Urban Institute: Health Policy

Progress Enrolling Children in Medicaid/CHIP: Who is Left and What are the Prospects for Covering More Children?

paffairs@urban.org ( Genevieve M. Kenney, Allison Cook, Lisa Dubay) — Mon, 16 Nov 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.

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.

Express Lane Eligibility and Beyond: How Automated Enrollment Can Help Eligible Children Receive Medicaid and CHIP

paffairs@urban.org ( Stan Dorn) — Wed, 06 May 2009 00:00:00 EST

Automated enrollment strategies have achieved remarkable results with many public and private benefit programs, dramatically increasing program participation while lowering administrative costs and reducing erroneous eligibility determinations. The recently passed Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) should make such steps much easier for states to take in covering eligible but uninsured children. Following CHIPRA's enactment, states have both new tools and new incentives to use automated strategies in fulfilling four key functions: identifying uninsured children; determining their eligibility for health coverage; enrolling eligible children into coverage; and retaining eligible children.

Improving Health Insurance Markets and Promoting Competition Under Health Care Reform : Before the United States House Committee on Ways and Means

paffairs@urban.org ( Linda J. Blumberg) — Wed, 22 Apr 2009 00:00:00 EST

Current health insurance markets suffer from many shortcomings. Comprehensive health care reform will be necessary to address them. Insurance market reforms and subsidies to make coverage affordable for the modest-income population within the context of a more organized health insurance market are essential strategies. A health insurance exchange can be developed to organize the insurance market and to provide guidance and oversight in achieving reform goals. Making a public health insurance plan option available to purchasers can further promote competition in insurance markets and could be an effective strategy for slowing health care cost growth.

Health Insurance Exchanges: Organizing Health Insurance Marketplaces to Promote Health Reform Goals

paffairs@urban.org ( Linda J. Blumberg, Karen Pollitz) — Wed, 22 Apr 2009 00:00:00 EST

A health insurance exchange can make it possible to organize health insurance markets more efficiently and effectively than takes place today. Because so many different problems must be addressed in the insurance marketplace in order for all to have meaningful and affordable coverage, an entity like an exchange is needed to coordinate tasks and guide markets to comply with consumer protections and compete in cost-efficient ways. While not a panacea for all that ails the health system, carefully designed, an exchange can be a vehicle that facilitates and monitors the movement of the system toward many national health reform goals.

Health Reform in the 21st Century: Reforming the Health Care Delivery System : Before the United States House Committee on Ways and Means

paffairs@urban.org ( Robert A. Berenson) — Wed, 01 Apr 2009 00:00:00 EST

Medicare and other insurers generally ignore the importance of established chronic illnesses in generating demands on the health care system and escalating costs, Institute Fellow Robert Berenson told the House Ways and Means Committee. At the same time, delivery system reforms are likely to fail unless immediate steps are taken to address the likely collapse of the primary care physician workforce in many parts of the country. He also underscored the need for a public plan -- patterned on Medicare but separate from it -- as an option for those seeking care.

Can a Public Insurance Plan Increase Competition and Lower the Costs of Health Reform?

paffairs@urban.org ( John Holahan, Linda J. Blumberg) — Wed, 18 Mar 2009 00:00:00 EST

Senator Barack Obama, along with others, has proposed developing a public plan that would compete with private insurers within an organized health insurance marketplace. The argument is that a public plan would have lower administrative costs and more ability to control provider payment rates. This paper assesses these arguments concluding that there would be administrative cost savings and lower provider payment rates but not as much as is often asserted. Strong private insurers that offer good value for premiums charged would survive. But most important, the amount of real competition in both insurance and hospital markets would be enhanced.

Five Questions For John Holahan on Health Care Reform

paffairs@urban.org ( John Holahan) — Thu, 05 Mar 2009 00:00:00 EST

Health Policy Center Director John Holahan answers five questions about health care reform.

President Obama has called health care reform his top fiscal priority and aims to rein in escalating medical costs while extending health insurance coverage. Massachusettss 2006 reforms could provide a model for the nation. Holahan and coauthor Linda Blumberg analyze the states progress to date in Massachusetts Health Reform: Solving the Long-Run Cost Problem.

Nine in Ten: Using the Tax System to Enroll Eligible, Uninsured Children into Medicaid and SCHIP

Fri, 27 Feb 2009 00:00:00 EST

In 2004, 89.4 percent of uninsured children who qualified for Medicaid or the State Children's Health Insurance Program lived in families who filed federal income tax forms. This substantially exceeds the proportion of uninsured but eligible children who can be reached through many other outreach strategies. Federal lawmakers could cover uninsured children in these families by: (a) changing federal income tax forms so parents can identify their uninsured children and request coverage; (b) investing in information technology allowing data exchange between states and the Internal Revenue Service; and (c) letting states cover uninsured children if tax information shows they qualify.

