The 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 reform, The 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 Policy, The 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 States, McKnight'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 there, Norwich 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 future, The 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 year, The 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 Reform, The 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.

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 Reform, Native 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 reform, The 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 ills, The 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 Little, Investor’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 began, Austin 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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