Search

During 2009, 730,000 prisoners were released from federal and state prisons-a 21 percent increase from the number of prisoners released in 2000. Poor health and poor health coverage have been major challenges for former prisoners trying to reintegrate into the community and find work. We discuss these challenges and the likely effect of recent federal legislation, including the Second Chance Act, the Mental Health Parity and Addiction Equity Act, and the Affordable Care Act. We estimated that with the implementation of health reform, up to 33.6 percent of inmates released annually-more than 245,000 people in 2009-could enroll in Medicaid. Similarly, we estimated that up to 23.5 percent of prisoners released annually-more than 172,000 people in 2009-could be eligible for federal tax credits to defray the cost of purchasing insurance from state health exchanges. This health insurance, combined with new substance abuse services and patient-centered medical home models, could dramatically improve the health and success of former inmates as they return to the community. States should consider several policy changes to ease prisoners' transitions, including suspending rather than terminating Medicaid benefits for offenders; incorporating corrections information into eligibility determination systems; aiming Medicaid outreach and enrollment efforts at prison inmates; and designing comprehensive approaches to meeting former prisoners' health care needs. [ABSTRACT FROM AUTHOR]

There are large differences in US health insurance coverage by racial and ethnic groups, yet there have been no estimates to date on how implementation of the Affordable Care Act will affect the distribution of coverage by race and ethnicity.We used a microsimulation model to show that racial and ethnic differentials in coverage could be greatly reduced, potentially cutting the eight-percentage-point black-white differential in uninsurance rates by more than half and the nineteen-percentage-point Hispanic-white differential by just under one-quarter. However, blacks and Hispanics are still projected to remain more likely to be uninsured than whites. Achieving low uninsurance under the Affordable Care Act will depend on effective state policies to attain high enrollment in Medicaid and the Children's Health Insurance Program and the new insurance exchanges. Coverage gains among Hispanics will probably depend on adoption of strategies that address language and related barriers to enrollment and retention in California and Texas, where almost half of Hispanics live. If uninsurance is reduced to the extent projected in this analysis, sizable reductions in long-standing racial and ethnic differentials in access to health care and health status are likely to follow. [ABSTRACT FROM AUTHOR]

The Affordable Care Act will expand Medicaid eligibility in 2014to adults with incomes of up to 133 percent of the federal poverty level.To maximize this opportunity, policy makers need to ensure that participation, or "take-up," among eligible adults exceeds current rates.Using the Current Population Survey 2005-10, we estimated that the nationwide Medicaid participation rate was 62.6 percent among eligible adults ages 19-64 without private insurance. Take-up varied widely by state, from 43.0 percent in Arkansas and Louisiana to 82.8 percent in Massachusetts, after adjusting for population demographics.Participation was highest among disabled adults, 75.8 percent, and lowest among childless adults, 38.3 percent. Factors linked to higher take-up included low cost sharing for beneficiaries; more generous benefits;and greater use of managed care programs for Medicaid populations.Factors associated with lower take-up rates included the existence of asset tests in some states. Massachusetts's health reform was associated with a major increase in Medicaid participation. Our results suggest that when Medicaid is expanded in 2014, take-up may be less than anticipated because new enrollees will be offered a more restrictive set of benefits-known as "benchmark coverage"-compared to those in traditional Medicaid, and the majority of newly eligible adults will be in groups with traditionally low take-up (primarily nondisabled adults). To encourage high participation in the expanded Medicaid program, states will need to offer comprehensive coverage of needed benefits; provide communitybasedoutreach; and consider more dramatic changes to their enrollment processes, such as automatically enrolling people in Medicaid based on their participation in other public programs.Reasons For The Wide Variation In Medicaid Participation Rates Among States Hold Lessons For Coverage Expansion In 2014. [ABSTRACT FROM AUTHOR]

