Medicaid

commentary

Can the Health Insurance System Handle Massive Medicaid Reductions?

For many who have or will soon lose Medicaid as monthly redeterminations restart, and for millions more who could lose insurance due to other factors like job loss, three recent policy developments might increase the chances that they find new health care coverage.

Christine Eibner @Chrissyeibner

commentary

The Importance of Getting the Affordable Part of the Affordable Care Act Right

The ACA's expansion of Medicaid and the marketplaces that sell subsidized policies have helped decrease the uninsured rate. Research on being underinsured shows that affordability at the point of care is central to keeping people healthy. For example, a new study found a significant relationship between having health insurance and better asthma control.

Petra W. Rasmussen

commentary

Twelve-Month Continuous Eligibility for Medicaid Adults Can Stabilize Coverage with a Modest Cost Increase

Churning—frequent moving in and out of Medicaid due to income fluctuation—increases insurance coverage gaps, disrupts access to health care, increases unnecessary administrative burden, and leads to suboptimal health outcomes. Federal and state policymakers might consider continuous eligibility to help stabilize Medicaid enrollment.

Harry H. Liu, Leighton Ku

commentary

Why States' 'Netflix Model' Prescription Drug Arrangements Are No Silver Bullet

Despite the buzz and catchy notion that subscription models are “Netflix for drugs,” it's hard to come up with a theoretical case that supports subscription models over traditional price negotiation between payers and manufacturers over a per-dose or per-unit price.

Harry H. Liu, Andrew W. Mulcahy @AndrewWMulcahy

commentary

What If the Supreme Court Strikes Down the ACA During the COVID-19 Pandemic?

With COVID-19 spreading across the United States, the fate of the Affordable Care Act is once again up in the air, hanging on the outcome of a Supreme Court case. Should the law be overturned, upwards of 20 million people could lose their health insurance during one of the deadliest pandemics in modern history.

Christine Eibner @Chrissyeibner, Courtney A. Gidengil @c_gidengil

commentary

A Threat to Immigrant Health Care with Potential Consequences for All

The proposed changes to the “public charge” rule could jeopardize decades of progress towards improved health care access and health for immigrants and U.S. citizens. Negative effects may include worse health outcomes, increased use of emergency rooms, and increased prevalence of communicable diseases.

Kathryn Pitkin Derose

blog

A Summer Reading List for Congress

No matter how policymakers spend their break—meeting with home-state constituents, traveling abroad with congressional delegations, or spending time with family—this summer reading list contains policy ideas that can help them hit the ground running when they return.

commentary

Tracking the Affordable Care Act with the RAND Health Reform Opinion Study

The HROS uses panel data to track changes in public opinion regarding the ACA and insurance coverage. By surveying the same respondents each month, the HROS observes not only aggregate changes, but also individual changes in opinion or insurance coverage over time.

Katherine Grace Carman

commentary

Improving Physical Health Care for Adults with Serious Mental Illness

A promising strategy for helping adults with serious mental illness gain access to appropriate primary and preventive medical services is to integrate those services into a setting in which the population already receives care.

Deborah M. Scharf

commentary

Survey Estimates Net Gain of 9.3 Million American Adults with Health Insurance

Early survey evidence indicates that the Affordable Care Act has already led to a substantial increase in insurance coverage. Consistent with the ACA's design, this gain in insurance has come not only from new enrollment in the marketplaces, but also from new enrollment in employer coverage and Medicaid.

Katherine Grace Carman, Christine Eibner @Chrissyeibner

commentary

Is the ACA Keeping a Lid on Growth in Healthcare Spending?

Some point to the healthcare spending slowdown as an early success of the Affordable Care Act. Others warn that it's merely a hangover from the recession, and that the inevitable spending rebound will be exacerbated by the ACA coverage expansions.

Chapin White

commentary

Who Does the Affordable Care Act Leave Behind?

Although one of the primary objectives of the Affordable Care Act is to achieve near-universal health insurance coverage, the Congressional Budget Office projects that 30 million residents, more than 10 percent of the nonelderly population, will remain uninsured after the major provisions of the ACA take full effect.

Christine Eibner @Chrissyeibner, Evan Saltzman

commentary

First Steps on a Long Road: Three Key Findings from ACA's Early Enrollment Numbers

The vision of the ACA was “no wrong door” and an affordable option for everyone, but it appears based on the data available so far that, in the non-Medicaid expansion states, there is a closed door.

