News Article | May 24, 2017
Consumer Reports has no relationship with any advertisers on this website. President Donald Trump’s 2018 budget blueprint calls for huge reductions to social safety net programs. In particular, it targets Medicaid, the program that provides health insurance for millions of poor, disabled, and elderly people, about 1 in 5 Americans. Republican plans to repeal and replace the Affordable Care Act already has proposed hitting people on Medicaid hard. The Affordable Health Care Act (AHCA) legislation, which the House passed earlier this month, called for $880 billion in cuts to the program. Trump’s budget calls for cutting another $615 billion from Medicaid. Together, the $1.5 trillion in cuts would slash federal Medicaid funds by nearly 50 percent in 10 years. “This cuts quite a bit more in federal funding than the AHCA alone,” says John Holahan, a fellow in the Health Policy Center at the Urban Institute, a non-partisan research organization. “States are going to have to figure out how to make up the difference." The budget proposal must be approved by Congress and much could change in the meantime. The Senate is working on a healthcare overhaul of its own. Democrats are opposed to steep Medicaid cuts, as are some moderate Senate Republicans, particularly those in states that expanded Medicaid. Still, the prospect of such a massive change to the government's largest health insurance program is troubling to consumer advocates. “The proposed cuts to Medicaid would decimate the program, dramatically reducing the number of people covered and the quality of coverage for the most vulnerable Americans,” says Betsy Imholz, director of special projects for Consumers Union, the policy and mobilization arm of Consumer Reports. The budget proposal comes at a time when Americans are increasingly concerned about their ability to afford health insurance. More than half (57 percent) of those surveyed for Consumer Reports second CR Consumer Voices Survey in March said they lack confidence they and their loved ones will be able to afford health insurance. And 41 percent now say they're not confident they'll have access to quality care to get the doctors, tests, treatments and medications they need. That’s up from 35 percent in the first CR Consumer Voices Survey in January. Here are five things you need to know about how the possible Medicaid cuts proposed by Trump and House Republican leadership would affect you. 1. The proposed cuts in the Trump budget and AHCA wouldn't take place until 2020. 2. How you are affected will depend on where you live. That's because under the current system, the federal government gives states money based on costs no matter how many are enrolled. The Trump budget blueprint reduces the amount given to states but lets each choose how they receive the money. States could opt to receive a limited and capped amount per person enrolled, or take a “block grant” and decide how to spend it. Trump and other Republicans say block grants give states more flexibility to design their own programs. But experts say it will be difficult for states to make up the shortfall from lost federal funds. 3. If enrolled in Medicaid, you might face stricter work requirements and have to cover more costs, such as higher co-pays, out of pocket. That's because the Department of Health and Human Services is encouraging states to experiment with ways to curtail costs. Under current law, several states, including Maine and Wisconsin, have already applied for waivers to make such changes, says Robin Rudowitz, an associate director for the Program on Medicaid and the Uninsured at the Kaiser Family Foundation. It's unclear how much money such changes would save, says Rudowitz. For example, only 15 percent of Medicaid dollars are currently spent on able-bodied adults who might be subject to new work requirements, according to an analysis by the Kaiser Family Foundation and the Urban Institute. 4. The disabled and the elderly will be hit the hardest. The disabled account for 42 percent of Medicaid spending, while the elderly account for 21 percent, to pay for services such as long-term care and nursing homes. Another 21 percent of Medicaid spending provides health insurance for children. 5. It's still unknown how many Medicaid recipients might lose coverage in the end. The Congressional Budget Office's initial analysis of the AHCA passed by the House, estimated that 14 million people would drop out of the program if the bill became law. The CBO plans to issue a new analysis Wednesday meant to reflect amendments to the initial AHCA legislation. But that analysis won't take into account the proposed cuts in the Trump budget. As a result, it's unknown how many people might lose coverage overall, says Dee Mahan, director of Medicaid Initiatives at Families USA, a non-profit focused on consumer healthcare issues. "But this is a massive cost shift from the federal government to states. States won't be able to make up all this money," says Mahan. "A lot of people will lose their coverage." More from Consumer Reports: Top pick tires for 2016 Best used cars for $25,000 and less 7 best mattresses for couples
News Article | May 12, 2017
