Urban Institute

About: Urban Institute is a nonprofit organization based out in Washington D.C., District of Columbia, United States. It is known for research contribution in the topics: Medicaid & Population. The organization has 927 authors who have published 2330 publications receiving 86426 citations.

Medicaid Expansions from 1997 to 2009 Increased Coverage and Improved Access and Mental Health Outcomes for Low‐Income Parents

Abstract: Objective To assess the effects of past Medicaid eligibility expansions to parents on coverage, access to care, out-of-pocket (OOP) spending, and mental health outcomes, and consider implications for the Affordable Care Act (ACA) Medicaid expansion. Data Sources Person-level data from the National Health Interview Survey (1998–2010) is used to measure insurance coverage and related outcomes for low-income parents. Using state identifiers available at the National Center for Health Statistics Research Data Center, we attach state Medicaid eligibility thresholds for parents collected from a variety of sources to NHIS observations. Study Design We use changes in the Medicaid eligibility threshold for parents within states over time to identify the effects of changes in eligibility on low-income parents. Principal Findings We find that expanding Medicaid eligibility increases insurance coverage, reduces unmet needs due to cost and OOP spending, and improves mental health status among low-income parents. Moreover, our findings suggest that uninsured populations in states not currently participating in the ACA Medicaid expansion would experience even larger improvements in coverage and related outcomes than those in participating states if they chose to expand eligibility. Conclusions The ACA Medicaid expansion has the potential to improve a wide variety of coverage, access, financial, and health outcomes for uninsured parents in states that choose to expand coverage.

Targeting the World's Slums as Fat Tails in the Distribution of COVID-19 Cases.

Abstract: A recent article by Corburn et al. lays out the policies that would help slum communities in the global south deal with COVID-19. That article notes the vulnerabilities of people in these informal settlements and argues that any assistance program must recognize these realities so that the policies do not further jeopardize the survival of large segments of the population of these communities. This note extends the arguments in that paper, focusing on some of the logistic issues involved in providing assistance to informal settlements. It argues that such assistance is essential not only for the help it would provide to people in these settlements but also because the residents of these communities should be key targets of assistance. Because of the location and occupation of most of the residents of these communities, targeting them simultaneously addresses health and economy-wide concerns generated by COVID-19. Their characteristics make them much more likely to be afflicted by the virus and spread it to others. The main conclusions of this note with respect to policy are that the scale of such assistance is likely to be larger than has so far been proposed, that in countries with limited testing ability slums provide one of the most effective places to target assistance, that the role of community groups in providing the assistance is difficult to exaggerate, and that philanthropy has a role to play in supporting innovation.

A Critique Of Waiver Research: Critical Next Steps in Assessing the Impacts of Laws for Transferring Juveniles to the Criminal Justice System

Abstract: Of the many recent changes in juvenile justice, none are more prominent than waiver laws designed to more easily transfer young offenders to adult courts. These laws create more options to punish youth as if they were adults, leading some to question the need for a separate juvenile justice system. As yet, however, we have little systematic empirical basis for assessing the effectiveness of these laws. To help develop the foundation for such an assessment, this article examines the leading intended and unintended impacts identified by researchers. It then discusses critical research gaps that must be addressed if we are to develop a balanced and empirically informed assessment of the effectiveness of waiver.

Changes in Living Arrangements during the Late 1990s: Do Welfare Policies Matter?.

Abstract: Using data from the 1997 and 1999 National Surveys of America's Families, the authors examine the consequences of state welfare policies and practices on the living arrangements of low-income families with children. Results from a multivariate difference-in-difference-in-differences model suggest that more effective collection of child support and family cap policies are correlated with declines in single parenting and increases in dual parenting. Other policies such as sanctions and special restrictions that apply to two-parent families have no clear, consistent association with living arrangements. © 2004 by the Association for Public Policy Analysis and Management.

The effect of changing state health policy on hospital uncompensated care.

Abstract: This paper examines the effect of changing state policy, such as Medicaid eligibility, payment generosity, and HMO enrollment, on provision of hospital uncompensated care. Using national data from the American Hospital Association for the period from 1990 through 1995, we find that not-for-profit and public hospitals? uncompensated care levels respond positively to Medicaid payment generosity, although the size of the effect is small. Not-for-profit hospitals respond negatively to Medicaid HMO penetration. Results suggest that public insurance payment generosity is an effective but inefficient policy instrument for influencing uncompensated care among not-for-profit hospitals. Further in localities with high HMO penetration or high penetration of for-profit hospitals, it may be necessary to establish explicit payments for car of the uninsured. (Inquiry 2000 Fall; 37: 253-267).