Publications on Health Insurance
Health care coverage protects individuals against the financial risk that might result from spending on health care services. In the United States, coverage may take the form of insurance offered by private companies and made available to individuals through employers or purchased directly. The government also provides coverage for certain populations via programs such as Medicare or Medicaid. RAND research on health care coverage dates from the RAND Health Insurance Experiment (HIE). Conducted in the 1970s and early 1980s, the HIE remains the only long-term, experimental study of cost sharing and its effect on health care utilization and spending, quality of care, and health. Since then, RAND studies have examined multiple dimensions of coverage, including the effects of premium costs on health care use, the cost and potential health effects of new insurance products such as high-deductible health plans, the challenges faced by small businesses in providing coverage to employees, the groups most at risk for being uninsured, state experiments with insuring the uninsured, coverage for behavioral health, and coverage for prescription drugs.
Selected Publications, 2007 to Present
2011
The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in California: An Analysis from RAND COMPARE — April 1, 2011
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in California through 2020.
The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in Connecticut: An Analysis from RAND COMPARE — April 1, 2011
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Connecticut through 2020.
The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in Illinois: An Analysis from RAND COMPARE — April 1, 2011
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Illinois through 2020.
The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in Montana: An Analysis from RAND COMPARE — April 1, 2011
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Montana through 2020.
The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in Texas: An Analysis from RAND COMPARE — April 1, 2011
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Texas through 2020.
2010
Analysis of the Affordable Health Care for America Act (H.R. 3962) — January 7, 2010
Using the COMPARE microsimulation model, estimates proposed health care reform legislation's effects on the number of uninsured, the costs to the federal government and the nation, revenues from penalty payments, and consumers' health care spending.
Analysis of the Patient Protection and Affordable Care Act (H.R. 3590) — February 11, 2010
Using the COMPARE microsimulation model, estimates the effects of the Patient Protection and Affordable Care Act (H.R. 3590) on the number of uninsured, the costs to the federal government and the nation, and consumers' health care spending.
Could We Have Covered More People at Less Cost? Technically, Yes; Politically, Probably Not — January 1, 2010
Using the COMPARE (Comprehensive Assessment of Reform Efforts) microsimulation model, this study evaluated how the recently enacted health reform law performed compared with alternative designs on measures of effectiveness and efficiency and found that only a few different approaches would cover more individuals at a lower cost to the government; however, these appeared politically untenable because they included substantially higher penalties, lower subsidies, or less generous Medicaid expansion.
Coverage, Spending, and Consumer Financial Risk: How Do the Recent House and Senate Health Care Bills Compare? — February 12, 2010
Compares how two health care reform bills, HR. 3962 and H.R. 3590, passed by the U.S. House and Senate, respectively, in late 2009 compare on a variety of projections made using the RAND COMPARE microsimulation model.
Does Price Transparency Legislation Allow the Uninsured to Shop for Care? — February 1, 2010
Assesses the response rate of California hospitals to a patient price request and compares the price estimates received to Medicare reimbursement.
Ease Medicaid/SCHIP Eligibility Rules — January 8, 2010
This document explores how expanding Medicaid/SCHIP eligibility would affect health system performance along nine dimensions.
The Effects of the Affordable Care Act on Workers' Health Insurance Coverage — September 1, 2010
The nature of employer-sponsored coverage may change substantially after implementation of the Patient Protection and Affordable Care Act, with an increase in the number of workers offered coverage through the health insurance exchanges.
Establishing State Health Insurance Exchanges: Implications for Health Insurance Enrollment, Spending, and Small Businesses — August 11, 2010
The Patient Protection and Affordable Care Act will increase insurance offer rates at small businesses. By 2016, rates would increase from 53 to 77 percent at firms with ten or fewer workers and from 71 to 90 percent at firms with 11 to 25 workers.
Feasibility and Design Options for a Potential Entity to Research the Comparative Effectiveness of Medical Treatments — January 15, 2010
The options available to Massachusetts as it considers establishing a comparative effectiveness center to guide health care purchasing decisions are feasible, but design decisions depend on the prioritization of comparative effectiveness research.
Grandfathering in the Small Group Market Under the Patient Protection and Affordable Care Act: Effects on Offer Rates, Premiums, and Coverage — June 2, 2010
To avoid changes in current health coverage, the Patient Protection and Affordable Care Act exempts existing plans from some regulations. These exemptions may lead to higher employer-sponsored insurance enrollment and lower government spending.
Increase the Use of "Bundled" Payment Approaches — January 8, 2010
This document explores how increased use of bundled payment approaches would affect health system performance along nine dimensions.
Modify Federal Tax Code to Create Incentives for Individuals to Obtain Coverage — January 8, 2010
This document explores how a refundable tax credit to offset the cost of health insurance premiums would affect health system performance along nine dimensions.
Require Employers to Offer Coverage — January 8, 2010
This document explores how requiring employers to offer health insurance (an employer mandate) would affect health system performance along nine dimensions.
