Urban Institute: Health Policy

The Cost of Uncompensated Care with and without Health Reform

paffairs@urban.org ( John Holahan, Bowen Garrett) — Wed, 10 Mar 2010 00:00:00 EST

In this report the authors estimate that under the health reform bill passed by the Senate, the cost of uncompensated care will fall from $62.1 billion in 2009 to $46.6 billion in 2019. If no health reform is enacted, they project that uncompensated care would rise to between $107 and $141 billion in 2019. Over the six-year period of proposed health reform legislation, 20142019, the costs of uncompensated care without health reform would be between $560 and $700 billion. With reform, the cost would be $330 billion under the Senate bill and provide substantive savings to each level of government.

How Will Comparative Effectiveness Research Affect the Quality of Health Care?

paffairs@urban.org ( Elizabeth Docteur, Robert A. Berenson) — Wed, 03 Mar 2010 00:00:00 EST

Building on the American Recovery and Reinvestment Act of 2009, health reform legislation would develop an infrastructure for the ongoing generation and dissemination of information on the comparative effectiveness, where "comparative effectiveness" has been defined as the study of methods to prevent, diagnoses, treat, and monitor A clinical condition or improve delivery of care to assist consumers, clinicians, purchasers, and policy makers to make informed decisions to improve health care at both individual and population levels. The issue brief explores the concept and describes areas of controversy that need to be addressed to make comparative effectiveness research successful.

THE BIGGEST LOSERS, HEALTH EDITION : Who Would Be Hurt the Most by a Failure to Enact Comprehensive Reforms?

paffairs@urban.org ( Linda J. Blumberg) — Wed, 24 Feb 2010 00:00:00 EST

This brief describes the groups with the most to lose if comprehensive health care reform is not enactedpeople who either lack coverage today or who are required to pay the most for health insurance and medical care. These include the self-employed, those working for small employers, those with health problems, older working-age adults and early retirees, the low-incomes, and others without access to employer-based insurance. Reform's combination of Medicaid expansions, subsidies for exchange-based coverage, broader-based sharing of risk, and administrative economies of scale would make meaningful coverage affordable for the vast majority of individuals disadvantaged by the current system.

Making Health Reform More Affordable for Working Families: The Effect of Employee Choice Vouchers

paffairs@urban.org ( Matthew Buettgens, Linda J. Blumberg) — Mon, 15 Feb 2010 00:00:00 EST

Many low-income workers would be prevented from accessing subsidies under current health reform proposals if they are offered employer-sponsored health insurance (ESI). This report examines the effectiveness of two employee choice voucher options in making health care more affordable for such families. Findings show that employee choice vouchers would make health coverage dramatically more affordable for the low-income families who take advantage of them, would increase insurance coverage very modestly, and would not significantly change government or employer spending. The voucher programs considered would modestly reduce the number of people covered by ESI while having little effect on premiums.

A Comment on "The Massachusetts Health Plan - Much Pain, Little Gain"

paffairs@urban.org ( Sharon K. Long) — Tue, 02 Feb 2010 00:00:00 EST

The Cato Institute recently released a study of health reform in Massachusetts by Aaron Yelowitz and Michael F. Cannon, entitled "The Massachusetts Health Plan: Much Pain, Little Gain." That study reports fewer gains in health insurance coverage and higher costs than have been reported by earlier studies. As the Urban Institute has done a substantial amount of research on health reform in Massachusetts, we have received a number of requests to reconcile the findings on health insurance coverage from the Cato study with the findings from earlier work. This paper is a response to those requests.

Health Care Spending Under Reform: Less Uncompensated Care and Lower Costs to Small Employers

paffairs@urban.org ( Lisa Clemans-Cope, Bowen Garrett, Matthew Buettgens) — Thu, 28 Jan 2010 00:00:00 EST

In this brief, we estimate that the annual cost of uncompensated health care for the uninsured would decrease from $61 billion to $25 billion under health reform legislation passed in the House. Because the government finances about three-quarters of uncompensated care, up to $27 billion per year could be used to offset the expansion of Medicaid and subsidies to employers and individuals. Overall, employers' net costs would increase by 2.9 percent over the current system, but small employers' net costs would decrease 8 percent due to employer subsidies, the expansion of Medicaid, and exemptions from penalties for not offering insurance.

