Urban Institute: Health Policy

Health Status of New Medicaid Enrollees Under Health Reform

paffairs@urban.org ( John Holahan, Genevieve M. Kenney, Jennifer Pelletier) — Tue, 07 Sep 2010 00:00:00 EST

According to the Congressional Budget Office, the Affordable Care Act will result in 16 million new Medicaid enrollees. A key question is whether the new population covered under Medicaid will be less healthy and thus be relatively expensive, or whether they will be healthier and therefore less expensive than the current Medicaid population. The answer to this question depends largely on the level of Medicaid participation rates under reform. Using the Medical Expenditure Panel Survey (MEPS) to provide a detailed look at the demographic and health characteristics of the population who will be newly eligible for Medicaid, we conclude that on average, this population is likely to be healthier and less costly than those currently enrolled in Medicaid.

State Mental Health Systems for Children: A Review of the Literature and Available Data Sources

paffairs@urban.org ( Stacey McMorrow, Embry M. Howell) — Tue, 07 Sep 2010 00:00:00 EST

States play an important role in serving children with a need for mental health services. In order to improve the mental health care system for this vulnerable population, it is necessary to better understand the need for mental health services, their availability, and their effectiveness across states. This report reviews the recent literature on childrens mental health services and examines a wide range of data sources for state-based analysis. It considers the feasibility of producing a comprehensive evaluation of state mental health systems for children and discusses the potential limitations of such an analysis.

Will the Patient Protection and Affordable Care Act Address the Problems Associated with Medical Malpractice?

paffairs@urban.org ( Randall R. Bovbjerg) — Fri, 13 Aug 2010 00:00:00 EST

Political battles over malpractice reform have recurred for 35 years, starting at the state level. Many states have enacted caps on awards and other tort reforms amid liability insurance crises proclaimed in the mid-1970s, mid-1980s, and early 2000s. Since the mid-1990s, Republicans have unsuccessfully sought similar malpractice limits at the federal level. Sharp run-ups in claims rates preceded the first two crises; the last seemed more driven by increases in awards and other costs, along with insurance market developments. Defensive medicine arose separately as a national policy issue in the late 1960s. At the time, medical liability was expanding from the very low level of the 1950s because of shifts in both tort doctrines and social culture.

What Are the Provisions in the New Law for Containing Costs and How Effective Will They Be?

paffairs@urban.org ( Stephen Zuckerman) — Fri, 13 Aug 2010 00:00:00 EST

Policymakers are trying a wide array of approaches in an attempt to control costs, including competition among health plans, taxes on high-cost plans, delivery system and payment reforms, wellness programs, and controls over Medicare provider payments. The law also creates a board that can directly influence Medicare payments and make recommendations to the private sector. Based on the CMS actuaries, these efforts should allow for a significant expansion in coverage without an acceleration of costs. However, we will not know for if the health reform provisions actually result in slower cost growth and avoid the need for stronger measures.

Does the Patient Protection and Affordable Care Act Permit the Purchase of Health Insurance Across State Lines?

paffairs@urban.org ( Linda J. Blumberg) — Fri, 13 Aug 2010 00:00:00 EST

The Patient Protection and Affordable Care Act (PACA) includes provisions that allow the purchasing of health insurance across state lines. However, these provisions are structured somewhat differently than earlier proposals. The differences are intended to provide states with more consumer protections from having those regulations undermined by cross state sales of insurance. The most important differences between the PPACA compact provisions and earlier interstate sales provisions are that the PPACA requires all states to comply with a minimum level of insurance regulation, and cross state sales would not be permitted in a state unless that state affirmatively joined a compact with one or more other states.

How Will the Patient Protection and Affordable Care Act Affect Small, Medium, and Large Businesses?

paffairs@urban.org ( Linda J. Blumberg) — Fri, 06 Aug 2010 00:00:00 EST

The new health care reform law will have different implications for employers depending upon their size and whether they currently offer health insurance to their workers. No new requirements are imposed on small employers (50 workers or less) but new health insurance alternatives will be available to them. Slightly larger employers may face some new requirements related to their workers' health insurance coverage but will also have access to new insurance options. Larger firms are unlikely to experience significant changes in the coverage they provide but may face higher costs associated with increased take-up of the policies that they offer.