Two scientists resign from EPA roles in protest at Donald Trump's climate change stance Two scientists who advised the Environmental Protection Agency (EPA) have resigned over Donald Trump’s environmental policies. Dr Carlos Martin, a senior research associate at the Urban Institute, and Dr Peter Meyer, President and Chief Economist of The EP Systems Group, both resigned citing political reasons. US says it will take 'right decision for US', not world, on climate As Mr Martin told The Independent, he simply could “not be a future prop for bad science". Mr Martin posted their joint resignation letter on Twitter, and in it the pair said they felt the EPA was “watering down credible science” by putting politics where it did not belong. On several occasions, Mr Trump has called climate a "hoax" perpetrated by the Chinese and is considering withdrawing the US from the global Paris Agreement on climate change. The US is one of the world's top emitters of carbon dioxide. Mr Meyer and Mr Martin were members of the Sustainable and Healthy Communities subcommittee of the Board of Scientific Counselors (BOSC) at EPA. The board, including all subcommittees, advises EPA scientists on various topics. In the letter they detail the reasons for their immediate resignation, prompted by non-renewal of two BOSC members who served as co-chairs of their subcommittee. On 5 May Dr Robert Richardson, a professor at Michigan State took to Twitter with an announcement. He had been “trumped” from his position. Dr Courtney Flint, a professor at Utah State University also received notice that her term on BOSC would not be renewed. An EPA spokesperson said they would be replaced by those in industry "who understand the impact of regulations on the regulated community". Mr Meyer told The Independent that “non-renewal is just a polite way of saying fired”. BOSC and subcommittee members are nominated by peers if they have significant scientific endeavours and have done research in the environmental field. Once approved, they normally serve two three-year terms. Ms Flint and Mr Richardson’s first term expired on 27 April, but they were expecting to be renewed. They were not political appointees under the previous Obama administration, but chosen for their scientific and research expertise. As chairs of the subcommittee, they would coordinate recommendations and reports written by Mr Meyer and Mr Martin and present them to EPA scientists. The decision to not renew their contracts was likely not financial despite Mr Trump’s 28 per cent proposed budget cuts to EPA, Mr Meyer said. The Office of Research and Development within EPA, to whom BOSC reports, would likely suffer a 40 per cent budget cut should Mr Trump's budget get approved. Mr Meyer is an economist and Mr Martin is an engineer by trade, so BOSC and their subcommittee in particular are multidisciplinary in order to best serve EPA scientists holistically in “making science serve you more cost effectively,” as Mr Meyer explained.
News Article | May 12, 2017
In an expanding controversy over the role of science in the Trump administration, two expert advisers to the Environmental Protection Agency resigned Friday in protest at the dismissal of half of the members of a key science committee. Carlos Martín, an engineer with the Urban Institute, and Peter Meyer, an economist with the E.P. Systems Group, an environmental and economic research firm, posted a joint resignation letter on Twitter, saying they were standing down to protest the agency’s decision to remove the scientists. “We cannot in good conscience be complicit in our co-chairs’ removal, or in the watering down of credible science, engineering, and methodological rigor that is at the heart of that decision,” they wrote. Martín and Meyer had advised the EPA science’s branch on research related to environmental contaminants and spills, the disposal of waste, and techniques for environmental cleanups. The Trump administration has proposed to cut the budget of that branch, called the Office of Research and Development, by $233 million in 2018. In their letter, Martín and Meyer cited in particular the failure to renew the terms of Courtney Flint, a sociologist at Utah State University, and Robert Richardson, an environmental economist at Michigan State University. Those researchers had served on the EPA’s 18-member Board of Scientific Counselors, and had co-chaired a subcommittee on “sustainable and healthy communities” whose membership included Martín and Meyer. Martín and Meyer called the loss of their group’s leadership “a shock from which we cannot easily recover nor which we readily accept.” “This current context suggests there is going to be an unfair amount of manipulation,” Martín, an engineer and architect who conducts social science research on built environments at the Urban Institute, said in an interview. “From the chairs themselves, to the proposed budget, to the general discussion around the fact that there might be different views put on these subcommittees and boards that aren’t scientifically rigorous.” Martín was referring to scientists’ concerns that the EPA’s federal advisory committees under Trump will shift away from academic scientists and toward industry. Last week, the agency decided not to renew the three year terms of half of the Board of Scientific Counselors, although the dismissed researchers said they had had previous assurances from EPA staff that they would be staying on. EPA spokesman J.P. Freire countered at the time that “no one has been fired or terminated” and that the scientists could reapply for the posts. Members of EPA advisory committees tend to be outside academics or other types of specialists who play a part-time role. In a statement, a spokesman for the EPA said: “EPA’s Board of Scientific Counselors serve three-year terms and are reviewed every three years. Because advisory panels like BOSC play a critical role reviewing the agency’s work, EPA will consider the hundreds of nominations through a competitive nomination process. Individuals who have previously served one term can, of course, apply through the competitive process.” Meyer suggested that process could be disruptive. “Having to start over again with brand new leadership, and leadership that, given the way our leadership has been removed, I’m not going to trust particularly, that creates a fairly substantial problem,” said Meyer in an interview.
