Category Archives: Health Care

Access to Health Insurance and the Use of Inpatient Medical Care: Evidence from the Affordable Care Act Young Adult Mandate

Source: Yaa Akosa Antwi, Asako Moriya, Kosali Ilayperuma Simon, National Bureau of Economic Research (NBER), NBER Working Paper No. w20202, June 2014
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From the abstract:
The Affordable Care Act of 2010 expanded coverage to young adults by allowing them to remain on their parent’s private health insurance until they turn 26 years old. While there is evidence on insurance effects, we know very little about use of general or specific forms of medical care. We study the implications of the expansion for the use of inpatient hospitalizations. Given the prevalence of mental health needs for young adults, we also specifically study mental health related inpatient care. We find evidence that compared to those aged 27-29 years, treated young adults aged 19-25 years increased their inpatient visits by 3.5 percent. Visits related to mental illness increased 9.0 percent. The prevalence of uninsurance among hospitalized young adults decreased by 12.5 percent; however, it does not appear that the intensity of inpatient treatment changed despite the change in reimbursement composition of patients.

Impact of Premium Subsidies on the Take-Up of Health Insurance: Evidence from the 2009 American Recovery and Reinvestment Act (Arra)

Source: Asako Moriya, Kosali Ilayperuma Simon, National Bureau of Economic Research (NBER), NBER Working Paper No. w20196, June 2014
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From the abstract:
We study the impact of the 65-percent federal health insurance premium subsidy, which aimed to help unemployed workers retain coverage and was in effect from February 2009 to May 2010 through the American Recovery and Reinvestment Act (ARRA). In doing so, we also estimate the price elasticity of demand for health insurance using very recent public policy variation. Our research contributes to the evaluation of the ARRA subsidy’s coverage impact and to a better understanding of consumer responses to subsidized coverage options through the Affordable Care Act. We find that the ARRA subsidy is associated with a 15.2-percent increase in the continuation of employer coverage. This translates into a price elasticity estimate of -0.24, which is towards the middle range of elasticities in existing studies. We also find evidence that part of the increase in the continuation of employer coverage was offset by a decrease in non-group insurance.

Re-Negotiating a Theory of Social Contract for Universal Health Care in America or, Securing the Regulatory State?

Source: George P. Smith II, Catholic University Law Review, Vol. 63, No. 1, 2014

From the abstract:
Political ideologies and evolving notions of social justice have shaped public health policies throughout American history in a quest to find a point of balance between the collective good and economic realities. In pursuit of this balance, Congress enacted the Affordable Care Act in 2010. This Article first examines the new law through the lens of the social contract as envisioned by Rousseau and adopted by the Framers of the Constitution. Using economic data, public opinion, and information from the medical community, Smith and Gallena proceed to offer a frank appraisal of the state of health care in America and the future implications of the Act.

The Article then examines the structure, power, and mandate of the Independent Payment Advisory Board (IPAB). Created by the Affordable Care Act, the IPAB simultaneously concentrates legislative authority in an autonomous executive agency, while shielding its actions from judicial review. Smith and Gallena argue that the IPAB undermines the fundamental principle of the separation of powers, poses an inevitable threat to current and future Medicare beneficiaries, and may ultimately destabilize the state of healthcare in the United States. Finally, Smith and Gallena propose a model for allocating health care resources that comports with both the philosophical underpinnings of the social contract and social justice.

The Effect of Child Health Insurance Access on Schooling: Evidence from Public Insurance Expansions

Source: Sarah Cohodes, Samuel A. Kleiner, Michael Lovenheim, Dan Grossman, National Bureau of Economic Research (NBER), NBER Working Paper No. w20178, May 2014
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From the abstract:
Public health insurance programs comprise a large share of federal and state government expenditure, and these programs are due to be expanded as part of the 2010 Affordable Care Act. Despite a large literature on the effects of these programs on health care utilization and health outcomes, little prior work has examined the long-term effects of these programs and resultant health improvements on important outcomes, such as educational attainment. We contribute to filling this gap in the literature by examining the effects of the public insurance expansions among children in the 1980s and 1990s on their future educational attainment. Our findings indicate that expanding health insurance coverage for low-income children has large effects on high school completion, college attendance and college completion. These estimates are robust to only using federal Medicaid expansions, and they are mostly due to expansions that occur when the children are older (i.e., not newborns). We present suggestive evidence that better health is one of the mechanisms driving our results by showing that Medicaid eligibility when young translated into better teen health. Overall, our results indicate that the long-run benefits of public health insurance are substantial.

Medicaid: A Review of the Literature

Source: Marianne P. Bitler, Madeline Zavodny, National Bureau of Economic Research (NBER), NBER Working Paper No. w20169, May 2014
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From the abstract:
We review the existing literature about the effects of the Medicaid program. We first describe the program’s structure and how it has changed over time. We then discuss findings on coverage, crowd out, take-up and health. Finally, we look at effects of the program on non-health outcomes such as welfare use and labor supply, marriage and fertility, and savings.

Medicare Advantage Money Grab

Source: Fred Schulte, Chris Zubak-Skees, Sarah Whitmire, Eleanor Bell, David Donald and Erin Durkin, Center for Public Integrity, 2014

Congress created private Medicare Advantage health plans 11 years ago to help control health care spending on the elderly. But a Center for Public Integrity investigation found that billions of tax dollars are wasted every year through manipulation of a Medicare payment tool called a “risk score.” The formula is supposed to pay health plans more for sicker patients and less for healthy people, but often it pays too much. The government has for years missed opportunities to corral tens of billions of dollars in overcharges and other billing errors tied to abuse of risk scores. Meanwhile, the growing power of the Medicare Advantage industry has muzzled many critics in Congress, and turned others into cheerleaders for the program.

