From Safety Net to Solid Ground

From Safety Net to Solid Ground offers local, state, and federal policymakers, advocates, practitioners, and philanthropic leaders several resources, including timely, rigorous analyses of potential changes to federal safety net programs. The initiative provides insights into how states manage change and employ administrative flexibility, evidence on how policy changes are implemented in communities, and an assessment of Americans' health and wellbeing. 

The Growing Opioid Crisis

The opioid epidemic is a public health emergency that is part of a larger problem of untreated substance use disorder in both rural and urban areas in the United States. By drawing on Urban experts from the health, justice, and safety net policy fields, we are uniquely positioned to detect emerging problems and risks, monitor policy changes, and identify and evaluate innovative solutions. Our ability to work across disciplines is one of Urban’s key strengths and allows us take a comprehensive approach to tackling this issue on multiple fronts.

Work Requirements in Medicaid and Other Safety Net Programs

States are now allowed to impose work requirements on Medicaid beneficiaries, a major policy shift for the 50-year-old health insurance program. The Centers for Medicare & Medicaid Services issued guidance on January 11, 2018 allowing states to test work requirements through Section 1115 demonstration waivers. Kentucky was the first state to be approved for a waiver; other states have received approvals for work requirements in Medicaid or have submitted waivers that would include them. Current policy proposals also include the expansion of work requirements in federal cash assistance, nutritional assistance, and housing assistance programs.

Trends in Family Health Insurance Premiums and Contributions for Employer Coverage, 2001–16

This analysis uses data from the Medical Expenditure Panel Survey–Insurance Component to examine the premiums families could face to maintain coverage for their children in the event of a retrenchment of CHIP and Medicaid eligibility for children.

Impacts of the ACA and Implications for Its Repeal

We are analyzing the implications of partial repeal of the Affordable Care Act (ACA) through budget reconciliation, along with the changes proposed by the American Health Care Act and the Better Care Reconciliation Act. 

Emerging Strategies for Integrating Health and Housing

Funded by the Urban Institute Policies for Action Research Hub, this study examines emerging interventions that integrate housing and health services for low-income people, with a focus on interventions where health care organizations have taken a significant leadership role.

Fostering Collaboration in Housing and Health

This series of reports, derived from a literature review and extensive discussions with policy and program experts, examines the current state of housing and health care collaborations, identifies common features and factors that make collaborations successful, and offers guidance to those interested in integrating housing and health care.

Medicaid Areas of Flexibility to Provide Coverage and Care to Justice-Involved Populations

Given the high prevalence of mental health issues, substance abuse, and chronic health conditions among people involved with the criminal justice system, providing health care services to them could improve public health and public safety outcomes. This series of briefs highlights areas of flexibility within Medicaid that can facilitate enrollment in health coverage and access to care in the community for justice-involved people.

Beyond Birth Control

Beyond Birth Control: Family Planning and Women’s Lives is a multiyear project examining the current state of access to contraception and how this access influences women’s lives in the short and long term.

Payment Methods and Benefit Designs

All payment methods have strengths and weaknesses, and how they affect the behavior of health care providers depends on their operational design features and how they interact with benefit design.

CHIPRA Quality Demonstration Evaluation

The Children's Health Insurance Program Reauthorization Act of 2009 included $100 million in grants for demonstration projects to improve the quality of children's health care. The Urban Institute was part of the team of researchers that conducted the federal evaluation of these projects.

Health Care Stewardship Case Studies

In early 2015, Urban conducted case studies examining health care stewardship in Colorado, Minnesota, Ohio, Oregon, and Vermont. Through interviews, we examined the unique ways each of the five states has leveraged its authority to improve the quality and efficiency of the state’s health care system.

Tracking Progress on Health Insurance Marketplace Enrollment

By the end of the 2014 open enrollment period, about 8 million people had chosen plans in the newly established health insurance marketplaces. As of April 8, 2015, 11.7 million had selected plans during the second annual open enrollment, an increase of 46 percent. This page contains data on subsidized and unsubsidized plan selections for each state and will continue to be updated with the latest enrollment figures as they are released.

What Lies Ahead for Children's Health Coverage?

New interactive tool shows impact of changes to children’s eligibility for Medicaid and the Children’s Health Insurance Program and federal subsidies for marketplace coverage

Health Care Reform in Massachusetts

The reforms implemented in Massachusetts in 2006 became the template for ACA. The Urban Institute conducted numerous studies of Massachusetts's ambitious effort to transform its health care system.

Health Reform Modeling Capacity

The Health Insurance Policy Simulation Model (HIPSM) is a sophisticated microsimulation model that is used to estimate the impacts of health reforms and to inform state and national policy design choices. HIPSM has been used to assist with ACA implementation and analysis of policy options under the ACA.

Health Reform Monitoring Survey

The Health Reform Monitoring Survey (HRMS) provides timely insights into the Affordable Care Act. From coverage to access to affordability, the HRMS delivers critical data before federal government surveys are available.

Interactive Map: Poor Uninsured Americans Eligible for Medicaid under ACA Expansion

There is wide local variation in the numbers of poor uninsured Americans who would be eligible for Medicaid if states opt for ACA expansion.

States and the Affordable Care Act 

This comprehensive monitoring and tracking project examines the implementation and effects of the ACA in 10 states. The accompanying reports document each state’s progress in establishing a health insurance marketplace, implementing insurance reforms, and preparing for Medicaid expansion.