Will Health Care Reform Hurt the Economy and Increase Unemployment?

paffairs@urban.org ( John Holahan) — Fri, 06 Aug 2010 00:00:00 EST

This paper examines the economic impact of health reform. The conclusion is that health reform is not likely to have a significant effect on the US economy or on employment. The changes in both spending and taxes generally have offsetting effects and are simply too small relative to the overall size of the economy to have much of an impact. The taxes on insurers and drug companies will be more than offset by new revenues from increased coverage. State and local governments should be beneficiaries as well as most small businesses. The effects will also turn fairly positive to the extent that the cost-containment efforts are successful.

Will Health Care Reform Increase the Deficit and National Debt?

paffairs@urban.org ( John Holahan) — Fri, 06 Aug 2010 00:00:00 EST

This paper reviews CBO forecasts of spending and revenues and assesses whether the estimates of the impact on future deficit are realistic and sustainable over time. The conclusion is that the CBO projections have not underestimated spending growth in any significant way. There are some ways in which spending may prove to be higher, but on the other hand, CBO may also have underestimated the effectiveness of many cost-containment provisions in the bill.

Managing and Delivering Performance

paffairs@urban.org ( Randall R. Bovbjerg, Harry P. Hatry) — Tue, 03 Aug 2010 00:00:00 EST

Organizations face increasing pressures to improve, and document, their performance. Good performance management systematically identifies desired ends, selects reasonable indicators of progress through means to those ends, and promotes continuous improvement over time. Key preconditions include assessing organizational measurement-readiness and overcoming inertiaand fearamong middle managers and front-line staff. To succeed, performance measurement must be seen as helping people do their jobs better, not creating new chains for yanking. Nurses and their employers have far to go to figure out how best to organize their caregiving and their administrative supports so as to improve quality and safety while constraining costs. Journal of Nursing Regulation 1(2):60 (July 2010); Marr, Bernard. Managing and Delivering Performance. Elsevier Ltd, 2009

Dental Care in the Los Angeles Healthy Kids Program: Successes and Challenges

paffairs@urban.org ( Sara Hogan, Ian Hill, Embry M. Howell) — Tue, 27 Jul 2010 00:00:00 EST

Overall, the Los Angeles Healthy Kids program has greatly improved coverage and access to dental care services for children enrolled in the program. However, as with many public insurance programs, the Los Angeles Healthy Kids program has been confronted with numerous challenges in meeting the dental care needs of program enrollees, such as initially assigning different dentists to some enrollees than they had selected, confusion over charges for dental services and underreporting of encounter data.

Federal Subsidy for Laid-Off Workers' Health Insurance : A First Year's Report Card for the New COBRA Premium Assistance

Tue, 27 Jul 2010 00:00:00 EST

Time-limited ARRA subsidies to laid-off workers for COBRA continuation coverage have substantially raised enrollment, even though layoffs sharply cut household income. The two largest data sets reviewed here showed average rises in take-up rates of 43 percent and 100 percent. However, rates varied widely across employers, and tax-subsidy claims to the IRS are thus far running much lower than expected. Coming closer to universal coverage for this population or for all Americans would require higher subsidy and possibly also a mandate to obtain coverage-two features that increase COBRA participation in a separate Massachusetts program for unemployed residents.

Assessing the Train-the-Trainer Model: An Evaluation of the Data & Democracy II Project

Tue, 27 Jul 2010 00:00:00 EST

This report concludes a comprehensive evaluation of The Data & Democracy II project, a program funded by The California Endowment and implemented by UCLA. These organizations sought to increase the capacity of local community-based organizations (CBOs) to collect, analyze, and interpret data to identify and prioritize areas for action. The program was structured after the Train-the-Trainer model, in which a group from local CBOs is trained in these skills and required to disseminate the information by conducting workshops in their own communities. We examine the program's effectiveness, long-term impacts, and challenges through observations, surveys and case studies.

