The Patient Protection and Affordable Care Act—health care reform—fundamentally changed health insurance and access to health care. Our researchers are unpacking the landmark law, studying the challenges of implementation, and using our Health Insurance Policy Simulation Model to estimate how its proposals will affect children, seniors, and families, as well as doctors, small businesses, and the national debt.
The Urban Institute also studies cost, coverage, and reform options for Medicare and Medicaid and analyzes trends and underlying causes of changes in health insurance coverage, access to care, and Americans’ use of health care services. Read more.
Hospital use and hospital mortality related to firearm-assault injuries varies considerably across demographic groups and states, as does the percentage of firearm-assault injury hospital costs borne by the public. Healthcare data from six states--Arizona, California, Maryland, New Jersey, North Carolina, and Wisconsin--show that hospital use for firearm-assault injury is disproportionately concentrated among young males, particularly young black males. Additionally, uninsured victims have higher hospital mortality rates for firearm-assault injury. Across all six states, the public pays a substantial portion of the hospital cost for injuries caused by firearm assault.
Urban Institute researchers studied nine marketplace websites (California, Colorado, Connecticut, District of Columbia, Massachusetts, Minnesota, Oregon, Rhode Island and Washington) and healthcare.gov, and offer recommendations on how to improve the transparency of the marketplace sites. Recommendations include creating clear and accurate "hover over" definitions of plan and network types and sizes for consumers scrolling over specific plans, and creating fully functional physician directories for each plan within the marketplace website.
The Affordable Care Act has resulted in considerable competition. In a large number of markets, this has resulted in lower premiums than expected, though there is considerable variability within each metal tier. This analysis assesses the variation in premiums within markets and the effects of competition in 10 states: Alabama, Arkansas, Colorado, Maryland, Massachusetts, New York, Oregon, Rhode Island, Virginia, and West Virginia. Four of the states have fairly limited competition, while the other six were very competitive, especially in urban, more populated markets.
Participation of employers in the small group Marketplaces, or Small Business Health Options Program (SHOP), has started very slowly. The reasons for this are largely consistent across the states, and many of them lend themselves to reversal or improvement. Significant challenges remain, but it would be inappropriate to judge the long term prospects of SHOP merely on its first-year experiences. This analysis of early implementation experiences is based on case study interviews in eight states: Colorado, Illinois, Maryland, Minnesota, New Mexico, New York, Oregon, and Rhode Island. Interviews were conducted with a broad array of stakeholders in each state.
In states not expanding Medicaid, 6.7 million residents will remain uninsured in 2016 as a result. These states are foregoing $423.6 billion in federal Medicaid funds from 2013 to 2022, lessening economic activity and job growth. Their hospitals are also losing $167.8 billion in Medicaid revenue. Every comprehensive state-level fiscal analysis that we could find concluded that expansion helps state budgets, generating savings and revenues that exceed increased Medicaid costs. Future federal cuts to ACA's high federal match rate are unlikely. Of more than 100 federal Medicaid cuts since 1980, just one lowered the federal share of Medicaid spending.