PubMed Health⌕ Search

Biomedical subjects

John Holahan

Publications and source records attributed to John Holahan.

18 recordsLinked to original sources
PubMed2006

The uninsured and the affordability of health insurance coverage.

The 2005 Current Population Survey (CPS) is used to estimate what share of uninsured Americans are eligible for coverage through Medicaid or the State Children's Health Insurance Program (SCHIP), need financial assistance to purchase health insurance, and are likely able to afford insurance. Twenty-five percent are eligible for public coverage, 56 percent need assistance, and 20 percent can afford coverage. This varies across uninsured populations: 74 percent of children are eligible for public programs, and 57 percent and 69 percent of parents and childless adults, respectively, need assistance. A central conclusion is that a large percentage of uninsured adults need help purchasing health insurance.

Adolescent↗
PubMed2006

Massachusetts health care reform: a look at the issues.

Massachusetts recently enacted a major health reform that could move the state to close to universal health insurance coverage. We describe some of the politics behind the legislation and the law's key details. We discuss four major issues that the plan would face: (1) a definition of affordability-how much should be borne by individuals and how much by government; (2) issues the state will face in implementing the Insurance Connector; (3) whether employers will respond by dropping coverage; and (4) whether the financing would be adequate, both immediately and over time. Massachusetts will face challenges, but it offers a model that could be followed elsewhere.

Health Benefit Plans, Employee↗
PubMed2006

Toward a more reliable federal survey for tracking health insurance coverage and access.

OBJECTIVE: Examination of the extent to which federal surveys provide the data needed to estimate the coverage/cost impacts of policy alternatives to address the problem of uninsurance. DATA SOURCES/STUDY SETTING: Assessment of the major federal household surveys that regularly provide information on health insurance and access to care based on an examination of each survey instrument and related survey documentation and the methodological literature. STUDY DESIGN: Identification of the data needed to address key policy questions on insurance coverage, assessment of how well existing surveys meet this need, definition of the critical elements of an ideal survey, and examination of the potential for building on existing surveys. DATA COLLECTION/EXTRACTION METHODS: Collection and critical assessment of pertinent survey documentation and methodological studies. PRINCIPAL FINDINGS: While all the federal surveys examined provide valuable information, the information available to guide key policy decisions still has major gaps. Issues include measurement of insurance coverage and critical content gaps, inadequate sample sizes to support precise state and substate estimates, considerable delays between data collection and availability, and concerns about response rates and item nonresponse. Our assessment is that the Current Population Survey (CPS) and the National Health Interview Survey could be most readily modified to address these issues. CONCLUSIONS: The vast resources devoted to health care and the magnitude of the uninsurance problem make it critical that we have a reliable source for tracking health care and coverage at the national and state levels and for major local areas. It is plausible that this could be more cost effectively done by building on existing surveys than by designing and fielding a new one, but further research is needed to make a definitive judgment. At a minimum, the health insurance information collected on the CPS should be revised to address existing measurement problems.

Data Collection↗
PubMed2006

Toward universal coverage in Massachusetts.

This paper presents several options designed to help the Commonwealth of Massachusetts move to universal health insurance coverage. The alternatives all build upon a common base that includes an expansion of the Medicaid program, income-related tax credits, a purchasing pool, and government-sponsored reinsurance. These measures in themselves would not yield universal coverage, nor would an employer mandate by itself. We show that an individual mandate, and an employer mandate combined with an individual mandate, both would yield universal coverage with a relatively small increase in government costs relative to state gross domestic product and current health spending. The cost of an employer mandate--with a "pay or play" design--is sensitive to the payroll tax rate and base, the number and kind of exemptions, and whether workers whose employers "pay" receive discounts when they purchase health insurance. The development of these alternatives and their analyses contributed to the eventual health care compromise that emerged in Massachusetts in April 2006.

Health Care Reform↗
PubMed2004

Government as reinsurer: potential impacts on public and private spending.

This paper analyzes the potential effects of alternative government reinsurance mechanisms on public and private expenditures in group and nongroup health insurance markets. High reinsurance thresholds, with the government taking responsibility for costs over dollars 50,000 per year, would absorb a small share of private costs. Lower thresholds would have greater effects, but would increase government costs significantly. We also find that reinsurance would reduce the variance in expenditures considerably and should reduce risk premiums charged by private insurers. We conclude that focusing on small employers and the nongroup market could target government spending where costs are highest and insurance markets most unstable.