How Would States Be Affected by Health Reform?

paffairs@urban.org ( John Holahan, Linda J. Blumberg) — Mon, 25 Jan 2010 00:00:00 EST

In this paper we examine various pathways through which individuals could gain coverage through the Senate and House health reform proposals. We show that large shares of the population, particularly the uninsured, could potentially gain coverage under health reform through one pathway or another, depending on income and employment status. The number of individuals who would gain coverage and how they would gain coverage varies considerably among states. The benefits of the reform would be disproportionately in southern and western states due to their current low levels of coverage and low incomes.

Reconciling House and Senate Health Reform Proposals: Eligibility, Enrollment, and Retention

paffairs@urban.org ( Stan Dorn) — Wed, 13 Jan 2010 00:00:00 EST

For health reform legislation to maximize coverage among low-income, uninsured Americans, the administrative details for subsidies need to make enrollment and retention simple, seamless, and as automatic as possible for consumers. Neither the House nor the Senate health reform bill extends to Medicaid the streamlined procedures that apply to other subsidies. And with multiple subsidy systems operating under reform, consumers could easily fail to receive coverage for which they qualify. To avoid such difficulties, lawmakers could establish, for all subsidy systems, a single, streamlined system for eligibility determination, enrollment, and retention that minimizes the need for consumers to complete paperwork.

Potential Impacts of Alternative Health Care Reform Proposals for Children with Medicaid and CHIP Coverage (Updated 1/8)

paffairs@urban.org ( Genevieve M. Kenney, Allison Cook) — Fri, 08 Jan 2010 00:00:00 EST

For children currently enrolled in Medicaid and CHIP, the health reform bills in the House and Senate present both potential benefits and risks in terms of the type of coverage these children would have and their access to needed care. This brief estimates the number of children enrolled in Medicaid and CHIP who would have been affected if provisions in pending health reform bills were implemented in 2007. Potential tradeoffs associated with shifting children from CHIP into Medicaid or new exchange plans are discussed.

What Would Health Care Reform Mean for Small Employers and Their Workers?

paffairs@urban.org ( Linda J. Blumberg, Stacey McMorrow) — Wed, 16 Dec 2009 00:00:00 EST

Small employers face significant challenges in providing health insurance to their employees. This paper reviews these barriers to purchasing coverage and examines the implications of the House of Representatives' and the Senate leadership's health care reform bills for small firms and their workers. Health insurance exchanges, insurance market reforms, and subsidies for the low-income can be expected to produce substantial improvements in the ability of small employers and their workers to obtain affordable coverage. In addition, the authors demonstrate that neither bill imposes substantial new financial burdens on small businesses.

Progress Enrolling Children in Medicaid/CHIP: Who is Left and What are the Prospects for Covering More Children? (Updated 12/14/09)

paffairs@urban.org ( Genevieve M. Kenney, Allison Cook, Lisa Dubay) — Mon, 14 Dec 2009 00:00:00 EST

This brief examines the characteristics of the children who were eligible for Medicaid/CHIP in 2007. The results show that while participation rates were high in both Medicaid and CHIP, some 5 million remained uninsured despite being eligible for coverage. Participation rates, which were found to vary across areas, have likely increased given recent declines in the number of uninsured children. The brief also shows that while interest in public coverage is high among low-income parents, many do not know not know that their child is eligible for Medicaid/CHIP, do not know how to apply, and/or find the application process difficult.

