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.

Statutory structure and policy implementation: the case of wetlands regulation

Abstract: A conceptual framework was developed and applied to assess the statutory structure of state wetlands regulations. The framework was derived from case study literature, but also incorporates broad generalizations. Eight specific variables were used to assess variation among 16 state regulations. Results demonstrate that this framework can be successfully applied to assess the comparative stringency of state regulations. (20 references, 6 tables)

Comparing errors in Medicaid reporting across surveys: evidence to date.

Abstract: Monitoring the success of the Patient Protection and Affordable Care Act (PPACA) requires valid estimates of health insurance coverage. As stated by Czajka and Lewis more than a decade ago: “Until we can make progress in separating the measurement error from the reality of uninsurance, our policy solutions will continue to be inefficient, and our ability to measure our successes will continue to be limited” (Czajka and Lewis 1999). In particular, the persistent presence of the Medicaid undercount—that is, that survey-based estimates of Medicaid enrollment are considerably below readily available counts from administrative data—calls into question our ability to accurately measure coverage and track reform efforts. Surveys provide the only source of estimates for the count or proportion of the population that have various forms of health insurance (public and private) or lack insurance altogether. To the extent that Medicaid enrollees are counted as uninsured, estimates of uninsurance will be biased upward; to the extent that Medicaid enrollees are counted as having other coverage, estimates of other insurance coverage will be biased but uninsurance estimates will be unaffected. Therefore, misreporting Medicaid coverage has implications for the accuracy of estimates of other types of health insurance and uninsurance. This article summarizes what is known about the accuracy of reports of Medicaid enrollment, describing the implications of misreporting for estimates of different types of insurance and people lacking insurance altogether. We have three major findings. First, measurement error in the most commonly used data source—the Current Population Survey—is large, apparently due to the full year reference period. Second, for other surveys with a point-in-time reference period, although measurement error remains a concern, confidence in estimates of uninsurance can be reasonably high as survey overstatements of uninsurance are modest. Third, confidence in estimates of the type of coverage should be lower because people known to have public coverage are more likely to have their type of coverage misclassified than to be reported as having no coverage.

Improving coverage for children under health reform will require maintaining current eligibility standards for Medicaid and CHIP.

Abstract: 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 r...

Short-Term Changes in the Prevalence of Probable Dementia: An Analysis of the 2011-2015 National Health and Aging Trends Study.

Abstract: Objectives Studies have reported decreasing dementia prevalence in recent decades in the United States. We explore with a new national data source whether declines have occurred since 2011, whether trends are attributable to shifts in dementia incidence or mortality, and whether trends are related to shifts in population composition or subgroup prevalence. Methods We use the 2011-2015 National Health and Aging Trends Study (N = 27,547) to examine prevalence of probable dementia among the 70 and older population. To minimize the influence of potential learning effects on prevalence rates, we require individuals to meet probable dementia criteria at two consecutive rounds. Results Prevalence of probable dementia declines over this period by 1.4% to 2.6% per year. Declines are concentrated among women, non-Hispanic white and black groups, and those with no vascular conditions or risk factors. The latter group also has experienced declines in dementia incidence. Declines in prevalence are largely attributable to age- and education-related shifts in population composition. Discussion Given the role of age and educational composition in short-term declines, the United States is likely to continue to experience short-term declines in dementia prevalence. However, persistently high rates among minority groups, especially of Hispanic origin, are concerning, and, barring new treatments, long-run trends may reverse course.

Implications of boundary choice for the measurement of residential mobility.

Abstract: Analyses of residential mobility are usually conditioned on a system of geography in which territory is divided into discrete units. Types of movement are defined in terms of these units, the most important distinction being that between local mobility and migration. Here we examine explicitly the implications of the choice of the migration-defining boundary in the U.S. over the 1940–1980 period. We demonstrate how boundary choice influences the extent and character of selectivity of the mobile population by using demographic and social characteristics. It appears that over time the state line may be replacing the county line in distinguishing kinds of migrants. Further, our results point to a growing fraction of footloose migrants, not tied to local territory, identified by their migration history rather than demographic characteristics.