Government Programs↗
PubMed2003

Is health care spending higher under Medicaid or private insurance?

This paper addresses the question of whether Medicaid is in fact a high-cost program after adjusting for the health of the people it covers. We compare and simulate annual per capita medical spending for lower-income people (families with incomes under 200% of poverty) covered for a full year by either Medicaid or private insurance. We first show that low-income privately insured enrollees and Medicaid enrollees have very different socioeconomic and health characteristics. We then present simulated comparisons based on multivariate statistical models that estimate the effects of private and Medicaid coverage on the likelihood of using services, and the level of expenditures, given any use, holding constant demographic, economic, and health status characteristics. The simulations demonstrate that if people with Medicaid coverage--with their health status, disability, and chronic conditions--were given private coverage, they would cost considerably more than they do today. Conversely, if the privately insured were given Medicaid coverage, spending would be lower. We find no evidence that spending differences between Medicaid and private coverage for low-income people are due to lower service use by Medicaid beneficiaries. We conclude that most of the difference in expenditures is due to differences in provider payment rates.

Acute Disease↗
PubMed2003

Which children are still uninsured and why.

A strong economy and increased enrollment in employer-sponsored health insurance coverage, together with expansions in Medicaid and State Children's Health Insurance Program (SCHIP) led to reductions in uninsurance among low-income American children between 1998 and 2000 (from 15.6% to 13.3%). Nonetheless, 12% (about 9 million) of children remained uninsured. Identifying these children and understanding the factors that contribute to their continued lack of health coverage is key to providing them access to health care. Using 1994, 1998, and 2000 census data, this article analyzes recent trends in children's health coverage, as well as the groups that make up the population of uninsured children. The picture that emerges from these analyses is one of tremendous variation in coverage for different groups of children, with some groups having a higher risk for lacking health insurance. For example, poor children, Hispanics, adolescents, and children with foreign-born parents (particularly those whose parents are not U.S. citizens) are overrepresented among the uninsured. The authors conclude that the strong economy and concomitant increase in employer-based coverage played a bigger part in reducing uninsurance rates than did expansions in public programs. They also argue that lack of participation by eligible children rather than inadequate eligibility levels is the key policy issue, and conclude with several recommendations to increase program participation.

Child↗
PubMed2002

Do welfare caseload declines make the Medicaid risk pool sicker?

Declining welfare caseloads may lead to a sicker population remaining in the Medicaid program, which could increase per enrollee costs and the level of adequate capitation rates. Using data from the 1997 National Survey of America's Families for adults and children, we examine differences in health status and utilization among welfare recipients and welfare leavers who did and did not retain Medicaid. We adjust utilization differences for insurance status and factors often used to adjust capitation rates. We conclude that declining welfare caseloads likely will result in a sicker and more expensive adult Medicaid risk pool.

Adult↗
PubMedDate not supplied

Medicaid managed care payment methods and capitation rates in 2001.

We present results from a survey of Medicaid managed care payment methods and rates in 2001 for AFDC/TANF and poverty-related Medicaid populations, updating a similar survey of 1998 rates. Rates were adjusted for differences in age-sex groupings, maternity payments, and service carve-outs. A twofold variation in Medicaid capitation rates remains, although there was a change in the composition of states at the top and bottom. The data also show that the growth in Medicaid capitation rates between 1998 and 2001 averaged 18 percent, considerably more than the increase in Medicare+Choice rates.

Actuarial Analysis↗
PubMedDate not supplied

Changes in insurance coverage: 1994-2000 and beyond.

The number of uninsured Americans fell in 2000 for the second consecutive year. The reduction has been attributed to the continued expansion of employer-sponsored insurance. However, the increase in employer coverage among adults was offset by declines of other types of coverage. For children, increases in public coverage plus the growth in employer-sponsored insurance led to the reduction in the number of uninsured children. Over the longer period (1994-2000), one of great economic growth, the uninsurance rate was essentially the same at the end as at the beginning. The rate of employer-sponsored insurance increased sharply, so that more people had employer coverage. However, these increases were offset by reductions in other forms of coverage, particularly Medicaid and state-sponsored insurance and private nongroup coverage, so the overall rate of uninsurance did not change.

