Expanding Health Care Coverage Research Articles

FRANKS ET AL. RESPOND

Farrelly and Engelen appear to have repeated our analyses, but have included 2 more recent years of data and used Nielsen retail price data as well as the tax burden data that we used. There are some noteworthy inconsistencies. First, despite using more years of data, their sample size was over 1 million persons smaller than ours. Second, they noted that a meta-analysis found an elasticity of −0.4, which is what we found in the earlier time period. However, the elasticity they reported throughout was much lower (range: −0.1 to −0.13). This lower elasticity is actually less than the elasticity we reported (−0.14) for poorer persons in the more recent time period. Third, despite the smaller sample size and lower elasticity, they reported the effect as statistically significant, whereas we found a larger effect not statistically significant. Fourth, the rationale for using Neilson data is that actual prices may be lower than those in the tax burden data. Thus, use of the tax burden data may underestimate elasticity. However, paradoxically, their results using Nielsen data compared with the tax burden data suggest less elasticity with the Nielsen data. The reasons for these inconsistencies are unclear, given the limited presentation of their methods. One possibility is that they ignored the clustered nature of the data (thereby overstating the statistical significance of their findings); another is that the Nielsen data are problematic.1 Beyond these methodological issues, there are some important policy implications of our findings. While higher prices may still contribute to smoking cessation (and reduced initiation), the gap between the poor and less poor in smoking is increasing. The burden of higher cigarette prices thus falls increasingly on poorer persons. Funding broad social policies (like expansion of health care coverage) through taxation aimed at a narrow, poor segment of society may be politically expedient. However, in our view, such policy is short sighted and contributes to the fragmentation of social cohesiveness. Further, if higher prices do lead to reduced smoking, then tax revenues will decline, undermining the fiscal basis of the expanded health coverage.

The U.S. Presidential Election and Health Care Workforce Policy

The candidates for the 2008 presidential election have offered a range of proposals that could bring significant changes in health care. Although few are aimed directly at the nurse and physician workforce, nearly all of the proposals have the potential to affect the health care workforce. Furthermore, the success of the proposed initiatives is dependent on a robust nurse and physician workforce. The purpose of this article is to outline the current needs and challenges for the nurse and physician workforce and highlight how candidates' proposals intersect with the adequacy of the health care workforce. Three general themes are highlighted for their implications on the physician and nurse workforce supply, including (a) expansion of health care coverage, (b) workforce investment, and (c) cost control and quality improvement.

Expanding health care coverage: National versus state leadership

Journal of Policy Analysis and ManagementVolume 26, Issue 1 p. 177-177 Point/Counterpoint Expanding health care coverage: National versus state leadership Richard P. Nathan, Richard P. Nathan No affiliationSearch for more papers by this author Richard P. Nathan, Richard P. Nathan No affiliationSearch for more papers by this author First published: 29 November 2006 https://doi.org/10.1002/pam.20232AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume26, Issue1Winter 2007Pages 177-177 RelatedInformation

Advocates Can Take Action To Increase Odds of Success

Advocates Can Take Action To Increase Odds of Success

Universal Health Care and Reform of the Health Care System: Views of Medical Students in the United States

Nearly 46 million Americans did not have health insurance in 2004. Recent studies have documented physicians' support for various remedies, including universal health care. The authors undertook this study to assess medical students' views on these topics. In 2002, the authors surveyed a national random sample of first-year and fourth-year medical students (from the American Medical Association Masterfile) to determine their views about health care reform options, including universal health care. Response data were weighted and compared using chi-squared tests; statistical significance was set at p < or = .05. Of 1,363 medical students, 770 completed the questionnaire (response rate = 56.5%). In rating the importance of several health care issues, more than 80% of both first-year and fourth-year students rated the expansion of health care coverage as important. Nearly all first-year (90%) and fourth-year (88%) students agreed with the statement, "Everyone is entitled to adequate medical care regardless of ability to pay." Most students favored health care reform that would achieve universal health care, with first-year students (70%) somewhat more likely than fourth-year students (61%) to support universal health care (p = .012). Students were less likely to believe that physicians support universal health care, and more likely to believe that the public does. Both groups of students generally support the expansion of health coverage to the uninsured and some form of universal health care. This may be relevant both to policymakers in their considerations of health care reform and to medical educators concerned with teaching students about health policy issues.