Premium and Cost-Sharing Subsidies under Health Reform: Implications for Coverage, Costs, and Affordability

paffairs@urban.org ( Bowen Garrett, Lisa Clemans-Cope, Matthew Buettgens) — Thu, 10 Dec 2009 00:00:00 EST

Using the Urban Institute's Health Insurance Policy Simulation Model (HIPSM), we estimate coverage, costs, and household financial burdens under legislation proposed by the Senate Finance Committee and under two alternative subsidy schedules: those specified in the Senate Leadership bill, and those specified in H.R. 3962, passed by the House of Representatives. This analysis shows that health care cost burdens can be substantial for those with modest incomes and significant health care needs. It shows how enhanced premium and cost-sharing subsidies could reduce burdens, while increasing overall coverage and government costs.

The Secrets of Massachusetts' Success: Why 97 Percent of State Residents Have Health Coverage

paffairs@urban.org ( Stan Dorn, Ian Hill, Sara Hogan) — Mon, 07 Dec 2009 00:00:00 EST

Less than two years after Massachusetts' 2006 reform law was implemented, 2.6 percent of residents were uninsured-the lowest proportion ever recorded in an American state. The state's individual mandate alone does not explain this result, since it is not enforced against adults with incomes at or below 150 percent FPL or children. During a multi-day site visit, researchers identified several factors contributing to Massachusetts' high enrollment, including an intensive marketing campaign; use of data to establish subsidy eligibility for newly-insured residents; an integrated eligibility system serving multiple subsidy programs with a single application; and healthcare provider/community-based organization-driven application assistance.

Applying 21st-Century Eligibility and Enrollment Methods to National Health Care Reform

paffairs@urban.org ( Stan Dorn) — Mon, 30 Nov 2009 00:00:00 EST

Many past health coverage expansions experienced low participation levels by the uninsured who qualified for help. To avoid similar pitfalls with national health reform, policymakers need to incorporate 21st-century approaches to eligibility determination, enrollment, and retention. One such approach qualifies individuals for subsidies based on reliable data in government hands rather than consumers' completion of traditional application forms. Federal income tax data could thus establish eligibility for subsidies, since more than 6 out of 7 uninsured-86.3 percentfile such returns. Such data-driven eligibility may also lower administrative costs and error rates.

Getting to a Public Option that Contains Costs: Negotiations, Opt-Outs and Triggers

paffairs@urban.org ( Robert A. Berenson, John Holahan, Stephen Zuckerman) — Wed, 25 Nov 2009 00:00:00 EST

This paper argues that the debate over the public option has gotten lost in rhetoric over the size and role of government. It underscores the central argument that a public option would likely have lower premiums than current private plans, with savings resulting from lower administrative costs, and average provider payment rates that are lower than what private plans currently negotiate. The authors also assess two approaches being considered to improve the political feasibility of a public option: (1) allowing states to opt out of a public option; and (2) delaying implementation of a public option until a triggering event related to health care costs occurred.

Can Accountable Care Organizations Improve the Value of Health Care by Solving the Cost and Quality Quandaries?

paffairs@urban.org ( Kelly Devers, Robert A. Berenson) — Thu, 05 Nov 2009 00:00:00 EST

Experts agree that the way health care is currently paid for in the United States, especially in the traditional, fee-for-service Medicare program, does not support coordinated care that is high quality and cost-efficient. To address these problems, policy-makers are taking a close look at accountable care organizations (ACOs). This policy brief explores what ACO are, how they compare to previous reform concepts such as Health Maintenance Organizations and Provider Sponsored Organizations, key design and implementation issues, and opportunities and challenges. The authors conclude that ACOs are no real game changers in the short term, but are nevertheless important to try.

Can Accountable Care Organizations Improve the Value of Health Care by Solving the Cost and Quality Quandaries? - Summary

paffairs@urban.org ( Robert A. Berenson, Kelly Devers) — Thu, 05 Nov 2009 00:00:00 EST

The High Cost of Small Business Health Insurance: Limited Options, Limited Coverage : Hearing Before the Committee on Energy and Commerce Subcommittee on Oversight and Investigations United States House of Representatives

paffairs@urban.org ( Linda J. Blumberg) — Tue, 20 Oct 2009 00:00:00 EST

Small employers and their workers face an assortment of barriers to obtaining health insurance coverage. These include high administrative costs, limited ability to spread health care risk, and a low-wage workforce. These issues have led to low rates of coverage offers by small employers and high rates of uninsurance among their workers. An insurance exchange, such as the one proposed in H.R. 3200, would spread health care risk and reduce administrative costs. The financial assistance provided to the low-income under the bill would benefit many small-firm workers. As such, the bill would significantly increase coverage among workers of small employers.