Los Angeles Healthy Kids Improves Access to Care and Health Status : Brief No. 26

Wed, 18 Feb 2009 00:00:00 EST

The Los Angeles Healthy Kids program provides health insurance to low income children in the county who have no other source of coverage (including undocumented children and children above the income limits for Medi-Cal and Healthy Families).These findings from a longitudinal survey of parents of young children in the program indicate that access to medical and dental care for enrolled children increased dramatically over time, use of the emergency room went down, and parents perceived improvements in the health status of their children. This analysis is one piece of a broader Urban Institute evaluation of the program.

Health Savings Accounts and High-Deductible Health Insurance Plans : Implications for Those with High Medical Costs, Low Incomes, and the Uninsured

paffairs@urban.org ( Linda J. Blumberg, Lisa Clemans-Cope) — Tue, 03 Feb 2009 00:00:00 EST

Health Savings Accounts (HSAs) and high-deductible health plans are prominently featured in many discussions of health reform.The hope of supporters is that they will make individuals more prudent purchasers of medical care. However, the tax structure and incentives built into HSAs make them most attractive to the high-income and the healthy, populations already advantaged by the current system. HSA/high deductible plans shift more of the health financing burden onto those using significant amounts of care, with negative ramifications for the low-income and high-need. Nor is it clear that cost-containment, higher value shopping, or reductions in the uninsured will follow.

HealthConnect in Our Community: What Do Health Navigators, Community Health Workers, and Families Say About the Program?

paffairs@urban.org ( Louise Palmer, Ian Hill, Asya Magazinnik) — Thu, 22 Jan 2009 00:00:00 EST

HealthConnect in Our Community is one component of a three-part initiative to address the health and related needs of children in Miami-Dade County. This report provides findings from five focus groups, two with community workers and three with parents. Both staff and parents are pleased with the program. They believe that the greatest strength of the program is its responsiveness to the cultural diversity represented in Miami-Dade County. The focus group participants also provided some areas for improvement, such as the need to raise the program's visibility in the community; improve targeting of services; and standardize data collection protocols.

Evaluation of HealthConnect in Our Community: Final Report

Thu, 22 Jan 2009 00:00:00 EST

In 2005 The Children's Trust of Miami-Dade County initiated HealthConnect in Our Community, designed to improve the health of children and adolescents in the county. The program uses community workers to reach out to underserved children and their families. The Urban Institute and three local consultants conducted a formative assessment the program's first year of operation. In a six-day site visit we interviewed 26 individuals, observed program operations in 19 separate locations, and conducted five focus groups, three with clients and two with program staff. This report summarizes the findings from the evaluation, and provides recommendations for improving the program.

Prospects for Reducing Uninsured Rates among Children: How Much Can Premium Assistance Programs Help?

paffairs@urban.org ( Genevieve M. Kenney, Allison Cook, Jennifer Pelletier) — Fri, 16 Jan 2009 00:00:00 EST

With the reauthorization of the State Childrens Health Insurance Program (SCHIP) under consideration in early 2009, an important question is the extent to which uninsured children could be covered under employer-sponsored insurance (ESI) through premium assistance programs. Only 440,000 uninsured children who are eligible for Medicaid or SCHIP have at least one parent with ESI coverage. Since many more uninsured children are eligible for public programs than have access to ESI through their parents, policies to increase enrollment and retention in Medicaid and SCHIP have much greater potential than premium assistance programs to close coverage gaps among children.

Massachusetts Health Reform: Solving the Long-Run Cost Problem

paffairs@urban.org ( John Holahan, Linda J. Blumberg) — Thu, 15 Jan 2009 00:00:00 EST

Many of Massachusetts's health reforms have brought about positive change: the number of uninsured has fallen by half, access to needed care has increased, and private insurance has not been "crowded out" by public insurance programs. But the Massachusetts initiative has also seen higher than anticipated costs. In a new analysis, John Holahan and Linda Blumberg summarize the state's accomplishments, examine the challenges, and suggest four options for addressing long-term costs. According to the authors, much of Massachusetts's high spending growth is due to the concentration in the state's hospital and insurance markets.

How Much State Fiscal Relief is Enough?

paffairs@urban.org ( Stan Dorn) — Thu, 15 Jan 2009 00:00:00 EST

Between increased Medicaid caseloads, rising indigent care costs, and Medicaid's share of state revenue losses, an economic downturn in the next two and a half years could impose between $74 billion and $118 billion in extra financial burdens on the 50 states, if unemployment averages between 8 and 10 percent. The amount Congress must spend to prevent state service cutbacks and tax increases depends on how fiscal relief is allocated. Basing each state's funding on objective, economic indicators makes federal dollars go farther towards solving state fiscal woes, since more of the money benefits the states that most need help.