Federalism And Health Policy

This paper presents a cyclical theory of U.S. federalism and social policy: Many social policy initiatives are tested and refined at the state level, especially during conservative periods, and later morph into national policies. The paper describes such federalism cycles and offers an interpretation of why and how they occur, focusing on Medicaid. State activism has preserved and expanded Medicaid through policy innovation and resistance to retrenchment, especially in conservative periods, by taking advantage of the flexibility the program provides. I conclude that Medicaid's incremental/partnership approach is appropriate and feasible to build on for a future expansion of health care coverage.

Preterm Birth: The Interaction of Traffic-related Air Pollution with Economic Hardship in Los Angeles Neighborhoods

Preterm birth may be affected by the interaction of residential air pollution with neighborhood economic hardship. The authors examined variations in traffic-related pollution exposure--measured by distance-weighted traffic density--using a framework reflecting the social and physical environments. An adverse social environment was conceptualized as low socioeconomic status (SES) neighborhoods--census tracts with concentrated poverty, unemployment, and dependence on public assistance. An adverse physical environment was depicted by the winter season, when thermal inversions trap motor vehicle pollutants, thereby increasing traffic-related air pollution. Los Angeles County, California, birth records from 1994 to 1996 were linked to traffic counts, census data, and ambient air pollution measures. The authors fit multivariate logistic models of preterm birth, stratified by neighborhood SES and third pregnancy trimester season. Traffic-related air pollution exposure disproportionately affected low SES neighborhoods in the winter. Further, in these poorer neighborhoods, the winter season evidenced increased susceptibility among women with known risk factors. Health insurance was most beneficial to women residing in neighborhoods exposed to economic hardship and an adverse physical environment. Reducing preterm births warrants a concerted effort of social, economic, and environmental policies, focused on not only individual risk factors but also the reduction of localized air pollution, expansion of health-care coverage, and improvement of neighborhood resources.

Impacts of Expanding Health Care Coverage on the Employment and Earnings of Participants in the SSI Work Incentive Program - Policy Brief

While people with disabilities often say that a loss of public health insurance is a deterrent to work, it is rare to find situations in which they might actually exhibit such a behavioral response to a change in access. Expansions in the income threshold for SSI work incentives program (Sections 1619(a) and (b)) provide an opportunity to observe such a response. Section 1619(b) allows SSI recipients to maintain Medicaid eligibility even if their income is above the level that makes them ineligible for SSI payments. If earnings increase beyond the 1619(b) threshold, however, the person loses their SSI and Medicaid eligibility. Section 1619(b) income thresholds vary significantly across states and over time. Stapleton and Tucker (2000) use the variation in Section 1619(b) income thresholds to examine the employment, earnings and program participation patterns of SSI recipients who have incomes near the threshold level for their state. They find strong evidence that many SSI recipients restrain their earnings to stay below the 1619(b) threshold. It is important to note, however, that the findings only provide evidence on the behavior of a small portion of the population with disabilities (i.e., SSI recipients who work). Nonetheless, this evidence seems to provide strong empirical support for the hypothesis that lack of access to health insurance is an important work disincentive for people with disabilities. They also find that 1619(b) participation varies significantly from month to month. Consequently, cross-sectional estimates on the share of SSI recipients participating in 1619(b) significantly understate the share of SSI recipients who ever participate. These findings are consistent with previous findings that cross-sectional estimates of employment tend to understate multi-period employment patterns for the broader population with disabilities.

