Health and Healthcare

This report synthesizes findings from case studies conducted in 2001 and 2002 in ten states selected for the Congressionally Mandated Evaluation of SCHIP: California, Colorado, Florida, Illinois, Louisiana, Missouri, New Jersey, New York, North Carolina, and Texas (Hill et al. 2002). Discussion addresses such issues as program design, outreach and enrollment strategies, benefits, service delivery systems, cost sharing, crowd out prevention, parental coverage, financing, and coordination of SCHIP and Medicaid. Overarching conclusions identify lessons learned from effective implementation.

This paper examines various reasons for the growth in Medicaid spending in the current decade. Although Medicaid spending has grown faster than the rate of increase in national health spending, much of this is explained by increased enrollment. Per enrollee, Medicaid spending actually compares favorably to increases in medical care prices and gross domestic product. The relative success in Medicaid cost containment seems to be attributable to limits on provider payment rates, expansion of managed care, limits on the use and pricing of prescription drugs, and expansion of community-based long-term care programs. We suggest two strategies for further cost containment.

Massachusetts residents are frequent users of emergency department (ED) care, with high levels of use continuing despite significant improvements in access to care as a result of the state’s 2006 health reform initiative. In an effort to better understand ED use in Massachusetts, this policy brief looks at ED use among working-age adults, focusing on reported reasons for using the ED and barriers to obtaining needed health care among ED users. Findings show adult ED users in Massachusetts are a sicker, more disabled, and more chronically ill population and report more difficulties obtaining care in the community and more unmet need for care than other adults in the state. Potential strategies for addressing preventable ED use include efforts targeted to specific care settings and particular population groups.

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.

Massachusetts, which enacted a landmark health care reform bill in April 2006, is now beginning the fourth year of its ambitious health reform initiative, with evidence of strong and continuing gains in insurance coverage. This policy brief, which is based on the 2009 Massachusetts Health Insurance Survey (HIS), shows uninsurance in Massachusetts continuing at historically low levels—at 2.7% for the overall population, 1.9% for children and 3.5% for non-elderly adults. The findings suggest that the recession had had limited impact on health insurance coverage as of spring of 2009.

The Urban Institute, along with its subcontractor, Social Science Research Solutions, conduct the Massachusetts Health Insurance Survey (HIS) for the Massachusetts Division of Health Care Finance and Policy to obtain information on health insurance coverage and access to and use of health care for the non-institutionalized population in Massachusetts. This report summarizes the results of the survey for health insurance coverage in 2008 and 2009, including the finding that more than 97 percent of Massachusetts residents have health insurance in 2009, despite the economic recession.

The national health reform debate continues to draw on Massachusetts' 2006 reform initiative, with a focus on sustaining employer-sponsored insurance. This study provides an update on employers' responses under health reform in fall 2008, using data from surveys of working-age adults. Results show that concerns about employers' dropping coverage or scaling back benefits under health reform have not been realized. Access to employer coverage has increased, as has the scope and quality of their coverage as assessed by workers. However, premiums and out-of-pocket costs have become more of an issue for employees in small firms.

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.

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.

Mapquest the route to tax reform and health reform and all roads lead to the Senate Finance Committee. Senator Ron Wyden (D-Ore.), a member of its health care and taxation subcommittees and chair of its global competitiveness subcommittee, has long been a proponent of making the tax code simpler, free of loopholes, and fairer to all Americans. Wyden will use the debut of the Tax Policy Center’s new Tax Reform 2.0 series to describe the tax aspects of the health care reform bill currently under debate in the Finance Committee and the alternatives laid out in his own health care reform bill, the Healthy Americans Act (S. 391). In addition, he will share his view of the prospects for comprehensive tax reform in 2010 and explain his own tax reform legislation, the Fair Flat Tax Act of 2007 (S. 1111).