Age Rating Under Comprehensive Health Care Reform: : Implications for Coverage, Costs, and Household Financial Burdens

paffairs@urban.org ( Linda J. Blumberg, Matthew Buettgens, Bowen Garrett) — Wed, 07 Oct 2009 00:00:00 EST

Congressional proposals health care reform proposals have differed in the premium rating rules that would be applied to non-elderly adults. Some have proposed allowing premiums for the older adults to be as much as 5 times as high as those for younger adults (5:1 rating), while others would limit the highest premiums to be twice that of the lowest (2:1 rating). This analysis uses the Health Insurance Policy Simulation Model (HIPSM) to compare the financial implications of the premium rating choice (5:1, 2:1, and 1:1) for households of different ages, incomes, and sizes.

Variation in Insurance Coverage Across Congressional Districts : New Estimates from 2008

Mon, 05 Oct 2009 00:00:00 EST

New data on health insurance coverage from the American Community Survey show extensive variation in rates of private and public coverage and uninsurance across congressional districts in the United States. Rates of private coverage are lowest in districts that have higher poverty rates which tend to be concentrated in the South and West and uninsurance remains most serious in districts with low rates of private coverage. This analysis identifies the districts in which residents would have the most to gain from health reforms that are designed to increase health insurance coverage toward a higher and more uniform national standard.

The Cost of Failure to Enact Health Reform: Implications for States

paffairs@urban.org ( Bowen Garrett, John Holahan, Lan Doan, Irene Headen) — Thu, 01 Oct 2009 00:00:00 EST

This paper used the Health Insurance Policy Simulation Model to examine the impact on insurance coverage in government, employer, and family spending in all 50 states in absence of reform. In all states employer sponsored insurance would fall, and Medicaid enrollment and the number of uninsured would increase. Employer spending would increase despite drops in coverage. Government spending for public health insurance programs and for financing of uncompensated care would increase. The results differ among states depending on the distribution of employees by firm size and wage levels, the breadth of coverage in public programs and projected population growth.

Estimating the Cost of Racial and Ethnic Health Disparities

paffairs@urban.org ( Timothy Waidmann) — Tue, 22 Sep 2009 00:00:00 EST

This analysis estimates cost burdens of racial and ethnic disparities in a select set of preventable diseases including diabetes, hypertension and stroke. Excess rates of these diseases among African Americans and Latinos relative to whites will cost the health care system $23.9 billion dollars in 2009. Medicare alone will spend an extra $15.6 billion, and private insurers will spend an extra $5.1 billion. Over the next decade, the total cost is approximately $337 billion. Left unchecked, these annual costs will more than double by 2050 as the representation of Latinos and African Americans among the elderly increases.

Debunking the Government Takeover Myth

paffairs@urban.org ( Stan Dorn, Stephen Zuckerman) — Mon, 14 Sep 2009 00:00:00 EST

Pending health reform legislation would leave our largely private medical care system intact, give the federal government no new authority to intervene in private health care decisions, and increase health care options for millions of Americans, two senior researchers make clear.

Health Reform in Massachusetts: An Update on Insurance Coverage and Support for Reform as of Fall 2008

paffairs@urban.org ( Sharon K. Long, Karen Stockley) — Fri, 11 Sep 2009 00:00:00 EST

Massachusetts began an ambitious push toward near universal health insurance coverage in 2006. This policy brief provides an update of the impacts of health reform in Massachusetts on insurance coverage as of Fall 2008 for working-age adults, the primary target population of the reform initiative, along with an update on support for health reform in the state. Findings demonstrate that the state has achieved its goal of near universal health insurance coverage and that state residents continue to show strong support for health reform, even in the face of increasing program costs and the recession that began in December 2007. Given the success of the coverage expansion, Massachusetts policymakers are turning to the next phase of health reform - reigning in health care costs.