Fewer than one-third of eligible Medicare beneficiaries enroll in Medicare savings programs, which pay premiums and, in some cases, eliminate out-of-pocket cost sharing for poor and near-poor enrollees. Many beneficiaries don't participate in savings programs because they must complete a cumbersome application process, including a burdensome asset test. We demonstrate that a streamlined alternative to the asset test--allowing seniors to qualify for Medicare savings programs by providing evidence of limited assets or showing a lack of investment income--would permit 78 percent of currently eligible seniors to bypass the asset test entirely. This simplified approach would increase the number of beneficiaries who qualify for Medicare savings programs from the current 3.6 million seniors to 4.6 million. Such an alternative would keep benefits targeted to people with low assets, eliminate costly administrative expenses and obstacles to enrollment associated with the asset test, and avoid the much larger influx of seniors that would occur if the asset test were eliminated entirely. [ABSTRACT FROM AUTHOR]

The Affordable Care Act gives states the option to create health insurance exchanges from which individuals and small employers can purchase health insurance. States have considerable flexibility in how they design and implement these exchanges. We analyze several key design options being considered, using the Urban Institute's Health Insurance Policy Simulation Model: creating separate versus merged small-group and nongroup markets, eliminating age rating in these markets, removing the small-employer credit, and setting the maximum number of employees for firms in the small-group market at 50 versus 100 workers. Among our findings are that merging the small-group and nongroup markets would result in 1.7 million more people nationwide participating in the exchanges and, because of greater affordability of nongroup coverage, approximately 1.0 million more people being insured than if the risk pools were not merged. The various options generate relatively small differences in overall coverage and cost, although some, such as reducing age rating bands, would result in higher costs for some people while lowering costs for others. These cost effects would be most apparent among people who purchase coverage without federal subsidies. On the whole, we conclude that states can make these design choices based on local support and preferences without dramatic repercussions for overall coverage and cost outcomes. [ABSTRACT FROM AUTHOR]

Nearly 30 percent of young adults with special health care needs in Ohio lack health insurance, compared to 5 percent of the state's children with special health care needs. As children with such needs become too old for Medicaid or insurance through their parents' employer, they face great challenges in obtaining insurance. Lack of insurance is highly predictive of unmet needs, which in turn are predictive of costly hospital-based encounters. Young adults with special health care needs who are uninsured are more than twice as likely as their peers with insurance to forgo filling prescriptions and getting care and to have problems getting care. Even after insurance status is accounted for, young adults with special health care needs are more likely than children with such needs to not fill prescriptions because of cost and to delay or forgo needed care. This study demonstrates that continuous and adequate health insurance is vital to the continued well- being of children with special health care needs as they transition to young adulthood. [ABSTRACT FROM AUTHOR]

Studies have shown that male circumcision greatly reduces the risk for heterosexual transmission of HIV, other sexually transmitted infections, infant urinary tract infections, penile cancer, and other adverse health outcomes. Given recent data regarding these health benefits and the cost-effectiveness of newborn male circumcision, national policy makers are developing new recommendations regarding circumcision for newborn, adolescent, and adult males. To investigate the implications, this study assessed insurance coverage and reimbursement for routine newborn and adult male circumcision in private and public health plans in 2009. We found that coverage varies across private and public payers. Private insurance provides far broader coverage than state Medicaid programs for routine newborn male circumcision. Specifically, Medicaid programs in seventeen states do not cover it, even though low-income populations have a higher risk of HIV and other sexually transmitted diseases compared to higher-income groups. For adult male circumcision, coverage is generally sparse across public and private plans. Presentation of evidence-based recommendations-for example, from the Centers for Disease Control and Prevention-may be necessary if coverage for newborn and adult male circumcision is to be expanded. [ABSTRACT FROM AUTHOR]