HSAs: More Than a (Tax) Shelter, Not Quite a House

Health savings accounts should not be the focus of a strategy to expand health care coverage to the uninsured, but should be considered complementary to more fundamental health care reform. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

CMS Reflections: A Milestone For Medicare And Medicaid

Web Exclusives Health AffairsVol. 24, No. Suppl1: Web Exclusives CMS Reflections: A Milestone For Medicare And MedicaidPUBLISHED:2005No Accesshttps://doi.org/10.1377/hlthaff.W5.325AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions AbstractPROLOGUE:On 30 July 1965 President Lyndon B. Johnson signed laws establishing the Medicare and Medicaid programs (Titles 18 and 19 of the Social Security Act), the nation's first federally sponsored programs to finance health insurance with tax dollars. Medicare, the federally administered and financed health insurance program for the elderly and disabled, covers more than forty million people age sixty-five or older or with permanent disabilities; program expenditures were $283 billion in 2003. Medicaid, which offers health insurance to the disabled as well as to needy adults and children, is jointly funded by states and the federal government but is managed primarily by individual states. The program covers more than fifty million people, with combined state and federal expenditures now exceeding $300 billion.At the programs' inception, Medicare and Medicaid were administered separately—Medicare under the Social Security Administration and Medicaid under the Social and Rehabilitative Services Administration. In 1977 the Carter administration created the Health Care Financing Administration (HCFA), within the Department of Health, Education, andWelfare (HEW), to consolidate the administration of these two programs. HCFA is known today as the Centers for Medicare and Medicaid Services (CMS) and is part of the Department of Health and Human Services (HHS).Despite perennial fiscal pressures, both programs have expanded in the past decade, via the State Children's Health Insurance Program (SCHIP), which since 1997 has helped states expand health care coverage to the nation's uninsured children, and the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, which, among other things, will offer drug coverage to all Medicare beneficiaries for the first time in the program's history. To commemorate the forty-year anniversary of Medicare and Medicaid, Health Affairs invited former HCFA/CMS administrators to share their thoughts and reflections on the programs and the agency that administers them. We include here essays from HCFA's first administrator, Robert Derzon, followed by pieces from Leonard Schaeffer, Bill Roper, Gail Wilensky, Bruce Vladeck, Nancy-Ann DeParle, and Tom Scully. The publication of these papers coincides with a 26 July 2005 event in Washington, D.C., cosponsored by the Commonwealth Fund and the Henry J. Kaiser Family Foundation, also commemorating the anniversary. AWebcast of the event, titled “Medicare + Medicaid at 40,” is available at www.kaisernetwork.org/healthcast/kff/26jul05 . TOPICSMedicaidMedicare savings programsFederal health plansMedicareSocial SecurityDisabledChildren's healthChildren's Health Insurance Program Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 5 June 2018 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.PDF download

Low-Income Children's Participation in a Public Health Insurance Program in Georgia

To expand health care coverage to uninsured, low-income children, the Congress created the State Children's Health Insurance Program (SCHIP) in 1997. Given ample evidence that state Medicaid programs have failed to enroll many eligible children, experts questioned whether SCHIP could successfully enroll low-income children. Using Georgia state SCHIP data, we analyzed enrollment patterns and identified factors contributing to program enrollment. This study found that the children's enrollment is explained by perceived costs and benefits of joining the program as well as the underlying family structure, demographic factors, and health status. We discuss implications of these findings on the participation of low-income families in public sector programs.

Health insurance expansion through states in a pluralistic system.

The United States continues to stand almost alone among developed nations in its lack of universal health care coverage. In this essay, we argue that even though the debate over whether the federal government or states should lead the effort to expand health care coverage under the federal system is relevant in strategizing how to cover the uninsured; the more critical issues stem from the challenge of the mixed and fragmented mode of public-private financing of our pluralistic health care system. We base this argument on (1) an in-depth review of Oregon's and Tennessee's five years of experience with broad coverage reform in the context of the United States health care system and on (2) a more abbreviated review of other state experiences in providing health care coverage. We conclude from our review that when the will exists, states can substantially expand coverage. However, as one moves up the income scale, political support and resources are harder to come by. Further, concerns grow about the interface of public and private coverage, with issues of "crowd out" and other distributional questions dominating the discussion of coverage expansion as policy makers focus less on how to cover people than on how to make sure one kind of coverage doesn't preempt another. Concern for crowd out can then lead to policies that keep out some of the very people policy makers may want to cover. In this context the question whether states or the federal government is more likely to succeed in expanding coverage is eclipsed by the more fundamental challenges raised by pluralism. Neither federal nor state government is likely to be fully successful without first identifying ways of better coordinating public and private activities and resources to provide continuous and affordable coverage.