Adult↗
PubMedDate not supplied

Health policy for low-income people: states' responses to new challenges.

The past five years have given states new opportunities in health policy for low-income people, with many changes increasing states' flexibility. However, new pressures on state policy also have arisen from a variety of factors, most recently from the economic downturn that has reduced revenues and increased demand for spending. This paper analyzes recent changes in health policy in the thirteen states that are the core of the Urban Institute's Assessing the New Federalism project, focusing on state fiscal conditions, health care coverage, acute care, and long-term care. Implications for the future are discussed.

Acute Disease↗
PubMedDate not supplied

Covering the uninsured: how much would it cost?

To provide benchmarks for evaluating the costs of alternative proposals to provide insurance coverage for the uninsured, this study presents two sets of cost estimates derived from medical spending patterns of lower- or middle-income people with private insurance plans and those of people with public insurance coverage during 1996-1998. The analysis suggests that the uninsured would use dollar 33.9-dollar 68.7 billion (in 2001 dollars) in additional medical care if they were fully insured. An increase in medical spending of this range would increase total health care spending by 3-6 percent and would raise health care's share of GDP by less than one percentage point.

Health Care Costs↗
PubMedDate not supplied

Which way for federalism and health policy?

The current balance of responsibility between states and the federal government for low-income people's health coverage has achieved a great deal. It covers many of the neediest people, supports the safety net, responds to emerging needs, and supports some experimentation. However, it leaves more than forty million people uninsured, allows excessive variation across states, places unsustainable pressure on state budgets, creates tension between the two levels of government, and yields too few benefits from experimentation. This mixed record argues for a significant simplification of and increase in eligibility for public programs, with the federal government either providing extra funds to states to meet these needs or assuming full responsibility for insuring the poor.

Budgets↗
PubMedDate not supplied

How much medical care do the uninsured use, and who pays for it?

With the number of uninsured people exceeding forty-one million in 2001, insuring the uninsured is again a major policy issue. This analysis establishes benchmarks for the inevitable debate over the cost of expanding coverage: How much is being spent on care for the uninsured, and where does the money come from? This information is essential for assessing how much new money will be required for expanded coverage, how much can be reallocated from existing sources, and how a new financing system would redistribute the burden of subsidizing care for the uninsured from private to public sources.

Benchmarking↗
PubMedDate not supplied

Changes in health insurance coverage during the economic downturn: 2000-2002.

Using Current Population Survey data from 2000-2002, this paper documents the changes that led the uninsured population to grow by 3.8 million during that time period. All of the increase in the uninsured occurred among adults, and two-thirds was among low-income adults. The extent to which the loss of employer coverage resulted in people becoming uninsured depended on their access to public programs: Children were more likely than adults to gain public coverage; women more likely than men; and parents more likely than nonparents. Middle- and higher-income Americans were also affected because many lost income and because rates of employer coverage were lower.

Adult↗
PubMedDate not supplied

Changes in economic conditions and health insurance coverage, 2000-2004.

Between 2000 and 2004, the number of uninsured Americans increased by six million, primarily because of a decline in employer-sponsored insurance. All of the increase occurred among adults, for whom the drop in employer coverage was not offset by an increase in public coverage. The number of uninsured children fell slightly. About two-thirds of the growth in the uninsured was among Americans below 200 percent of the federal poverty level. Coverage rates have also fallen among higher-income Americans. About half of the growth in the uninsured was among young adults ages 19-34, about 55 percent among whites, and 73 percent among native-born citizens.

Adult↗
PubMedDate not supplied

Understanding the recent growth in Medicaid spending, 2000-2003.

Growth in Medicaid spending averaged 10.2 percent per year between 2000 and 2003, resulting in a one-third increase in program spending. Spending growth was lower from 2002 to 2003 because of slower growth in enrollment and in spending per enrollee, particularly for acute care services, and declines in disproportionate-share hospital (DSH) payments and upper payment limit (UPL) programs. For the entire 2000-2003 period, Medicaid spending increases were largely driven by enrollment growth, much of which was attributable to the economic downturn. Increases in spending per enrollee over the period were faster than inflation but slower than increases in private insurance spending.

Health Expenditures↗