Preventable Hospitalizations Among Children in Los Angeles County and the Impact of the CHI

paffairs@urban.org ( Michael Cousineau, Albert Farias, Trevor Pickering) — Thu, 22 Jul 2010 00:00:00 EST

This analysis shows that pediatric hospitalization rates are low both nationally and in Los Angeles County in comparison to adult hospitalization rates, and have gradually declined since 2000. This downward trend shows the impact of changes in the health care system that increasingly emphasizes ambulatory care and prevention over inpatient care. ACSC hospitalization rates decreased in Los Angeles, for both low- and high-income groups after the CHI was implemented (February 2003) compared to before implementation. Disparities, however, remain, and more work is needed to help close the gap in access to care for low income families in Los Angeles. Los Angeles: University of Southern California. July 2009.

Emergency Medi-Cal and Its Challenging Relationship with Healthy Kids

paffairs@urban.org ( Ian Hill, Sara Hogan, Michael Cousineau, Albert Farias) — Thu, 22 Jul 2010 00:00:00 EST

For 25 years, low-income, non-citizen Los Angeles County residents ineligible for Medi-Cal coverage have had access to emergency, pregnancy-related, and nursing home services through the Emergency Medi-Cal (EMC) program. With the 2003 creation of Healthy Kids, many children enrolled in EMC became eligible for more comprehensive coverage under Healthy Kids. But no formal mechanism was established to coordinate the programs, and the potential for children to be enrolled in both Healthy Kids and EMC was created. This study examines the benefits and challenges created by dual coverage and efforts made to capture state and federal funds to support Healthy Kids.

Impact of Enrolling in Health Insurance on Low-Income Children that Enrolled for a Medical Reason

paffairs@urban.org ( Patricia Barreto, Moira Inkelas) — Thu, 22 Jul 2010 00:00:00 EST

Children enrolling for a medical reason in Healthy Kids reported a range of common conditions including allergies, anemia, asthma, cough/cold, stomach problems, and ear/eye infection as their reason for enrollment. A large portion (67%) of parents report enrolling because the child needed prescription medication the family could not afford. Enrollment was associated with improved access to health care and lower out-of-pocket costs. However, families of children enrolled for a medical reason faced persistent barriers in accessing sub-specialty care and demonstrated higher use of emergency department services compared to those not enrolled for a medical reason. Los Angeles, CA: University of California Los Angeles. May 2009.

What are the Implications of Losing Healthy Kids?

paffairs@urban.org ( Ian Hill, Sarah Benatar) — Thu, 22 Jul 2010 00:00:00 EST

This report examines the state of the L.A. Healthy Kids program in light of recent economic and political challenges. In particular, this paper explores what may be lost if Healthy Kids' must close due to insufficient funds for children 6-18 premiums. Implications of closing the program identified include the loss of health insurance coverage for roughly 80,000 children across California, a weakened health care safety net, decreased health care access for adults and parents, loss of an outreach funding source in Los Angeles county, far-reaching effects on children's attendance and school performance, and loss of momentum towards universal children's coverage.

Changes in the Content of Developmental Care with Enrollment in Health Insurance

paffairs@urban.org ( Patricia Barreto, Moira Inkelas) — Thu, 22 Jul 2010 00:00:00 EST

Enrollment in Healthy Kids is associated with some improvement in eliciting parent concerns and providing health education, but participation did not increase information for parents about their concerns or affect the proportion of children for whom parents have some type of concern regarding learning, development or behavior. The lack of improvement in these areas despite enrollment in a medical insurance program likely results from larger systems-level barriers to adequate developmental assessment/monitoring and anticipatory guidance within primary care. Findings suggest these barriers such as time, competing demands, and incentives in primary care are not reduced simply by enrollment in health insurance. Los Angeles: University of California at Los Angeles. September 2009.

Rates of Emergency Department Use for Ambulatory Sensitive Conditions in the Los Angeles Healthy Kids Program

paffairs@urban.org ( Moira Inkelas, Patricia Barreto) — Thu, 22 Jul 2010 00:00:00 EST

This brief examines rates of ED visits associated with ACSC diagnoses in the first few years of Healthy Kids (2005-06). Low rates of ED use for ACSC suggest that high use is not a major problem among program enrollees. The rate of ACSCs as a proportion of ED visits also did not decline over the study period, suggesting that while the Healthy Kids evaluation shows an impact upon perceived access to care and affiliation with a primary care provider, the expansion may not have a significant impact upon relatively rare events, such as pediatric hospital stays and ED visits.

