On July 7, the National Bureau of Economic Research (NBER) published a study examining the impact of providing health coverage to uninsured low-income individuals.  Focusing on the impact on health service utilization, health outcomes, and financial burden, the study examined the effects of a 2008 Oregon Medicaid expansion that used a lottery system to select 10,000 participants to enroll in Medicaid out of a pool of approximately 90,000 applicants.  NBER found that beneficiaries had statistically significantly higher health service utilization and better self reported physical and mental health than the control group, which was comprised of individuals not selected for Medicaid coverage in the lottery.  Additionally, the authors found statistically significantly lower out-of-pocket (OOP) medical spending and medical debt among beneficiaries when compared to the control group.  The study has implications for the impact of the national health care reform law’s Medicaid expansion on uninsured individuals.

Finkelstein, Amy et. al. (2011). The Oregon health insurance experiment: evidence from the first year. National Bureau of Economic Research, (17190). http://www.nber.org/papers/w17190

Authors: Amy Finkelstein, Sarah Taubman, Bill Wright, Mira Bernstein, Jonathan Gruber, Joseph P. Newhouse, Heidi Allen, and Katherine Baicker.

The Commonwealth Fund has released a survey of expert opinions regarding vulnerable populations in the U.S. health care system.  Nearly 70 percent of survey respondents reported believing the national health care reform law will improve health care access for vulnerable populations.  The authors also found that nearly 80 percent of respondents believed that the system is currently unsuccessful in providing equal health care access, quality, and outcomes for vulnerable populations.

From the report:

Virtually all leaders in health care and health care policy believe traditional safety-net institutions such as community health centers, public hospitals, and faith-based and mission-driven organizations will still fulfill critical roles in the U.S. health system after implementation of the Affordable Care Act, according to a Commonwealth Fund/ Modern Healthcare Health Care Opinion Leaders Survey. Nearly seven of 10 respondents believe the new law will effectively improve access and financial protection for vulnerable populations, and 70 percent support policies that would guarantee access to care for undocumented immigrants. Preferred strategies for improving the quality of care delivered by safety-net providers include ensuring access to enabling services, facilitating the adop­tion and spread of patient-centered medical homes, and moving toward tightly integrated models of care delivery. Approximately 80 percent feel the health system is currently unsuccessful in achieving equity across the specific domains of access, quality, and out­comes for vulnerable populations.

Full report: The Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey: Views Vulnerable Populations (PDF | 743.10 KB)

Commonwealth Fund.  (2011).  The Commonwealth Fund/Modern Healthcare health care opinion leaders survey: views vulnerable poplations.  Stremikis, K., Berenson, J., Shih, A. and Riley, P.

The Commonwealth Fund has released a brief examining implementation of the national health care reform law's Pre-Existing Condition Insurance Plan (PCIP), the law's high-risk health coverage pools.  The brief examines early enrollment trends and early changes to plan structures and premiums.  The authors also estimate beneficiaries' out-of-pocket (OOP) costs by service utilization and plan type.  Although enrollment thus far has been low, the brief suggests the pools have played an important safety net role in the lead up to full implementation of the national health care reform law.

From the report: 

As a transitional program, the PCIP is playing an important role in making coverage available to otherwise uninsurable Americans with preexisting conditions. Structural elements of the program, including affordability of coverage and the requirement to have been uninsured for six months, are probably barriers to enrollment for many who might otherwise benefit. Nevertheless, increased outreach efforts and additional modifications to plans based on enrollment experience will likely result in continued growth in enrollment. Moreover, for those already enrolled, the PCIP programs are a critical source of bridge coverage until the health insurance exchanges are operational.  An important lesson from examining PCIP programs is the difficulty in comparing costs and coverage across plans in the absence of stricter federal guidelines on plan structure and coverage. The flexibility allowed for PCIP programs was a necessity for meeting the 90-day timeline for implementation, but it should not be a factor in the development of guidelines for the health insurance exchanges. Indeed, uniformity in exchange design will be essential for consumers to make informed decisions about the coverage that will best meet their needs and fit their budgets.

Full report: Realizing Health Reform's Potential: Early Implementation of Pre-Existing Condition Insurance Plans: Providing an Interim Safety Net for the Uninsurable (PDF | 546.37)

Commonwealth Fund.  (2011).  Realizing health reform's potential: early implementation of pre-existing condition insurance plans: providing an interim safety net for the uninsurable.  Hall, J. and Moore, J.