Articles include:
Why Medicare Advantage costs taxpayers billions more than it should
150 billion reasons Medicare Advantage matters
Whistleblower suit says health plan cheated government out of more than $1 billion
How risk scores changed
Explaining Medicare Advantage, and why it matters to you
Methodology for ‘Medicare Advantage Money Grab’
Medicare Advantage made simple: a glossary

A Simple Change To The Medicare Part D Low-Income Subsidy Program Could Save $5 Billion

Source: Yuting Zhang, Chao Zhou and Seo Hyon Baik, Health Affairs, Vol. 33 no. 6, June 2014
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From the abstract:
Medicare Part D provides a subsidy to beneficiaries with incomes below 150 percent of the federal poverty level. Enrollees with the low-income subsidy accounted for 75 percent of the $60 billion in total federal Part D spending in 2013. The government randomly assigns any new beneficiary who automatically qualifies for the subsidy, or who successfully applies for it without indicating a preferred plan, to a stand-alone Part D plan whose premium is equal to or below the average premium for the basic Part D benefit in the region. We used an intelligent reassignment algorithm and 2008–09 Part D drug use and spending data to match enrollees to available plans according to their medication needs. We found that such a reassignment approach could have saved the federal government over $5 billion in 2009, for mean government savings of $710 (median: $368) per enrollee with a low-income subsidy. Implementing that simple change to reassign beneficiaries would have also lowered the proportion of prescriptions that required utilization review from 29 percent to 20 percent, and the proportion of prescriptions with quantity limits from 27 percent to 19 percent.

Impacts of the Affordable Care Act Dependent Coverage Provision on Health-Related Outcomes of Young Adults

Source: Silvia Barbaresco, Charles Courtemanche, Yanling Qi, National Bureau of Economic Research (NBER), NBER Working Paper No. w20148, May 2014
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From the abstract:
The first major insurance expansion of the Affordable Care Act – a provision requiring insurers to allow dependents to remain on parents’ health insurance until turning 26 – took effect in September 2010. We estimate this mandate’s impacts on numerous health-related outcomes using a difference-in-differences approach with 23-25 year olds as the treatment group and 27-29 year olds as the control group. For the full sample, the dependent coverage provision increased the probabilities of having insurance, a primary care doctor, and excellent self-assessed health, while decreasing unmet medical needs because of cost. However, we find no evidence of improvements in preventive care utilization or health behaviors. Subsample analyses reveal particularly striking gains for college graduates, including reduced obesity. Finally, we show that the mandate’s impacts on 19-22 year olds were generally weaker than those on 23-25 year olds, although we observe a reduction in pregnancies for unmarried 19-22 year old women.

Healthy, Wealthy, and Wise: How Corporate Power Shaped the Affordable Care Act

Source: Kevin Young and Michael Schwartz, New Labor Forum, Vol. 23 no. 2, May 2014
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Among the many promises of Barack Obama’s 2008 election campaign was a thorough reform of U.S. healthcare. The radical inefficiency of the existing system was obvious: although per-capita healthcare costs were about twice as high as in other industrialized countries, at least forty-six million people still lacked health insurance and forty-five thousand died each year as a result.

The 2010 Patient Protection and Affordable Care Act (“Obamacare”) will not solve these problems. The reform does contain some positive elements, most notably its subsidies to low-income individuals, the extension of children’s insurance to age twenty-six (assuming their parents are already insured), and the ban on insurance companies denying coverage based on pre-existing conditions. But these improvements are embedded in a structure that preserves and consolidates a fundamentally flawed system administered by private insurance corporations and populated by virtually unregulated for-profit providers.

The crux of the reform is the “individual mandate” requiring everyone to purchase insurance from private companies or pay a fine, a model that is far removed from a system of genuine universal healthcare in which progressive taxation funds a government-administered, single-payer insurance plan. This latter option, often called “Medicare for All,” was never even considered by Congress or the administration, despite being far more efficient and humane than the alternatives. Even a non-compulsory government-run insurance program (the “public option”) was never seriously entertained in the Senate.

Here we analyze the healthcare reform as an illustration of the embeddedness of large corporations in U.S. policymaking. The affected industries were centrally involved in the process from the start, guaranteeing that their interests would receive priority, while public opinion and human rights considerations mattered little. The creation of Obamacare offers a lens through which to understand how and why the government embraces the class interests of the corporate elite. Yet the state is not just an instrument of domination; it is also a site of struggle. After reviewing the reform process, we offer some strategic propositions for the Medicare for All movement. …

How Bipartisanship and Incrementalism Stitched the Child Health Insurance Safety Net (1982–1997)

Source: Samuel S. Flint, Health & Social Work, Volume 39, Issue 2, May 2014
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From the abstract:
Today, 96.5 percent of children and adolescents either have health insurance or are uninsured but eligible for a public plan. This proportion far exceeds the most optimistic coverage projections for adults under the Patient Protection and Affordable Care Act. The child health insurance safety net was crafted from 1982 to 1997 through several incremental, bipartisan federal and state legislative actions. It began by offering and later mandating state Medicaid eligibility expansions and culminated with the enactment of the State Child Health Insurance Program. Two-thirds of the states leveraged these laws to expand coverage beyond federal requirements. As a senior executive with the American Academy of Pediatrics, the author was directly involved or closely monitored these federal and state child health insurance expansions. This case study is a participant–observer analysis of that period, an era that stands in stark contrast to today’s highly partisan times. The successive expansions of publicly funded children’s health insurance during this conservative period, when many other human services programs were slashed, are attributed to public sympathy for children, political acceptability by the right and the left, manageable costs, and the relative ease of state implementation as these changes came in incremental pieces over several years.