The Los Angeles Healthy Kids Program Perseveres Amid Increasing Financial Strain: 3rd Case Study of Implementation

paffairs@urban.org ( Ian Hill, Sara Hogan, Patricia Barreto) — Thu, 22 Jul 2010 00:00:00 EST

The Los Angeles Healthy Kids program, during its first four years, extended comprehensive, affordable coverage to over 40,000 poor and vulnerable children, and improved their access to and use of care. Yet, the program also faced serious challenges, primarily related to financing. Funding for children ages 6 through 18 ran short in spring 2005 and Healthy Kids capped their enrollment. State health reform efforts that could have stabilized funding for the program have failed. Based on interviews with over 40 stakeholders, this case study analyzes the complex challenges that the Los Angeles Healthy Kids program faces at this critical juncture. Washington, DC: The Urban Institute. November 2009.

The Urban Institute's Health Microsimulation Capabilities

paffairs@urban.org ( The Urban Institute) — Mon, 19 Jul 2010 00:00:00 EST

The Health Insurance Policy Simulation Model (HIPSM) is a detailed microsimulation model of the health care system. It estimates the cost and coverage effects of proposed health care policy options and is designed for quick-turn around analysis of policy proposalsfrom novel health insurance offerings and strategies for increasing affordability to state-specific-proposals. This document provides an overview of HIPSM, describes the type of policies it can examine and studies that have used the model, and point to potential future studies that the model makes possible, including analyses of options left open to states after health reform.

Healthy Kids Program and the Safety Net: Perceptions of Community Clinic Administrators

paffairs@urban.org ( Albert Farias, Timiyin E-Nunu, Michael Cousineau) — Mon, 19 Jul 2010 00:00:00 EST

It is widely known that improving access to ambulatory care helps prevent hospitalizations for ambulatory care sensitive conditions. The Children's Health Initiative of Greater Los Angeles (CHI) formed in order to improve children's access to primary care by increasing Medi-Cal and Healthy Families enrollment. Previous reports showed the CHI reduced the overall rate of preventable hospitalizations in low-income children. This study examines if the CHI similarly reduced preventable hospitalizations for low-income children in Los Angeles County by analyzing hospitalization rates in Los Angeles for lower income compared to higher income children, and calculating hospitalization rates for ambulatory care sensitive conditions.

How Will Hospitals Be Affected by Health Care Reform?

paffairs@urban.org ( Robert A. Berenson, Stephen Zuckerman) — Mon, 19 Jul 2010 00:00:00 EST

The roughly 30 million newly insured Americans will generate about $40 billion in new revenues for all hospitals by 2019, about twice as much as the Medicare payment cuts and the reductions in payments that will be made to offset the reduced costs of uncompensated care. For the most part, the payment changes that affect hospitals represent a modest move in the direction of paying for value rather than volume. More substantial changes, such as using forms of global payments to produce more fundamental alterations in hospitals business model will be tested in pilots and demonstrations.

How Will Physicians Be Affected by Health Care Reform?

paffairs@urban.org ( Stephen Zuckerman, Robert A. Berenson) — Mon, 19 Jul 2010 00:00:00 EST

Although physicians understandably have focused on the sustainable growth rate policy and its potential for large Medicare fee cuts, many may benefit from the key provisions of health care reform. Expansions in insurance coverage and increases in fees for primary care services will have direct benefits on practice revenues for large numbers of physicians. The likely effects of efforts to bend the cost curve are less clear. But, if they succeed in producing a more efficient health care system, physicians could gain relative to other providers and, among physicians, primary care physicians could gain relative to specialists.

The Impact of the Los Angeles Healthy Kids program on County Indigent Care Programs

paffairs@urban.org ( Michael Cousineau, Albert Farias) — Mon, 19 Jul 2010 00:00:00 EST

Presently, two options exist for covering medical services for uninsured, low income children. The first is to enroll eligible children into comprehensive insurance programs such as Los Angeles Healthy Kids, which provides coverage for children ineligible for Medi-Cal or Healthy Families with family incomes below 300% FPL. The second option is through indigent care services delivered by county-operated safety net clinics that provide care to all people regardless of their ability to pay. This study examines the impact of Healthy Kids since its inception and compares it to utilization of pediatric care visits paid for through county indigent care programs. Los Angeles: University of Southern California. November 2008.