Long Term Care and Dual Eligibles: Overview and Managed Care Opportunities The Kaiser Family Foundation has released a brief examining health coverage challenges facing unemployed individuals and outlining their options for maintaining coverage.  The brief notes that 13.9 million individuals were unemployed in May 2011, of whom 6.2 million had been uninsured for at least six months.  The authors suggest that individuals’ options to maintain health coverage diminish as they remain unemployed for six months or more, highlighting COBRA, public health coverage, and the individual insurance market as options for unemployed individuals to obtain health coverage.  The authors assert that implementation of the national health care reform law will result in a wider range of affordable coverage options for the unemployed.

From the report:

Long Term Care and Dual Eligibles: Overview and Managed Care Opportunities

In May 2011, 13.9 million people in the U.S. were unemployed, and 6.2 million of these workers had been unemployed for six months or more.  The weak job market jeopardizes health coverage for the 57% of the nonelderly population in the U.S. that receive health insurance through an employer.  When individuals with employer-sponsored coverage become unemployed, they face the loss of both income and health insurance. Moreover, any of the employee's dependents that are covered through the employer could also lose coverage. The long-term unemployed are particularly vulnerable to loss of coverage as they face extended periods of reduced or no income.

Full report:  Health Coverage for the Unemployed (PDF | 564.50 KB)

Kaiser Family Foundation.  (2011).  Health coverage for the unemployed.  Schwartz, K. and Streeter, S.

The Center for Healthcare Research & Transformation has released a brief examining the impact of the national health care reform law on health coverage in Michigan.  Using a model that assumes the law was implemented in 2007/2008, the authors estimate the 5 percent more of the population would have had public coverage than without the law, at 33 percent.  The authors also estimate that 65 percent of residents would have had private coverage under the law, rather than the 61 percent who did in 2007/2008.

From the report: 

The Patient Protection and Affordable Care Act is intended to significantly reduce the number of uninsured individuals in the country. If the Act were fully implemented in 2014, and all those who were eligible for coverage and/or mandated to purchase coverage enrolled in or purchased that coverage, there would be considerable growth in both private and public sector coverage in the state. That is, while 28 percent of those in Michigan had public coverage in 2007/2008, under health reform, 33 percent would be eligible (and if all enrolled, covered). And while 61 percent of the state's population had private coverage in 2007/2008, post-reform that number could grow to 65 percent assuming all who are required to purchase coverage did so (and those who currently have employer based group coverage but would be Medicaid eligible continue to retain employer based coverage). Those who are currently covered by individually-purchased private insurance and meet income eligibility criteria for Medicaid under reform (i.e., have incomes less than 133 percent of poverty) make up one percent of Michigan's population, but it is unclear whether they would choose to enroll for Medicaid or retain their private coverage.

Full report: Impact of Health Reform on Coverage in Michigan (PDF | 992.38 KB)

Center for Healthcare Research & Transformation.  (2011).  Impact of Health Reform on Coverage in Michigan.

On May 31, the Urban Institute released a brief examining health coverage challenges for children under the national health care reform law.  The authors found that approximately 20 million children live in family situations that could create problems accessing health coverage due to eligibility variations within families.  Additionally, the brief notes that nearly 28 million children live apart from at least one parent, presenting additional coverage complexities.  The authors suggest that the U.S. Department of Health and Human Services (HHS) tailor regulations such that children can maximize health coverage under health reform.

From the report:

The Affordable Care Act (ACA) will expand health insurance coverage options for many children and their families. The Medicaid expansion will extend eligibility to many individuals, and federal subsidies to purchase coverage in the health insurance exchanges will improve the affordability of coverage for low-and moderate-income families. To further encourage a reduction in uninsurance, the law also includes an individual requirement to obtain qualifying coverage that applies to most Americans. The ACA will improve accessibility and affordability of coverage for many Americans, but special attention may be required during implementation to ensure that children (age 0 to 18) in particularly complex coverage situations benefit from reform.

Full Report: Addressing Coverage Challenges for Children Under the Affordable Care Act (PDF | 323 KB)

Urban Institute. (2011). Addressing coverage challenges for children under the Affordable Care Act. McMorrow, S., Kenney, G., and Coyer, C.