When the Affordable Care Act of 2010 is fully implemented, it will extend health insurance coverage to many adult Americans who currently lack it. It is not known, however, how the health reform legislation will affect children and parents who would otherwise be uninsured. Based on our analysis, the Affordable Care Act has the potential to cut the number of uninsured children by about 40 percent, from 7.4 million to 4.2 million, and the number of uninsured parents by almost 50 percent, from 12.7 million to 6.6 million. However, the actual impact will depend on increasing the share of children and parents who are enrolled in public coverage and on other implementation outcomes. Most strikingly, if the requirement that states continue their Medicaid and Children's Health Insurance Program (CHIP) coverage is rescinded and if Congress does not continue funding CHIP, the uninsurance rate of children could more than double, increasing from 4.2 million to 7.9-9.1 million children. In that case, the uninsurance rate among children would be higher than if the Affordable Care Act had not been adopted. [ABSTRACT FROM AUTHOR]

Because the reforms under the Affordable Care Act of 2010 will leave an estimated twenty million or more people still uninsured, some Americans will continue to seek care at low or no cost through existing safety-net systems. To identify appropriate care models, this comparative case study assessed the costs of care provided by four large, well- structured, comprehensive safety-net programs for the uninsured in Colorado, Michigan, North Carolina, and Texas. The average monthly resource cost-including the value of referred, donated, and in-kind services-in these model programs was $141-$209 per adult in 2008. This was 25-50 percent less than the estimated cost of care for comparison groups covered by local Medicaid programs or by private insurance that provided similar services. Although these programs' services are somewhat less comprehensive than those of generous insurance plans, the findings suggest that these model safety-net programs could be adapted to provide an alternative type of coverage for the uninsured, including both low-income and middle-class people. [ABSTRACT FROM AUTHOR]

In 2010, US health spending is estimated to have grown at a historic low of 3.9 percent, due in part to the effects of the recently ended recession. In 2014, national health spending growth is expected to reach 8.3 percent when major coverage expansions from the Affordable Care Act of 2010 begin. The expanded Medicaid and private insurance coverage are expected to increase demand for health care significantly, particularly for prescription drugs and physician and clinical services. Robust growth in Medicare enrollment, expanded Medicaid coverage, and premium and cost-sharing subsidies for exchange plans are projected to increase the federal government share of health spending from 27 percent in 2009 to 31 percent by 2020. This article provides perspective on how the nation's health care dollar will be spent over the coming decade as the health sector moves quickly toward its new paradigm of expanded insurance coverage. [ABSTRACT FROM AUTHOR]

Since 2007, San Francisco, California, has transformed its traditional safety-net health care "system"--in reality, an amalgam of a public hospital, private nonprofit hospitals, public and private clinics, and community health centers--into a comprehensive health care program called Healthy San Francisco. The experience offers lessons in how other local safety-net systems can prepare for profound changes under health reform. By July 2010, 53,546 adults had enrolled (70- 89 percent of uninsured adults in San Francisco), and satisfaction is high (94 percent). Unnecessary emergency department visits were less common among enrollees (7.9 percent) than among Medicaid managed care recipients (15 percent). These findings indicate that other safety-net systems would do well to invest in information technology, establish primary care homes, increase coordination of care, and improve customer service as provisions of the national health care reform law phase in. [ABSTRACT FROM AUTHOR]

Loss of employment and declining incomes meant that five million Americans lost employment-based health insurance during the recent economic recession (2007-09). All groups of Americans were affected, but the growth in the number of uninsured people was particularly noticeable for whites, native-born citizens, and residents of the Midwest and South. Adults did not benefit nearly as much as children from public programs designed to offset the decline in employer-sponsored insurance and thus bore all of the burden of rising uninsurance. Throughout the past decade, even in good economic times, the number of Americans with employer-sponsored insurance has fallen, and the number of uninsured Americans has increased. This finding underscores the importance of planned coverage expansions under the Affordable Care Act. [ABSTRACT FROM AUTHOR]

A personal narrative is presented which explores the author's experience as a patient of primary progressive multiple sclerosis (PPMS), who uses a wheelchair due to loss of control of his arms and legs, and has to depend on personal care assistants.