Evaluation of the Los Angeles Healthy Kids Program: Special Study of Children Who Left the Program

paffairs@urban.org ( Ann Bagchi, Martha Kovac, Kathleen Paganelli, Matt Jacobus) — Mon, 19 Jul 2010 00:00:00 EST

Presently, two options exist for covering medical services for uninsured, low income children. The first is to enroll eligible children into comprehensive insurance programs such as Los Angeles Healthy Kids, which provides coverage for children ineligible for Medi-Cal or Healthy Families with family incomes below 300% FPL. The second option is through indigent care services delivered by county-operated safety net clinics that provide care to all people regardless of their ability to pay. This study examines the impact of Healthy Kids since its inception and compares it to utilization of pediatric care visits paid for through county indigent care programs. Princeton, NJ: Mathematica Policy Research, Inc. April 2008.

How Will the Patient Protection and Affordable Care Act of 2010 Affect Young Adults?

paffairs@urban.org ( Genevieve M. Kenney, Jennifer Pelletier, Linda J. Blumberg) — Wed, 07 Jul 2010 00:00:00 EST

Young adults should benefit from several policy changes that were introduced as part of health reform, particularly the Medicaid expansion, the subsidies offered for coverage through the new health insurance exchanges, the expansion in dependent coverage, and the health insurance market reforms. While many young adults are expected to benefit from health reform, some above 133 percent of the FPL will face penalties for opting out of coverage or will spend more on coverage than they would have otherwise chosen. However, young adults will also benefit from other health care investments in public health, prevention, and chronic disease management.

How Will the Patient Protection and Affordable Care Act Affect Seniors?

paffairs@urban.org ( Robert A. Berenson, John Holahan) — Wed, 07 Jul 2010 00:00:00 EST

The Patient Protection and Affordable Care Act will affect seniors in a number of ways. They will benefit from reductions in cost sharing for prescription drugs and for preventive services. There will however be reductions in current benefits some seniors now gain from Medicare Advantage plans and increases in premiums for high income people. Provider payment rate cuts if extended for several years could have implications for access to care. Many new provisions that will affect payment and delivery system reforms and most likely benefit seniors but could also potentially harm access to care.

Did the Los Angeles Children's Health Initiative Outreach Effort Increase Enrollment in Medi-Cal?

paffairs@urban.org ( Anna S. Sommers, Ariel Klein, Ian Hill, Joshua McFeeters) — Wed, 07 Jul 2010 00:00:00 EST

In 2003, the Children's Health Initiative of Greater Los Angeles (CHI) launched the Healthy Kids Program to cover children in families with incomes below 300 percent of the federal poverty level regardless of immigration status. Concurrently, the CHI contracted community-based organizations to support outreach to uninsured children eligible for any public program, including Medi-Cal (California Medicaid). We analyze five years of data on enrollment and disenrollment to investigate whether, in addition to Healthy Kids enrollment, CHI outreach generated "spillover" enrollment into Medi-Cal. Findings suggest outreach contributed to modest increases in Medi-Cal enrollment that were somewhat offset by increases in disenrollment.

Will the Patient Protection and Affordable Care Act of 2010 Improve Health Outcomes for Individuals and Families?

paffairs@urban.org ( Stacey McMorrow) — Tue, 06 Jul 2010 00:00:00 EST

The importance of insurance coverage in accessing medical services and improving health outcomes has been well documented, and over 30 million newly insured individuals could experience health improvements as a result of the Patient Protection and Affordable Care Act (PPACA).Coverage enhancements, a renewed focus on prevention, as well as incentives for safety, quality and care coordination may also create positive health effects.The ability of the health care system to effectively serve a vastly expanded insured population remains in question, however, and will be critical to the success of the reforms in improving health for individuals and families.

