Uninsured/Uncompensated Care

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.

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.

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.

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.

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.

Older youth face many challenges including continuing health care as they approach adulthood. The Affordable Care Act will provide new coverage for young adults. This 10 state study provides new data on Medicaid health costs for youth turning age 18. On average, boys are more expensive than girls at this age. Three groups are particularly high cost, disabled youth enrolled in Supplemental Security Income, foster care youth, and those with behavioral health problems. These three groups account for less than 20 percent of all youth that age, but over half the cost of the program.

The Heritage Foundation has repeatedly and misleadingly claimed that Urban Institute research shows most states would experience budget problems if they implemented the ACA's Medicaid expansion. In fact, every comprehensive fiscal analysis done at the state level has concluded that expansion would yield net state budget gains, with revenues and savings that exceed increased state costs. All states must pay for national health reform but only those that expand Medicaid will receive large, offsetting allotments of federal Medicaid dollars, with resulting economic activity, jobs, and state revenue. Solid research shows that Medicaid expansion saves lives and improves access to care.

The Family Health and Birth Center in Washington, D.C. provides accessible, culturally appropriate prenatal care and delivery services to low income women. This study of the outcomes of care at that center improves on previous research by controlling for risk selection into birth center care. We find that women who receive at least two prenatal visits from birth center midwives regardless of whether they deliver at the center or in a hospital—are less likely to have a C-section and less likely to have an induced delivery. They have fewer preterm babies and their babies have higher birth weights.