Structuring, Financing and Paying for Effective Chronic Care Coordination

paffairs@urban.org ( Robert A. Berenson, Julianne Howell) — Fri, 11 Sep 2009 00:00:00 EST

Growing evidence demonstrates that certain approaches to financing and paying for chronic care coordination for patients are effective not only for improving patient well-being but can also reduce health care spending. However, chronic care approaches should vary for different patient populations and can be carried out effectively by diverse organizations and professionals reflecting the heterogeneity of health care delivery throughout the US. The Report considers the different populations in need of care coordination, summarizes current evidence of effectiveness, describes the various entities that can serve as focal points for coordinating care, and details the possible financing and payment options that can support these approaches.

Current Health Reform Proposals: No Government Takeover of American Health Care

paffairs@urban.org ( Stan Dorn, Stephen Zuckerman) — Tue, 08 Sep 2009 00:00:00 EST

This paper debunks claims that proposed health reforms represent a government takeover of health care. We show, among other findings, that pending legislation would: (1) retain the nation's largely private medical care system, in which more than 90 percent of doctors are in private practice and 84 percent of all hospital admissions are to private facilities; (2) avoid government interference in the practice of medicine, instead simply extending existing public responsibilities to fund coverage for low-income Americans and regulate insurance; and (3) cover only 12 million people through a public option, based on Congressional Budget Office projections.

The Nursing Workforce Challenge : Public Policy for a Dynamic and Complex Market

paffairs@urban.org ( Randall R. Bovbjerg, Barbara A. Ormond, Nancy M. Pindus) — Mon, 31 Aug 2009 00:00:00 EST

Nurses are health care's backbone, spending the most time with patients, and working with teams of caregivers in institutions and serving as advanced practice nurses in primary care settings. Short-term shortages wax and wane, but concerns about a shortage are more serious now because the next decade may see more older nurses retiring than new ones entering the workforce. Education needs to be augmented and improved, but no precise estimation method can show how many nurses society "should" produce. Policy should focus more on nurses' scopes of practice and aligning how they are treated and paid with the value they add to patient care.

How Will the Uninsured be Affected by Health Reform?

paffairs@urban.org ( Lisa Dubay, Allison Cook, Bowen Garrett) — Fri, 28 Aug 2009 00:00:00 EST

In this analysis, a health reform scenario is modeled that would expand Medicaid to an estimated 17.0 million uninsured individuals with incomes up to 133 percent of the federal poverty level (FPL), would provide subsidies to 16.3 million uninsured individuals with incomes between 133 and 399 percent of the FPL, and would require an additional 4.3 million uninsured individuals to obtain coverage through an individual mandate, though they would not be eligible for Medicaid or subsidies. The first brief contains an overview of the entire nonelderly uninsured population, and the three remaining briefs address children, parents and childless adults, respectively.

How Does the Quality of U.S. Health Care Compare Internationally?

paffairs@urban.org ( Elizabeth Docteur, Robert A. Berenson) — Mon, 24 Aug 2009 00:00:00 EST

In a review of published literature, authors Elizabeth Docteur and Robert Berenson, explored the question, How Does the Quality of U.S. Health Care Compare Internationally? The findings don't provide a definitive answer but suggest no support for the oft-repeated claim that "U.S. health care is the best in the world." The U.S. does relatively well in some areas, including cancer care, and less well in others, including conditions amenable to prevention and coordinated management of chronic conditions. The authors conclude that concerns that health reform could compromise currently excellent care are unwarranted; health reform can only help.

Lessons for Health Reform from the Federal Employees Health Benefits Program

paffairs@urban.org ( Randall R. Bovbjerg) — Wed, 19 Aug 2009 00:00:00 EST

The Federal Employees Health Benefits Program is the nation's largest employer-sponsored health plan, offering enrollees numerous options for health insurance. The program has long kept participation high, administrative costs low, and premiums affordable-making it an enticing model for health reformers of all political stripes. Most curent federal reform proposals include a similar insurance "exchange" to offer a range of private-market insurance choices to a broader population. While opening the FEHBP to non-federal employees or replicating its features nationally is not feasible, program experience suggests lessons about benefits design, relations with participating health plans, and avoiding adverse selection in enrollment.