How Will the PPACA Impact Individual and Small Group Premiums in the Short and Long Term?

paffairs@urban.org ( Linda J. Blumberg) — Tue, 06 Jul 2010 00:00:00 EST

The impact of the Patient Protection and Affordable Care Act (PPACA) on small group and individually purchased health insurance will depend upon many factors.These include the characteristics of the health insurance markets prior to reform, whether plans are grandfathered or are newly created under reform, the health status and claims experience of the covered group or individual, individual coverage decisions, policy decisions that will be made at the state level, and success of cost containment efforts. This brief presents the central factors that will influence premiums for coverage and identifies the direction of that influence.

Cross-State Risk Pooling Under Health Care Reform: An Analytic Review of the Provisions in the House and Senate Bills

paffairs@urban.org ( Linda J. Blumberg, Karen Pollitz) — Mon, 28 Jun 2010 00:00:00 EST

How health care risk is pooled is of defining importance to health care systems. This paper explores provisions in the House and Senate health reform bills that could pool risk across state lines. These provisions include options for states to jointly operate insurance exchanges and enter into interstate health insurance compacts, as well as the development of national health plan offerings. Using available literature and discussions with an array of experts in the fields of health policy, insurance, regulation, and purchasing pools, the paper summarizes the potential for cross-state pooling and the challenges faced in implementation of the specific strategies.

What Is the Evidence on Health Reform in Massachusetts and How Might the Lessons from Massachusetts Apply to National Health Reform?

paffairs@urban.org ( Sharon K. Long) — Thu, 24 Jun 2010 00:00:00 EST

The Patient Protection and Affordable Care Act (PPACA) is in many ways patterned after the Massachusetts 2006 reforms. These reforms provided for an expansion of public programs, income related subsidies, health insurance exchanges, and an individual mandate. This paper reviews the evidence from Massachusetts and shows that there was a substantial increase in coverage, little crowding out of employer-sponsored insurance, high levels of compliance with individual mandate, improvement to access and use of health care services, and reduced financial burdens from health reform. The paper concludes by considering issues of provider capacity and health care costs that were not directly a focus of the legislation and but now being addressed.

An Updated Analysis of Utilization in the Los Angeles Healthy Kids Program

paffairs@urban.org ( Ariel Klein, Embry M. Howell, Ian Hill) — Thu, 24 Jun 2010 00:00:00 EST

Launched in 2003, the Los Angeles Healthy Kids Program covers children in families with incomes below 300 percent of the federal poverty level regardless of immigration status. This report presents findings on utilization of health services by children ages 0 to 5 enrolling during the programs third year. These children were more likely to receive a preventive care visit, receive any primary care visit, or have a prescription filled, compared to children enrolling during the program's second year. Hospital and emergency room visit rates remained at a constant but low level from the program's second year to the third year.

What Is the Impact of the Patient Protection and Affordable Care Act (PPACA) on the States?

paffairs@urban.org ( John Holahan, Stan Dorn) — Wed, 23 Jun 2010 00:00:00 EST

The Patient Protection and Affordable Care Act (PPACA) will have substantial effects on state governments. There will be a dramatic expansion of Medicaid enrollment; however, in most cases the federal government will pay a very high share of the costs associated with the expansion. States who offer more limited coverage today will see the greatest benefits. The legislation should also reduce many costs that states now bear for caring for the uninsured. They could also save by no longer covering Medicaid beneficiaries with incomes above 133 percent of the federal poverty line (FPL); states are also likely to save on current coverage of children, and could see lower expenditures for elderly and disabled. States will also benefit from income-related subsidies that provide federal support to individuals with low and moderate incomes.

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

Mon, 07 Jun 2010 00:00:00 EST

This report presents findings from the first 18 months of an evaluation of San Mateo County's Health System Redesign and Adult Coverage Initiative (ACE), an effort to improve access to high quality care for uninsured and underinsured adults and improve the financial sustainability of the San Mateo Medical Center (SMMC) and related delivery systems. The County has begun implementation of team-based care, disease management, Advanced Access scheduling, and electronic medical records. Enrollment in the ACE program continues to exceed expectations, and data collected for the evaluation show increased access to care and receipt of doctor visits.