Require Individuals to Obtain Coverage — January 8, 2010
This document explores how requiring individuals to obtain health insurance (an individual mandate) would affect health system performance along nine dimensions.
Rights and Responsibilities in Health Care: Striking a Balance — June 9, 2010
This commentary argues that people must become full participants and assume much greater responsibility for their actions if health benefits are to be maintained at an affordable cost.
2009
Children's Health in Washington, D.C.: Access and Health Challenges Despite High Insurance Coverage Rates — October 28, 2009
Assesses children's health issues in Washington, D.C., including the health care delivery system and neighborhood health environments.
Controlling Health Care Spending in Massachusetts — September 10, 2009
In 2006, Massachusetts passed landmark legislation ensuring near-universal health insurance coverage to its residents, but rising costs threaten the initiative; this policy brief assesses 21 options for controlling health care spending in the state.
Controlling Health Care Spending in Massachusetts: An Analysis of Options — August 17, 2009
Presents a comprehensive menu of cost containment strategies and options and determines their potential effect on Massachusetts' health care system.
Create or Expand Access to Purchasing Pools — October 12, 2009
This document explores how creating or expanding access to purchasing pools would affect health system performance along nine dimensions.
Health Care Cost Growth and the Economic Performance of U.S. Industries — July 30, 2009
Suggests that excess growth in health care costs has adverse economic effects and that these effects are more pronounced in industries that have a higher percentage of workers with employer-sponsored insurance.
Hospital Pay for Performance — October 12, 2009
This document explores how hospital pay for performance (P4P) programs would affect health system performance along nine dimensions.
Increase Cost-Participation by Employees (e.g., Through High-Deductible Health Plans) — October 12, 2009
This document explores how increased cost participation by employees would affect health system performance along nine dimensions.
Increase Health Information Technology Adoption and Connectivity — October 12, 2009
This document explores how increased health information technology (HIT) adoption and connectivity would affect health system performance along nine dimensions.
Insurer Bargaining and Negotiated Drug Prices in Medicare Part D — January 1, 2009
The authors test whether insurers that experience larger enrollment increases due to Medicare Part D negotiate lower drug prices with pharmacies. Overall, the authors find that 100,000 additional insureds lead to 2.5-percent lower pharmacy prices negotiated by the insurer, and 5-percent reductions in pharmacy profits earned on prescriptions filled by enrollees of that insurer.
Open Access to the Federal Employees Health Benefits Program (FEHBP) — October 12, 2009
This document explores how expanding access to the Federal Employees Health Benefits Program (FEHBP) would affect health system performance along nine performance dimensions.
Physician Pay for Performance — October 12, 2009
This document explores how physician pay for performance (P4P) programs would affect health system performance along nine dimensions.
Prescription Drug Cost Sharing: A Powerful Policy Lever to Use with Care — October 21, 2009
Describes the effects that prescription drug cost sharing has on drug spending, compliance with drug therapy, patient health, and overall health care costs.
RAND COMPARE: Understanding the Effects of Health Care Reform from a National Perspective — August 28, 2009
Provides an overview of COMPARE and shows the estimated effect of four policies: employer mandates, Medicaid and SCHIP expansions, individual mandates, and refundable tax credits.
Recent Trends in State Children's Health Insurance Program Eligibility and Coverage for CSHCN — December 1, 2009
This study found that a dramatic increase between 2001 and 2005 in the number of uninsured children with special health care needs who were eligible for SCHIP.
The Scientific Evidence for Child Health Insurance — January 15, 2009
Discusses two critical policy options related to child health insurance: reauthorization and potential expansion of the State Children's Health Insurance Program (SCHIP), and expansion of health insurance to all children.
When Drug Cost-Sharing Increases, Patients Newly Diagnosed with a Chronic Illness Delay Starting Medication — June 29, 2009
Describes a study showing that increasing copayments for prescription drugs causes patients newly diagnosed with hypertension, high cholesterol, and diabetes to delay starting treatment, which in turn increases their risk for heart attack and stroke.
2008
Access to Appointments Based on Insurance Status in Washington, D.C. — August 1, 2008
Using a hypothetical emergency patient requiring close follow-up, D.C. providers were queried by phone to evaluate accessibility. The rate of privately insured receiving appointments was 71%, with Medicaid fee-for-service 36.6% and uninsured 13%.
The Economic Burden of Providing Health Insurance: How Much Worse Off Are Small Firms? — March 17, 2008
This report explores trends in the economic burden faced by small and large businesses that provide health insurance, as well as the quality of plans that small and large firms offer.
High-deductible Health Plans and Better Benefit Design — May 1, 2008
Advocates of high-deductible health plans, which shift more of the cost of care to individuals, believe that consumers will more carefully assess the balance of health care benefits versus costs, ultimately improving efficiency and quality of care.
Identity Crisis: An Examination of the Costs and Benefits of a Unique Patient Identifier for the U.S. Health Care System — September 21, 2008
This monograph examines the operational advantages and disadvantages, compares the errors, examines the costs, and discusses the privacy issues associated with the unique patient identifier and with statistical matching based on personal attributes.