Health Care Town Hall Debating Points

Fri, 07 Aug 2009 00:00:00 EST

Emotions are flaring as constituents speak their minds to members of Congress home for August recess. That's to be expected, since health care is both a personal and public issue, but let's not forget to debate the basics:

Increasing Health Insurance Coverage for High-Cost Older Adults

paffairs@urban.org ( Linda J. Blumberg, Timothy Waidmann) — Mon, 03 Aug 2009 00:00:00 EST

Because a small fraction of individuals account for a large share of total health expenditures, insurers gain more by excluding high-cost people from coverage than by efficiently managing the care of enrollees. The incentives for insurers to avoid high-cost and high-risk enrollees affect not only the likelihood of health insurance coverage for the high-risk population, but also the cost and accessibility of coverage overall in the small-group and nongroup private health insurance markets. This paper identifies public policies that might address these problems in private health insurance markets more effectively and delineates the advantages and disadvantages of each.

How We Can Pay for Health Reform

Thu, 30 Jul 2009 00:00:00 EST

In this paper and brief, the authors discuss alternative ways that health reform could be financed. They analyze different options including several proposals for delivery system reforms and for reduction in Medicare and Medicaid payments. They estimate the cost savings that could occur due to the introduction of a public plan option. Finally, they explore a range of revenue options. The key message of the paper is that health reform can be paid for, but it is best to obtain funds from a large number of measures to spread the burden broadly.

A Report on the First Year of the San Mateo County Adult Coverage Initiative and Systems Redesign for Adult Medicine Clinic Care

paffairs@urban.org ( Embry M. Howell, Sarah Benatar, Dana Hughes) — Wed, 29 Jul 2009 00:00:00 EST

This report presents early findings of an evaluation of San Mateo County's Health System Redesign and Adult Coverage Initiative (ACE), an effort to improve effectiveness, efficiency, and care coordination among uninsured and underserved adults in the county. Enrollment in the ACE program has exceeded expectations, yet sustained financing for the program has yet to be identified. We have observed reforms in scheduling, team-based care, and the implementation of electronic medical records. However, we found significant barriers to access for primary care and specialty appointments. This analysis is the first of several ongoing evaluation reports by the Urban Institute and UCSF.

Reducing Obesity: Policy Strategies from the Tobacco Wars

paffairs@urban.org ( Carolyn L. Engelhard, Arthur Garson, Jr., Stan Dorn) — Mon, 27 Jul 2009 00:00:00 EST

To combat the epidemic of obesity, lawmakers can adapt policy approaches that have substantially cut tobacco use. A 10 percent tax on fattening food, identified based on a model used by the British government to determine the foods that may not be advertised to children, would reduce consumption while raising more than $500 billion over 10 years. Adding simple, "traffic light" nutrition labels to the front of each food package would change consumers' buying habits, as would listing calories on menus at chain restaurants. Consumption of fattening food would be further reduced by banning its advertisement in the mass media.

Do Access Experiences Affect Parents' Decisions to Enroll Their Children in Medicaid and SCHIP? Findings from Focus Groups with Parents

Fri, 24 Jul 2009 00:00:00 EST

For the Robert Wood Johnson Foundation's Covering Kids and Families evaluation (CKF), researchers conducted focus groups to explore parents' experiences accessing health care for their children, and to assess whether these experiences affected decisions to enroll their children in Medicaid or the State Children's Health Insurance Program (SCHIP). In each community, groups were conducted with parents of children insured by Medicaid or SCHIP and parents of uninsured children. Researchers concluded that even when parents encountered problems accessing care, very few indicated that this discouraged them from enrolling their children into Medicaid or SCHIP, or from renewing their children's public coverage.