Universal coverage in the United States: lessons from experience of the 20th century.

Both the rising numbers of uninsured Americans and the recent presidential election have put the issue of universal health insurance coverage back on the national agenda. Lack of health insurance is a major barrier to care for 44 million Americans, and lack of high-quality, comprehensive insurance is a barrier to millions more. Universal coverage is one of the best ways to ensure that all Americans have equitable access to quality care, and it also contributes to the financial stability of health care providers, especially those in the urban safety net. A wide variety of ideas to expand health care coverage were proposed, and in some cases enacted, during the last century. At the beginning of the 21st century, the American health care system is made up of varied elements, ranging from employer-sponsored health insurance for the majority of working-age adults to the public Medicare program for the elderly. While this patchwork system leaves many Americans without health insurance, it also creates many different ways to expand coverage, including various options in both the private and public sectors. By understanding how the current health care system developed, how the various proposals for universal health coverage gained and lost political and public support, and the pros and cons of the various alternatives available to expand coverage, we create a solid base from which to solve the problem of the uninsured in the 21st century.

Oregon's bold experiment: whatever happened to rationing?

In 1994 Oregon began rationing health care for its Medicaid population, offering health policy makers and analysts around the country a view of one alternative future for health care delivery. The question now, four years after the experiment began, is what does that future look like? The short answer is that it does not look all that different from the present, but it looks different enough to offer important lessons to other states and the federal government. The Oregon experiment, including the prioritization of services and the aggressive use of managed care, has facilitated the expansion of health care coverage to over 100,000 additional Oregonians, helped decrease the percentage of the uninsured as well as reduce uncompensated care in hospitals, reduced the use of hospital emergency rooms, and reduced cost shifting. By most measures, the Oregon experiment appears to be a success.

History of ambulatory care facilities from a roving hospital administrator's point of view.

Over the past four decades, the delivery of health care services has seen dramatic changes. Medicare coverage in 1966 expanded the ability of the health care industry to treat a growing segment of the population. Technology improvements have made great strides in the treatment of disease. Public policy decisions expanded health care coverage from an employee benefit to entitlement for large segments of the population. Managed care growth has reorganized the basic health care delivery system. The aggregate effect of all these items was a dramatic increase in the cost of providing health care in the United States. Beginning in the late 1960s, and escalating in the 1970s and 1980s, the increase of the cost of care was the primary issue for the industry. Only in the 1990s has the rate of increase modified through the impact of managed care, and now there is significant competition for the health care dollar among many competing providers.

Expanded health care coverage for needy children.

Expanded health care coverage for needy children.

Expanding health care coverage and patient rights

Expanding health care coverage and patient rights

Comparative Economic Systems

The U.S. health care system faces well-known problems: 47 million people without health insurance, rapidly rising costs that consume 16 percent of the country's economic output, and widely uneven quality of care. Even many people with coverage are experiencing serious problems paying for the rapidly rising costs of health care and insurance.This book - a joint product of the National Academy of Public Administration and the National Academy of Social Science - undertakes a sweeping analysis of the management and administrative issues that arise in expanding health care coverage. The book identifies the core administrative functions that need to be performed in assuring access to health coverage, describes how these functions are performed at present and under proposed alternatives, draws lessons from experience in the U.S. and abroad, and assesses suggested administrative approaches designed to facilitate the improvement and expansion of health care coverage.Adequate health care is one of today's most crucial domestic policy concerns. Expanding Access to Health Care is designed to bring together in one place some of the best thinking on the subject, not as an exercise in advocacy, but rather to lay out the issues in a balanced way so that policymakers, researchers, and citizens can better understand the complex details of health care reform.