Chapin White, Christine Eibner @Chrissyeibner

q&a

Quick Takes: The Math of Medicaid Expansion

Expanding Medicaid under the Affordable Care Act (ACA) is both contentious and complicated. RAND mathematician Carter Price has been using the COMPARE model to help those making decisions understand what their choices mean for their budgets and population health.

commentary

Medicaid Access for the Formerly Incarcerated Under the ACA: Helping the Oft-Forgotten

America's prison population tends to be sicker than the general population. While Medicaid eligibility under the ACA offers an historic opportunity, enrolling the formerly incarcerated into the health exchanges or Medicaid will be neither simple nor straightforward.

Lois M. Davis @LoisMDavis

commentary

Will the Affordable Care Act Make Health Care More Affordable?

Out-of-pocket spending on health care will decrease for both the newly insured as well as for those changing their source of insurance. These decreases will be largest for those who would otherwise be uninsured.

Christine Eibner @Chrissyeibner

blog

Ask Me Anything: Carter Price on the Affordable Care Act

As of October 1, many Americans can now shop for health insurance through state exchanges created as part of the Affordable Care Act (ACA), the sweeping health care reform often referred to as 'Obamacare.' To provide some insight into the ACA, RAND's Carter Price hosted an 'Ask Me Anything' session on Reddit today.

commentary

Will ACA Implementation Lead to a Spike in Demand for Care?

The growing number of Americans newly-insured under the ACA will undoubtedly lead to a surge in demand for care, whether through Medicaid or insurance exchanges. But, if predictions hold, the increase won't be as dramatic as some may fear, writes David I. Auerbach.

David I. Auerbach

commentary

Applying What Works to Reduce Non-Urgent Emergency Department Use

It is likely that communities with low rates of non-urgent ED use not only have better access to primary care, but patients who are educated about appropriate care seeking and convenient alternatives for acute care, writes Lori Uscher-Pines.

Lori Uscher-Pines

commentary

Governors Missing the Point on Medicaid

While a governor or legislator may disagree with Medicaid expansion for philosophical reasons, the claims that the expansion will be a burden on states' economies seem misguided given the full range of projected economic impacts on the states, writes Carter C. Price.

Carter C. Price @CarterCPrice

commentary

Modeling the Effects of the Affordable Care Act in Arkansas

The Medicaid expansion under the ACA will result in about 400,000 people newly insured in Arkansas by 2016. Of these, about 190,000 would be newly enrolled in Medicaid and the rest would be newly insured through the new insurance exchanges. The state is likely to save about $67 million for reduced uncompensated care costs for the uninsured.

Carter C. Price @CarterCPrice

commentary

Health Care Costs Must Be Curbed, No Matter Who Wins

Regardless of which candidate wins in November, and regardless of whether “Obamacare” is repealed, amended, or defended by the next Congress, the next president will have to contend with the spiraling cost of health care in the United States—a problem that is growing more acute with each passing year, writes Arthur Kellermann.

Arthur L. Kellermann

blog

Caring for the Uninsured: What Role Do Emergency Rooms Play?

Absent from the discussion about health care during the first debate between President Barack Obama and Governor Mitt Romney was any mention of one of the main providers of care for America's uninsured: emergency rooms. What does research tell us about the use of ERs and the relevant implications on health care access and cost?

commentary

Be Hungry or Be Sick? Proposed Medi-Cal Co-Pay Could Force the Choice for Many

The $15 co-pay a mother is expected to cover represents half of a full week's food costs under the U.S. Department of Agriculture's

Arthur L. Kellermann, Robin M. Weinick

blog

Attempts by States to Save Money by Locking Medicaid Enrollees out of the ED Are Likely to Backfire

In a recent article in the New England Journal of Medicine, we argue that attempts by states to save money by seeking to lock Medicaid enrollees out of the emergency department are likely to backfire. We argue that a better solution is to reverse what for many years has been a trend of shrinking access to primary care for Medicaid beneficiaries.

Robin M. Weinick

commentary

Emergency Departments, Medicaid Costs, and Access to Primary Care—Understanding the Link

The fact that many ED (emergency department) visits could be managed in primary care settings does not mean that such care is available, write Arthur L. Kellermann and Robin M. Weinick.

Arthur L. Kellermann, Robin M. Weinick