Achieving Quality, Affordable Health Insurance for All New Yorkers: An Analysis of Reform Options

Fri, 24 Jul 2009 00:00:00 EST

Under contract to the State of New York, researchers conducted in-depth micro-simulation analyses of four types of health care reforms being considered for state implementation: a single payer public health insurance option, Assembly Member Gottfried's New York Health Plus proposal that provides an option for all New Yorkers to enroll in Family Health plus, public-private hybrid options that simplify and expand existing public programs and reform private health insurance, and a market-based option that relies on regulatory flexibility and tax credits. The cost and coverage implications of state reform options falling into these four categories are presented in this report.

Beyond the $1.6 Trillion Sticker Shock

paffairs@urban.org ( Linda J. Blumberg, John Holahan) — Tue, 21 Jul 2009 00:00:00 EST

Recently, the Congressional Budget Office (CBO) estimated that the Senate Finance Committee's health reform plan would cost $1.6 trillion over 10 years. The estimate left many in Washington and around the country with sticker shock. Authors Linda Blumberg and John Holahan place the estimate in context by showing that the costs of health reform are less than 1 percent of estimated GDP and a small fraction of expected health care spending for that period as well. They also contend that the costs associated with inaction are at least as big as those of directly addressing the problems we currently face.

National Long-Term Care Insurance: How Much Would It Cost?

paffairs@urban.org ( Howard Gleckman) — Mon, 06 Jul 2009 00:00:00 EST

About two-thirds of those over 65 will need some long-term care before they die. Howard Gleckman looks at a key question at the heart of the debate over long-term care insurance: how much will premiums cost?

Is the Public Plan Option a Necessary Part of Health Reform?

paffairs@urban.org ( John Holahan, Linda J. Blumberg) — Fri, 26 Jun 2009 00:00:00 EST

This paper makes the argument that a public plan is important to health reform because it will contribute to cost containment, primarily by addressing problems caused by increased concentration in insurance and hospital markets. We describe how the public plan might be structured, how many people might be expected to enroll, and how much money the public plan might save. We discuss the most frequent arguments that are made in opposition to the public plan. We conclude that the private insurance industry would survive at about the same size but be more efficient and more effective in controlling health care spending.

Changes to the Tax Exclusion of Employer-Sponsored Health Insurance Premiums: A Potential Source of Financing for Health Reform

paffairs@urban.org ( Lisa Clemans-Cope, Stephen Zuckerman, Roberton Williams) — Fri, 26 Jun 2009 00:00:00 EST

Many have suggested that reducing or eliminating the tax exclusion of employer-sponsored health insurance (ESI) could generate significant additional tax revenue to fund expansions in health insurance coverage. In this paper, we focus on two specific policy design elements: (1) a cap, or dollar limit, on the amount of employer-sponsored health insurance premiums excluded from taxable income; and (2) an index that determines how this cap might grow over time. Our analysis shows that limiting the tax exclusion would provide substantial funding for health reform and mitigate the huge inequities built into the current treatment of employer premiums.

Hearing on Health Reform in the 21st Century: Proposals to Reform the Health System : Before the United States House Committee on Ways and Means

paffairs@urban.org ( John Holahan) — Wed, 24 Jun 2009 00:00:00 EST

The testimony begins by mentioning a large number of positive aspects of the legislation. The role and importance of an individual mandate is then briefly discussed. It argues that the public plan that is proposed in the plan is important for overall cost containment and for budget savings. The plan would address problems in the current market that are caused by increasing concentration in insurance and hospital markets. Further it is argued that it is in fact possible to structure a fair competition between public and private health insurance plans. Finally, the testimony makes recommendations for the financing of the Medicaid expansion and for modifying the employer mandate proposal.

Medicaid Outreach and Enrollment for Pregnant Women: What Is the State of the Art?

