Achieving the Potential of Health Care Performance Measures (Policy Briefs/Timely Analysis of Health Policy Issues)
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There is a consensus that evaluating and reporting on the performance of health care providers can be instrumental in improving value in U.S. health care. But the growth of performance measurement has been accompanied by increasing concerns about the scientific rigor, transparency, and limitations of available measure sets, and how measures should be used to provide incentives to improve performance. This Robert Wood Johnson Foundation-funded paper describes the current state of performance measurement and reporting, details what’s wrong, and outlines seven policy recommendations that offer a path to achieving the promise of performance measurement while avoiding its adverse consequences.
An Early Look at the Impact of Express Lane Eligibility on Medicaid and Children's Health Insurance Program Enrollment:: An Analysis of the Statistical Enrollment Data System (Research Report)
|Posted to Web: May 23, 2013||Publication Date: May 23, 2013|
With ELE, a state's Medicaid and/or CHIP program can rely on another agency's eligibility findings to qualify children for public coverage. Using 2007 to 2011 quarterly enrollment data, we estimate difference-in-difference equations with quarter and state fixed effects to measure the effect of ELE on enrollment. The estimated impacts of ELE on Medicaid enrollment were consistently positive across model specifications, ranging between 4.0 and 7.3 percent. The analysis also finds that ELE increased Medicaid/CHIP enrollment. Our results imply that ELE has been an effective way for states to increase new enrollment or improve retention among eligible children.
CHIPRA Mandated Evaluation of Express Lane Eligibility: First Year Findings (Research Report)
|Posted to Web: May 22, 2013||Publication Date: June 04, 2012|
The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) reauthorized CHIP and funded it through 2013. Under CHIPRA, Congress provided states with new policy tools to address shortfalls in enrollment and retention, one of which is Express Lane Eligibility (ELE). With ELE, a state's Medicaid and/or CHIP program can rely on another agency's eligibility findings to qualify children for public health coverage. This evaluation describes existing state ELE programs including the administrative costs and ELE enrollment trends, estimates the impact of ELE adoption on total enrollment, and previews the issues that will be examined through future evaluation activities.
What Difference Does Medicaid Make? Assessing Cost Effectiveness, Access, and Financial Protection under Medicaid for Low-Income Adults (Research Report)
|Posted to Web: May 22, 2013||Publication Date: December 15, 2012|
Information on the role of Medicaid is once again taking center stage as federal and state policymakers debate how to address budget deficits and states consider next steps in extending coverage to their low-income populations. Using the Medicaid Expenditure Panel Survey, Urban researchers examine the use and cost of health care among low-income nonelderly adults who are covered by Medicaid relative to their expected service use and costs if they instead had employer-sponsored insurance coverage or were uninsured. Consistent with previous work, the analysis demonstrates that Medicaid provides access to health care services comparable to that of ESI but at significantly lower costs. Also, compared to ESI coverage direct out-of-pocket spending for health care services would be three times higher if Medicaid beneficiaries were instead covered by ESI. The analysis also confirms the better access and financial protection Medicaid beneficiaries have over their uninsured counterparts.
Using SNAP Receipt to Establish, Verify, and Renew Medicaid (Research Report)
|Posted to Web: May 22, 2013||Publication Date: May 03, 2013|
States expanding Medicaid eligibility under the ACA can substantially expedite Medicaid enrollment and retention for SNAP participants, 97 percent of whom will qualify for Medicaid, according to this study. Even in states where SNAP provides broad-based categorical eligibility that extends SNAP’s gross income limits to at least 185 percent of the federal poverty level, 94 percent of SNAP recipients will qualify for Medicaid. Data showing SNAP receipt can thus verify Medicaid applicants’ financial eligibility, allow administrative renewal for Medicaid beneficiaries, and facilitate Medicaid enrollment for numerous eligible consumers when expanded coverage begins in early 2014.
Limiting the Tax Exclusion of Employer-Sponsored Health Insurance Premiums: Revenue Potential and Distributional Consequences (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: May 17, 2013||Publication Date: May 17, 2013|
The exclusion of employer-sponsored health insurance premiums and medical benefits reduced federal tax revenues by $268 billion in 2011 alone-by far the largest federal tax expenditure. Moreover, the exclusion disproportionately subsidizes those with higher incomes. In this brief, we provide estimates of the revenue potential and distributional consequences of limiting the exclusion from income and payroll taxes at the 75th percentile of 2013 premiums, indexing by GDP. The policy would produce $264.0 billion in new tax revenues over the coming decade while preserving 93 percent of the tax subsidies available under the current policy.
Enrollment-Driven Expenditure Growth: Medicaid Spending during the Economic Downturn, FY 2007-2011 (Research Report)
|Posted to Web: May 08, 2013||Publication Date: May 08, 2013|
This report presents data on changes in Medicaid's enrollment and spending between federal fiscal year 2007 and federal fiscal year 2011, a period which includes the worst economic downturn in the United States since the Great Depression of the 1930s. The paper also examines what factors drove Medicaid spending over the period, and concludes that overall spending growth from 2007 to 2011 was driven largely by the enrollment growth that resulted from many people losing jobs and income during the recession. However, on a per enrollee basis, Medicaid spending has grown more slowly than other sectors of the health system.
Developing Subannual Estimates of Health Insurance Coverage from the American Community Survey: Challenges and Promising Next Steps (Research Report)
|Posted to Web: April 24, 2013||Publication Date: April 24, 2013|
Following the introduction of a question on health insurance coverage in 2008, the American Community Survey (ACS) has increasingly been used as a source for state-level health insurance estimates. This reflects a number of key advantages of the ACS, including a survey design that supports state representative estimates for all states and the large size of its sample. As a result, the ACS yields relatively precise state-level estimates of annual health insurance coverage. This paper explores the feasibility of expanding the value of the ACS for tracking health insurance coverage by generating subannual estimates.
|Posted to Web: April 17, 2013||Publication Date: April 17, 2013|