Medicare HMO Impact on Utilization at the End of Life — January 1, 2008
Medicare beneficiaries who died while enrolled in independent practice association model HMOs, including the Kaiser model, had many fewer hospital days during the two years before death than beneficiaries who died with fee-for-service coverage.
2007
Behavioral Health Parity: Consequences for Federal Employee Health Plans — April 17, 2007
This research brief assesses the effects of the government-required Federal Employees Health Benefits Program's provision of behavioral health benefits equal to its general health benefits on insurers and consumers' use of services and spending.
Consumer-Directed Health Care: Early Evidence Shows Lower Costs, Mixed Effects on Quality of Care — February 8, 2007
This research brief summarizes research on the effect of enrollment in consumer-directed health care (involving plans with high deductibles -- $1,000 or more annually) on the use, cost, and quality of medical care.
Effect of Disease Management on Prescription Drug Treatment: What Is the Right Quality Measure? — April 1, 2007
The authors hypothesize that DM improves adherence to prescriptions more than the rate with which prescriptions are being filled.
The Effects of Health Sector Market Factors and Vulnerable Group Membership on Access to Alcohol, Drug, and Mental Health Care — June 1, 2007
Uses Andersen's Behavioral Model to see if health sector market conditions affect vulnerable subgroups' use of ADM differently than general population
Health Coverage Options for Military Retirees — July 4, 2007
This research brief summarizes the results of a 2006 pilot survey of military retirees, providing information on retirees' enrollment in civilian health care plans and reliance on TRICARE, the Department of Defense-sponsored health insurance.
Impact of Full Mental Health and Substance Abuse Parity for Children in the Federal Employees Health Benefits Program — February 1, 2007
The Federal Employees Health Benefits Program implemented full mental health and substance abuse parity in January 2001.
Impact of the State Children's Health Insurance Program on Adolescents in New York — January 1, 2007
Adolescents face financial and nonfinancial barriers to health care.
Improved Health Care Among Children with Special Health Care Needs After Enrollment Into the State Children's Health Insurance Program — January 15, 2007
Enrollment onto New York's SCHIP improved medical care for CSHCN.
A Look inside the "Doughnut Hole": How Drug-Benefit Limits Affect Retiree Prescription Use — September 11, 2007
This research brief examines the likely effects of the gap in the Medicare Part D standard drug benefit after $2,400 in pharmaceutical spending, using data from a private employer.
Mental Health and Substance Abuse Insurance Parity for Federal Employees: How Did Health Plans Respond? — December 4, 2007
The intent of parity regulation is to equalize private insurance coverage for mental and physical illness (an equity concern) and to eliminate wasteful forms of competition due to adverse selection (an efficiency concern). In 2001, a presidential directive requiring comprehensive parity was implemented in the Federal Employees Health Benefits (FEHB) Program. In this study, the authors examine how health plans responded to the parity directive.
Partially Capitated Managed Care Versus FFS for Special Needs Children — January 1, 2007
Little research has examined whether MCPs that incorporate case management are effective in coordinating services for CSHCN.
Pharmacy Benefit Caps and the Chronically Ill — January 1, 2007
In this paper the authors examine medication use among retirees with employer-sponsored drug coverage both with and without annual benefit limits.
Prescription Drug Cost Sharing: Associations with Medication and Medical Utilization and Spending and Health — January 1, 2007
Prescription drugs are instrumental to managing and preventing chronic disease.
Prescription Drug Coverage and Elderly Medicare Spending — January 1, 2007
The introduction of Medicare Part D has generated interest in the cost of providing drug coverage to the elderly.
Racial Differences in the Use of Epidural Analgesia for Labor — January 1, 2007
There is strong evidence that pain is undertreated in black and Hispanic patients.
Reducing Medical Malpractice By Targeting Physicians Making Medical Malpractice Payments — March 1, 2007
Some states use physicians' histories of medical malpractice payments to try to reduce the incidence of medical malpractice (and for other reasons).
The Role of Product Design in Consumers' Choices in the Individual Insurance Market — January 1, 2007
Modest subsidies will have small effects on purchase in the nongroup market.
State Insurance Mandates and Consumer-Directed Health Plans: Are They Helping Small Business Provide Health Insurance to Employees? — December 5, 2007
This research brief describes the effects of state health-insurance mandates and consumer-directed health plans (CDHPs) on the access to and affordability of health insurance for small businesses.
A Systematic Review of the Adverse Effects of Prescription Drug Cost Sharing — September 11, 2007
This fact sheet summarizes a systematic review of published studies to analyze how the cost-sharing features of prescription drug benefits may affect access to prescription drugs and, consequently, health outcomes.
The Welfare Effects of Public Drug Insurance — January 1, 2007
Rewarding inventors with inefficient monopoly power has long been regarded as the price of encouraging innovation.
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