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.
This guide provides an in-depth introduction to using qualitative comparative analysis (QCA) – an approach based on set theory and Boolean algebra – in patient-centered medical home evaluations. Specifically, QCA can be used to identify practice-level "conditions" (e.g., practice characteristics, medical home care processes) that are linked to an outcome of interest (e.g., improved care quality, higher patient satisfaction ratings, or reduced health care utilization or expenditures). The guide includes a description of key analytic steps involved in the QCA approach.
There is bipartisan agreement on the need to move from volume-based to value-based payment for health care providers. Rather than paying for activity, the aspirational goal is to pay for outcomes that take into account quality and costs. The Affordable Care Act (ACA) created the physician "value-based payment modifier," a pay-for-performance approach that, by 2017, will reward or penalize physicians based on the calculated value of care each provides to Medicare beneficiaries. This paper argues that although value-based payment is right aspirationally, in practice, it is impossible to accurately measure any physician's overall value. It recommends abandoning this approach and using performance measurement more strategically to support approaches to complement fundamental payment reform.
Not getting much attention is the 5.4 million uninsured young adults who will be eligible for Medicaid in 2014. Young adults eligible for Medicaid are a heterogeneous group but over half have an existing connection to another government program. However, 4.3 million uninsured young adults with incomes below 138 percent of the Federal Poverty Level will not be eligible for Medicaid because they live in states that are not expanding, most of whom will remain uninsured, given their lack of access to affordable coverage.
As a consequence of the ACA's reformed nongroup insurance market, some have raised concerns about short-term "rate shock" — an increase in premiums as a result of enhanced consumer protections and more risk-sharing compared with the pre-reform market – as well as longer-term instability due to adverse selection, the phenomenon by which particular insurance plans or markets attract an enrollment with higher than average health care risks. While the ACA includes strategies intended to mitigate these effects, some states are introducing additional strategies to strengthen the protections. This paper explores policies designed to address these concerns being implemented in 11 states.