Health Insurance Coverage in the District of Columbia: Estimates from the 2009 DC Health Insurance Survey

paffairs@urban.org ( Barbara A. Ormond, Ashley Palmer, Lokendra Phadera) — Tue, 04 May 2010 00:00:00 EST

This chartbook presents results from a survey of insurance status and options in the District of Columbia, conducted with 4,717 households in fall 2009. Only 6.2% of residents report being currently uninsured, among the lowest rates nationally. Somewhat more, 10.2%, report having been uninsured at some time during the year. Employer-sponsored insurance was the most common source of coverage for non-elderly adults. Among children, public coverage was nearly as important as employer-sponsored coverage. Only about 10% of publicly insured children have the option of employer-sponsored insurance. Among employed adults with public coverage, about half work in firms that offer coverage.

2009 District of Columbia Health Insurance Survey: Methodology Report

Tue, 04 May 2010 00:00:00 EST

This report describes the methods used to conduct the 2009 DC Health Insurance Survey, which collected information on insurance status and options in the District of Columbia. Data collection strategy, survey design, data processing, weights and response rate are among the discussed details. It also discusses the dual sample frame design strategy used to capture information on landline households as well as cell phone-only households.

Health Insurance Coverage in the District of Columbia: A Profile of the Insured, 2009

paffairs@urban.org ( Barbara A. Ormond, Ashley Palmer, Lokendra Phadera) — Tue, 04 May 2010 00:00:00 EST

This issue brief presents findings from the 2009 District of Columbia Health Insurance Survey conducted August to November 2009. It compares the characteristics of nonelderly DC residents with employer-sponsored insurance and to those with public insurance coverage. We consider type of insurance across gender, race, income, ward of residence, and health and disability status. For workers, we look at work status (full-time vs part-time) and type of firm.

Uninsurance in the District of Columbia: A Profile of the Uninsured, 2009

paffairs@urban.org ( Barbara A. Ormond, Ashley Palmer, Lokendra Phadera) — Tue, 04 May 2010 00:00:00 EST

This issue brief presents findings from the 2009 District of Columbia Health Insurance Survey conducted August to November 2009. It presents a profile of nonelderly adult residents in DC who reported that they were uninsured looking at gender, race and ethnicity, income, length of residence in DC, ward of residence, and employment status. It also presents the reasons that residents gave for not having health coverage.

The Effects of Large Premium Increases on Individuals, Families, and Small Businesses

paffairs@urban.org ( Matthew Buettgens, Bowen Garrett, John Holahan) — Fri, 23 Apr 2010 00:00:00 EST

Recent announcements by prominent insurers in several states of very large premium increases have attracted much attention.Many are concerned that this could become a trend.In this report, the authors examine the effects of premium increases much higher than the rate of health care cost growth on coverage, costs and the decisions by small firms to offer ESI.They find that such increases would adversely affect low- to middle-income families and older, nonelderly persons most, though there would be significant loss of coverage even among higher income families.Fewer small employers would choose to offer insurance to their workers.

What if All Physician Services Were Paid Under the Medicare Fee Schedule? : An Analysis Using Medical Group Management Association Data

Fri, 19 Mar 2010 00:00:00 EST

This joint study by the Urban Institute and the Medical Group Management Association demonstrates that it is possible to simulate physician compensation as if all physician services were paid under the Medicare Fee Schedule and to compare the results with the actual compensation. This analysis confirms substantial differences in actual hourly and annual compensation across specialties, and that, under simulated Medicare compensation, the compensation ratios across specialties are narrowed very little. The non-surgical, procedural specialties, particularly cardiology, continue to do relatively better under the Medicare Fee Schedule than under current reimbursements that includes Medicare as well as other payers.

The Cost of Failure to Enact Health Reform: 2010 - 2020 (Updated)

Mon, 15 Mar 2010 00:00:00 EST

This report assesses the changes in coverage patterns and health care costs that will occur nationally if major reforms are not enacted. The authors find that by 2015, there could be 59.7 million people uninsured. The number could swell to 67.6 million by 2020, up from an estimated 49.4 million in 2010. As premiums nearly double, employees in small firms would see offers of health insurance almost cut in half, dropping from 41 percent of firms offering insurance in 2010 to 23 percent in 2020. Individual spending could jump 34 percent by 2015 and 79 percent by 2020.

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.