The fifty states will play a critical role in implementing the Affordable Care Act, and California is one of the states at the forefront of reform. The act can provide coverage to millions of currently uninsured Californians and offers important benefits in terms of more-affordable coverage, improved access to services, and better health outcomes. As the paper by Peter Long and Jonathan Gruber in this issue of Health Affairs notes, the ultimate effects of health reform in California will be influenced by the policy and program decisions that state lawmakers and administrators make during the next three years. Key issues include revamping cumbersome eligibility determination and enrollment processes that could prevent rapid enrollment in expanded public health insurance-but also affording that expansion in the face of large state budget deficits. California policy makers need to move thoughtfully and strategically to ensure that the potential of federal health reform becomes a reality for state residents. [ABSTRACT FROM AUTHOR]

The Affordable Care Act is the most fundamental legislative transformation of the US health care system in forty years. This analysis estimates that the act will provide health insurance for an additional 3.4 million people in California in 2016. This will mean that nearly 96 percent of documented residents of California under age sixty-five will be insured. Enrollment in Medi-Cal, the state's Medicaid program, is expected to increase by 1.7 million people, while 4.0 million people are expected to enroll in the state's planned new health insurance exchange. Employer-sponsored insurance and spending on health insurance will decline slightly. Low-income households will experience substantial financial benefits, but families at the highest income levels will pay more. [ABSTRACT FROM AUTHOR]

The Oregon Health Plan was created to be a sustainable program that could weather budgetary storms without having to cut enrollees from Medicaid. A 2003 redesign of the program increased premiums, raised cost sharing, and imposed rigid premium payment deadlines for members in the "Standard" version of the program but not for members of the "Plus" version. This paper adds two years of longitudinal data to a previous study on the impacts of these changes. It shows that the redesign was a key factor driving a 77 percent disenrollment rate in the Standard program, from a high of 104,000 enrollees in February 2003 to just 24,000 by the end of the study period, November 2005. Those who were in the Standard plan when the reduced benefits and higher member costs went into effect were also nearly twice as likely to have unmet health care needs compared to those in the Plus plan. These changes underscore that in a period of economic downturn, policy makers must understand the impact of increased cost sharing on vulnerable populations. [ABSTRACT FROM AUTHOR]

Kathleen Sebelius, secretary of health and human services, has issued a challenge to enroll the millions of uninsured children eligible for public insurance in Medicaid or the Children's Health Insurance Program (CHIP). This paper provides estimates of the rates at which children in the various states participated in these programs in 2008 as well as the number who were eligible for them but uninsured. According to our coverage estimates, an estimated 7.3 million children were uninsured on an average day in 2008, of whom 4.7 million (65 percent) were eligible for Medicaid or CHIP but not enrolled. Participation rates varied across states from 55 percent to 95 percent, and ten states had participation rates close to or above 90 percent. Thirty-nine percent of eligible uninsured children (1.8 million) live in just three states--California, Texas, and Florida--and 61 percent (2.9 million) live in ten states. Meeting Secretary Sebelius's challenge means achieving success in these populous states, in part through tools and resources available under the 2009 CHIP reauthorization law. [ABSTRACT FROM AUTHOR]

Comparative effectiveness research holds great promise for improving the care of people with mental health conditions and disorders related to substance abuse. But inappropriate application of such research can threaten the quality of that care. We examine the controversy surrounding a large real-world trial of schizophrenia treatments and conclude that the initial presentation of results led to overly simplistic policy suggestions that had the potential to harm patients. Patient advocacy groups helped illuminate these consequences and helped stimulate further discussion and analysis. Researchers must engage stakeholders, especially patients, in all aspects of comparative effectiveness research and translate the findings into sound mental health policy and practice. [ABSTRACT FROM AUTHOR]

Provisions of the American Recovery and Reinvestment Act authorize incentive payments to hospitals and clinicians who become "meaningful users" of health information technology (IT). We argue that various private-sector entities--commercial payers, employers, consumer groups, health care ratings organizations, large provider organizations, and regulatory bodies--can further accelerate health IT adoption by implementing strategies that are complementary to the Medicare and Medicaid incentive programs. This paper describes these strategies and potential approaches to implementation. [ABSTRACT FROM AUTHOR]

