Latest Urban Institute Reports

There is a consensus that evaluating and reporting on the performance of health care providers can be instrumental in improving value in U.S. health care. But the growth of performance measurement has been accompanied by increasing concerns about the scientific rigor, transparency, and limitations of available measure sets, and how measures should be used to provide incentives to improve performance. This Robert Wood Johnson Foundation-funded paper describes the current state of performance measurement and reporting, details what’s wrong, and outlines seven policy recommendations that offer a path to achieving the promise of performance measurement while avoiding its adverse consequences.

Reform of the Social Security benefit structure should proceed on the basis of principles and goals related to adequacy, protections in old age, encouragement of work to protect the tax base on which programs like this depend, and equal justice under the law for those equally situated. Many features of current law violate basic principles of public finance without promoting other worthy goals in an effective or well-targeted manner. In his testimony before the House Ways and Means Subcommittee on Social Security, Gene Steuerle lays out how to go beyond the types of options put forward by many proposals under consideration to achieve such reform.

In a contribution to the New York Times' Room for Debate, Kim Rueben argues if the tax rate for marijuana is too high, people will continue to buy weed from the guy on the street. However, setting the tax rate too low leaves revenue on the table and use might boom.

With ELE, a state's Medicaid and/or CHIP program can rely on another agency's eligibility findings to qualify children for public coverage. Using 2007 to 2011 quarterly enrollment data, we estimate difference-in-difference equations with quarter and state fixed effects to measure the effect of ELE on enrollment. The estimated impacts of ELE on Medicaid enrollment were consistently positive across model specifications, ranging between 4.0 and 7.3 percent. The analysis also finds that ELE increased Medicaid/CHIP enrollment. Our results imply that ELE has been an effective way for states to increase new enrollment or improve retention among eligible children.

States expanding Medicaid eligibility under the ACA can substantially expedite Medicaid enrollment and retention for SNAP participants, 97 percent of whom will qualify for Medicaid, according to this study. Even in states where SNAP provides broad-based categorical eligibility that extends SNAP’s gross income limits to at least 185 percent of the federal poverty level, 94 percent of SNAP recipients will qualify for Medicaid. Data showing SNAP receipt can thus verify Medicaid applicants’ financial eligibility, allow administrative renewal for Medicaid beneficiaries, and facilitate Medicaid enrollment for numerous eligible consumers when expanded coverage begins in early 2014.

Older youth face many challenges including continuing health care as they approach adulthood. The Affordable Care Act will provide new coverage for young adults. This 10 state study provides new data on Medicaid health costs for youth turning age 18. On average, boys are more expensive than girls at this age. Three groups are particularly high cost, disabled youth enrolled in Supplemental Security Income, foster care youth, and those with behavioral health problems. These three groups account for less than 20 percent of all youth that age, but over half the cost of the program.

In April 2012, Living Cities asked the Urban Institute to study the Partnership for Sustainable Communities, and the HUD Regional Planning Grants specifically, as a way to understand how the federal government could break down "silos," institutional or political barriers to cooperative and collaborative efforts. The research team reviewed key documents and conducted in-person interviews with personnel at federal agencies as well as organizations leading the regional planning grant projects in five case sites. These findings suggest that federal efforts can, in fact, contribute to breaking down silos both within the federal government and at the regional level.

In April 2012, Living Cities asked the Urban Institute to study the Partnership for Sustainable Communities, and the HUD Regional Planning Grants specifically, as a way to understand how the federal government could break down "silos," institutional or political barriers to cooperative and collaborative efforts. The research team reviewed key documents and conducted in-person interviews with personnel at federal agencies as well as organizations leading the regional planning grant projects in five case sites. These findings suggest that federal efforts can, in fact, contribute to breaking down silos both within the federal government and at the regional level.

In this Washington Post commentary, Robert Lerman and Stuart Eizenstat argue that the U.S. manufacturing sector is poised for a comeback, but faces serious workforce challenges. To avoid squandering the opportunity to sustain a manufacturing resurgence, the U.S. must match the quality and quantity of skills training achieved in many other countries. One way to do this is a 21st-century apprenticeship program. By training youth and adults through a combined work-based learning and classroom instruction program leading to a recognized and valued occupational credential, apprenticeships can increase employment, while insuring a close match between the skills learned and the skills required.

In this commentary for BlogHer.com, Urban Institute fellow Olivia Golden discusses a two-generation policy agenda that can help promote young children's development and low-wage workers' economic stability, which should start with a national focus on the first year of life.