Thu, 11 Jun 2009 00:00:00 EST

This Urban Institute study, with partner the National Academy for State Health Policy, presents findings from a 50-state analysis of Medicaid outreach and enrollment strategies targeting pregnant women. The study finds significant variation across states, but observes that the majority have policies to facilitate pregnant women's access to coverage through simplified enrollment; however, there is considerable room for improvement in outreach efforts and enhanced prenatal care. The paper presents policy recommendations for state officials to facilitate enrollment of pregnant women, raise public awareness of available coverage, and broaden the scope of prenatal care. The March of Dimes funded this study.

Health Care Reform for Children with Public Coverage: How Can Policymakers Maximize Gains and Prevent Harm?

paffairs@urban.org ( Genevieve M. Kenney, Stan Dorn) — Thu, 11 Jun 2009 00:00:00 EST

This brief examines the potential 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). 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.

Capping the Tax Exclusion of Employer-Sponsored Health Insurance: Is Equity Feasible?

paffairs@urban.org ( Stan Dorn) — Tue, 02 Jun 2009 00:00:00 EST

Some policymakers propose capping the amount of employer-sponsored insurance that is exempt from federal income and payroll taxes. If such a cap is based on employer premiums, inequities will result. Workers could pay higher taxes if their employer is located in a high-cost area, if many co-workers are in their 50s and 60s, or if a few employees have a major illness or accident. To avoid such inequities, the cap could be based on benefit generosity, measured by actuarial value, which is the cost of expected claims if a nationally representative population received the covered benefits.

How Effectively Does the American Recovery and Reinvestment Act Help Laid-Off Workers and States Cope with Health Care Costs?

paffairs@urban.org ( Stan Dorn) — Fri, 29 May 2009 00:00:00 EST

The American Recovery and Reinvestment Act of 2009 sought to help laid-off workers retain health insurance and to provide state Medicaid programs with fiscal relief. By paying 65 percent of premiums for COBRA coverage, the bill will help many unemployed purchase insurance, but a significant number will be unable to afford their 35 percent premium share. ARRA's $87 billion in fiscal relief will likewise prevent many Medicaid reductions, but because most of the money is not targeted to the states experiencing the greatest economic harm, those states may not get sufficient help to avoid major health care cutbacks.

Access to and Affordability of Care in Massachusetts as of Fall 2008: Geographic and Racial/Ethnic Differences

paffairs@urban.org ( Sharon K. Long, Paul Masi) — Wed, 27 May 2009 00:00:00 EST

Massachusetts continues to move forward on comprehensive health reform, with improvements in coverage, access to care and the affordability of care in the state. This policy brief provides a supplement to a recent Health Affairs article on health reform in Massachusetts, examining geographic and racial/ethnic differences in access to care and affordability of care across the commonwealth in Fall 2008.

What about long-term care?

paffairs@urban.org ( Howard Gleckman) — Tue, 26 May 2009 00:00:00 EST

More than 250 million Americans-more than 80 percent of us- have health coverage, usually through employers or Medicare,Howard Gleckman points out in a USA Today commentary. By contrast, just 7 million have long-term care insurance. That, it seems, is the real crisis of the uninsured.

Health Reform: The Cost of Failure

paffairs@urban.org ( John Holahan, Bowen Garrett, Irene Headen, Aaron Lucas) — Thu, 21 May 2009 00:00:00 EST

This report uses the Health Insurance Policy Simulation Model (HIPSM) to quantify the intermediate and longer-term implications if Americas health care system is not significantly overhauled.Under a range of economic scenarios, the analysis shows an increasing strain on business owners and their employees over the next decade if reform is not enacted.There would be a dramatic decline in the number of people insured through employers, and millions more could become uninsured.There would be large growth in Medicaid/CHIP enrollment and spending, and increased spending on uncompensated health care.Middle-income working families would be the most affected.

"Contact Your Doctor": Bad Advice?

paffairs@urban.org ( Robert A. Berenson) — Fri, 08 May 2009 00:00:00 EST

Immediate concerns over swine flu might be waning, but public health and government officials continue their fight against the illness, directing people with flu symptoms to see their doctor. But advice like this takes for granted a well-functioning health care system. Many Americans don't have a doctor to contact, either because they don't have health insurance or because primary-care physicians are in seriously short supply.