More than two-thirds of uninsured U.S. children are eligible for public coverage, and most current policy debate assumes that this is largely attributable to poor takeup. This paper explores the contribution of poor retention in Medicaid and the State Children's Health Insurance Program (SCHIP) to this phenomenon. The results indicate that one-third of all uninsured children in 2006 had been enrolled in Medicaid or SCHIP the previous year. Among those uninsured but eligible for public coverage in 2006, at least 42 percent had been enrolled in Medicaid or SCHIP the previous year. Both of these measures of disenrollment have increased since 2000. [ABSTRACT FROM AUTHOR]

Some speculate that Americans are neither politically capable of nor morally committed to solving the health system problems. We disagree. We propose a plan that insures all and improves the value and cost-effectiveness of health care by knitting together employer-sponsored insurance and Medicaid; promoting prevention, research, and information technology; and financing its investments through a dedicated value-added tax. By prioritizing practicality, fairness, and responsibility, the plan aims to avoid ideological battles and prevent fear of major change. By emphasizing the moral imperative for change, especially relative to other options on the policy agenda, it aims to create momentum for expanding and improving health coverage for all. [ABSTRACT FROM AUTHOR]

Growth in Medicaid spending averaged 10.2 percent per year between 2000 and 2003, resulting in a one-third increase in program spending. Spending growth was lower from 2002 to 2003 because of slower growth in enrollment and in spending per enrollee, particularly for acute care services, and declines in disproportionate-share hospital (DSH) payments and upper payment limit (UPL) programs. For the entire 2000-2003 period, Medicaid spending increases were largely driven by enrollment growth, much of which was attributable to the economic downturn. Increases in spending per enrollee over the period were faster than inflation but slower than increases in private insurance spending. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various topics within the issue like the coronavirus disease 2019 (COVID-19) vaccines and therapeutics, effects of insurance coverage expansions, and willingness to pay for higher-quality medical care.

This section offers news briefs related to grants in medical care in the U.S. as of October 2018. Topics discussed include the June 2018 federal court decision in Stewart v. Azar about the Kentucky HEALTH Medicaid waiver, examples of philanthropy's funding of Medicaid projects, and the announcement by the Foundation for a Health Kentucky in May 2018 that it will partner with the administration of Governor Matt Bevin to help people in Kentucky maintain coverage under HEALTH Medicaid waiver.

An introduction to the journal is presented in which the editor discusses various articles published within the issue on topics like Medicaid policy, enrollment disparities in high-deductible health plans (HDHP), and racial and ethnic disparities in COVID-19 test outcomes.

Nearly five million uninsured children in the United States are currently eligible for Medicaid or the Children's Health Insurance Program (CHIP) but are not enrolled in these programs. A top Obama administration priority is to achieve the long-sought goal of ensuring that uninsured children are enrolled--and that they stay enrolled for as long as they are eligible. The author, who is secretary of the U.S. Department of Health and Human Services (HHS), outlines measures that HHS and other federal agencies are implementing to reach this goal. She also cites existing state efforts to enroll more children and improve children's coverage, and she describes steps that states, local governments, and the private sector can take to expand outreach efforts, increase enrollment, and keep eligible children covered. [ABSTRACT FROM AUTHOR]

In this article, the author discusses the role of Senator Edward M. Kennedy in setting the reform agenda for health care. The author mentions the book "In Critical Condition," written by Kennedy, which focuses on the financial barriers in the health care. He states that Kennedy had provided valuable role in clarifying the political debate regarding American medical care. He highlights the changes made by Kennedy in heath care like the creation of the Children's Heath Insurance Program (CHIP).

The article presents the highlights of several U.S. health policy-related blogs, including Medicaid, Access to Care, and Pharmaceuticals & Medical Technology.

