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.

Lessons from early Medicaid expansions under health reform: interviews with Medicaid officials.

Abstract: Background: The Affordable Care Act (ACA) dramatically expands Medicaid in 2014 in participating states. Meanwhile, six states have already expanded Medicaid since 2010 to some or all of the low-income adults targeted under health reform. We undertook an in-depth exploration of these six “early-expander” states—California, Connecticut, the District of Columbia, Minnesota, New Jersey, and Washington— through interviews with high-ranking Medicaid officials. Methods: We conducted semi-structured interviews with 11 high-ranking Medicaid officials in six states and analyzed the interviews using qualitative methods. Interviews explored enrollment outreach, stakeholder involvement, impact on beneficiaries, utilization and costs, implementation challenges, and potential lessons for 2014. Two investigators independently analyzed interview transcripts and iteratively refined the codebook until reaching consensus. Results: We identified several themes. First, these expansions built upon pre-existing state-funded insurance programs for the poor. Second, predictions about costs and enrollment were challenging, indicating the uncertainty in projections for 2014. Other themes included greater than anticipated need for behavioral health services in the expansion population, administrative challenges of expansions, and persistent barriers to enrollment and access after expanding eligibility—though officials overall felt the expansions increased access for beneficiaries. Finally, political context—support or opposition from stakeholders and voters—plays a critical role in shaping the success of Medicaid expansions. Conclusions: Early Medicaid expansions under the ACA offer important lessons to federal and state policymakers as the 2014 expansions approach. While the context of each state’s expansion is unique, key shared experiences were significant implementation challenges and opportunities for expanding access to

Unchecked Provider Clout In California Foreshadows Challenges To Health Reform

Abstract: Faced with declining payment rates, California providers have implemented various strategies that have strengthened their leverage in negotiating prices with private health plans. When negotiating together, hospitals and physicians enhance their already significant bargaining clout. California’s experience is a cautionary tale for national health reform: It suggests that proposals to promote integrated care through models such as accountable care organizations (ACOs) could lead to higher rates for private payers. Because antitrust policy has proved ineffective in curbing most provider strategies that capitalize on providers’ market power to win higher payments, policy makers need to consider approaches including price caps and all-payer rate setting.

The association of AIDS education and sex education with sexual behavior and condom use among teenage men.

Abstract: Multivariate and 1 and 2-limit to bit models were used to analyze data from 1880 noninstitutionalized never-married men 15-19 years of age included in the US 1988 National Survey of Adolescent Males (NSAM) Cross-sectional data are compared in order to assess the levels of sexual behavior and condom use after AIDS and sex education Condom consistency rates were calculated Race age urban residence annual family income family receipt of welfare within the last 12 months religious denomination school attendance the state incidence of AIDS/100000 population and confirmation of mothers teenage pregnancy were used to control for confounding factors AIDS knowledge and attitudes were also obtained The 1-limit tobit model was used to analyzed the number of partners and acts of intercourse Condom use was analyzed with a 2-limit tobit model The findings were that there has been widespread receipt of AIDS education and sex education in topics on AIDs birth control biology and resistance skills which accounted for 77% of the variance in the 8 topics and were significantly correlated The receipt of AIDS education was associated with decreases in the number of sexual partners after controlling for race age religion and other background variables AIDS education was responsible for 1) a 4% increase in the proportion of students with recent sexual partners (within the past 12 months); 2) a mean reduction of 12 partners among those with recent sex partner; 3) a 7% decrease in the proportion who had never used condoms; recently sex partner; 4) a 9% increase in the proportion using condoms 100% of the time; and a mean increase of 2% among all who ever used a condom Age ethnic group religion urban residence and presence of a teenage mother were significant variables in the analysis of AIDS education effects and the relationship is indicated In the analysis of other sex education only AIDS resistance skills and birth control were analyzed Each topic was associated with an increase in condom use (t = 191=198 at p = 05) In the ordinary least squares analysis the association between instruction and behavior was not mediated by changes in knowledge or attitudes No topic affected the perceived risk of infection Resistance instruction has a strong independent association with fewer sexual partners and acts of intercourse An integrated and comprehensive approach to HIV education and sex education is suggested Self-reporting and selection biases are discussed as limitations

Home care for the disabled elderly: predictors and expected costs.

Abstract: While interest in publicly funded home care for the disabled elderly is keen, basic policy issues need to be addressed before an appropriate program can be adopted and financed. This article presents findings from a study in which the cost implications of anticipated behavioral responses (for example, caregiver substitution) are estimated. Using simulation techniques, the results demonstrate that anticipated behavioral responses would likely add between $1.8 and $2.7 billion (1990 dollars) to the costs of a public home care program. Results from a variety of cost simulations are presented. The data base for the study was the 1982 National Long-Term Care Survey.

The Health Reform Monitoring Survey: Addressing Data Gaps To Provide Timely Insights Into The Affordable Care Act

Abstract: The Health Reform Monitoring Survey (HRMS) was launched in 2013 as a mechanism to obtain timely information on the ACA during the period before federal survey data will be available. The HRMS provides quarterly data on insurance coverage, access to health care, and health care affordability, along with changing topics of relevance to current policy and program issues. For example, data from summer 2013 show that more than 60 percent of those targeted by the health insurance exchanges struggle with understanding key health insurance concepts, raising concerns about their ability to evaluate trade-offs when choosing coverage.