The article offers updates on health policies and public health issues in the U.S. as of December 2019. Topics covered include five federal district courts that issued preliminary injunctions against the public charge rule of U.S. President Donald Trump, efforts of some states to align local and national quality improvement strategies with evidence-based practices, and a conference by AcademyHealth and the Robert Wood Johnson Foundation in May 2019 on barriers to patient-centered care.

The article offers information on health care reform initiatives in the U.S. since September 2017. These include the bipartisan agreement on short-term reforms sought by the Senate Health, Education, Labor, and Pensions (HELP) Committee, the resurrection of efforts to repeal and replace the Affordable Care Act (ACA) through the Graham-Cassidy bill, and the approval by the Centers for Medicare and Medicaid Services (CMS) of Minnesota's reinsurance proposal.

The article discusses the U.S. Senate's deliberation on its version of legislation that would replace the Affordable Care Act (ACA) as of July 2017. Topics covered include the Democrats solid front against wholesale ACA changes, the division of Republicans on Medicaid ACA provisions, and their strategy of private discussions towards an agreed package that will be moved quickly. Also noted are U.S. President Donald Trump's health care budget cuts, and his growing influence on regulation.

The article examines the policy and political changes involved in the effort to repeal and replace the Affordable Care Act (ACA). Topics covered include how leading health provider groups such as the American Medical Association and American Hospital Association have expressed their opposition to Republican proposals to replace the ACA, the market stabilization proposed rule, and the extension of grandmothered policies.

The article features examples of foundation grants in relation to social health care program Medicaid. Foundation funding discussed include funds from Conrad N. Hilton Foundation to help Center for Health Care Strategies (CHCS) incorporate use of Screening, Brief Intervention, and Referral to Treatment (SBIRT) services into adolescent primary care, and SCAN Foundation-funded July 2016 CHCS brief "State Trends in the Delivery of Medicaid Long-Term Services and Supports."

An introduction is presented in which the editor discusses various reports within the issue on topics including the emergency department (ED) visits of patients participating in the Bridges to Care program in the U.S., the co-occurrence of substance and mental health disorders, and the utilization and cost of low-value health services.

Corrections to articles are presented including "The Evolution Of Biotechnology And Its Impact On Health Care" in the February 2015 issue, and "Medicaid Expansion In Opt-Out States Would Produce Consumer Savings And Less Financial Burden Than Exchange Coverage" in the February 2015 issue.

An introduction is presented in which the editor discusses various reports within the issue on topics including role of Medicaid program in health care system of U.S., primary care, the MetroHealth Care Plus program to increase standards of care.

An introduction is presented in which the editor discusses articles within the issue on U.S. Affordable Care Act (ACA) topics including the Small Business Health Options Program (SHOP), the effect of qualifying events on the availability of coverage, and the Children's Health Insurance Program (CHIP).

This section offers news briefs on Medicaid and the U.S. health sector as of July 2014. Highlights of the Capitol Hill briefing on community health centers sponsored by the Alliance for Health Reform and the Commonwealth Fund in May 2014 are reported. It announces the grant awarded by the Healthcare Georgia Foundation to Georgians for a Healthy Future. An overview of the brief "Impact of the Affordable Care Act on Charity Care Programs" from the Center for Health Care Strategies is provided.

The article reports on the first enrollment period for the Affordable Care Act (ACA) in the U.S. in 2014 that is believed to be the foundation for the success of health reform in the country.

The article focuses on the Affordable Care Act (ACA). It discusses the challenges faced by the U.S. government in implementing the ACA. U.S. Health and Human Services secretary Kathleen Sebelius describes ACA implementation as a continuous self-improvement project. The impact of the ACA on private insurance and primary care services is highlighted.

An introduction is presented in which the editor discusses various reports within the issue on topics including the federalism in Medicaid program in the U.S., the impact of Prozac antidepressant to Medicaid beneficiaries, and the recognition for the article "The Alternative Quality Contract."