Decker S.L.,Centers for Disease Control and Prevention |
Kenney G.M.,Urban Institute |
Long S.K.,Urban Institute
JAMA - Journal of the American Medical Association | Year: 2013
Importance: Under the Affordable Care Act (ACA), states can extend Medicaid eligibility to nearly all adults with income no more than 138% of the federal poverty level. Uncertainty exists regarding the scope of medical services required for new enrollees. Objective: To document the health care needs and health risks of uninsured adults who could gain Medicaid coverage under the ACA. These data will help physicians, other clinicians, and state Medicaid programs prepare for the possible expansions. Design, Setting, and Patients: Data from the National Health and Nutrition Examination Survey 2007-2010 were used to analyze health conditions among a nationally representative sample of 1042 uninsured adults aged 19 through 64 years with income no more than 138% of the federal poverty level, compared with 471 low-income adults currently enrolled in Medicaid. Main Outcomes and Measures: Prevalence and control of diabetes, hypertension, and hypercholesterolemia based on examinations and laboratory tests, measures of self-reported health status including medical conditions, and risk factors such as measured obesity status. Results: Compared with those already enrolled in Medicaid, uninsured adults were less likely to be obese and sedentary and less likely to report a physical, mental, or emotional limitation. They also were less likely to have several chronic conditions. For example, 30.1% (95% CI, 26.8%-33.4%) of uninsured adults had hypertension, hypercholesterolemia, or diabetes compared with 38.6% (95% CI, 32.0%-45.3%) of those enrolled in Medicaid (P =.02). However, if they had these conditions, uninsured adults were less likely to be aware of them and less likely to have them controlled. For example, 80.1% (95% CI, 75.2%-85.1%) of the uninsured adults with at least 1 of these 3 conditions had at least 1 uncontrolled condition, compared with 63.4% (95% CI, 53.7%-73.1%) of adults enrolled in Medicaid. Conclusion and Relevance: Compared with adults currently enrolled in Medicaid, uninsured low-income adults potentially eligible to enroll in Medicaid under the ACA had a lower prevalence of many chronic conditions. A substantial proportion of currently uninsured adults with chronic conditions did not have good disease control; projections based on sample weighting suggest this may represent 3.5 million persons (95% CI, 2.9 million-4.2 million). These adults may need initial intensive medical care following Medicaid enrollment. ©2013 American Medical Association. All rights reserved.
Rosenbaum S.,George Washington University |
Kenney G.M.,Urban Institute
Health Affairs | Year: 2014
Thirty-eight percent of US children depend on publicly financed health insurance, reflecting both its expansion and the steady erosion of employment-based coverage. Continued funding for the Children's Health Insurance Program (CHIP) is an immediate priority. But broader reforms aimed at improving the quality of coverage for all insured children, with a special emphasis on children living in low-income families, are also essential. This means addressing the "family glitch," which bars premium subsidies for children whose parents have access to affordable self-only employer-sponsored benefits. It also means addressing the quality of health plans sold in the individual and small-group markets-whether or not purchased through the state and federal exchanges-that are governed by the "essential health benefit" standard of the Affordable Care Act (ACA). In this article we examine trends in coverage and the role of Medicaid and CHIP. We also consider how the ACA has shaped child health financing, and we discuss critical issues in the broader insurance market and the need to ensure plan quality, including the scope of coverage, use of a pediatric medical necessity standard that emphasizes growth and development, the structure of pediatric provider networks, and attention to the quality of pediatric health care.
Dubay L.C.,Urban Institute
International Journal of Health Services | Year: 2012
The literature on health disparities in the United States typically focuses on race/ethnicity or on socioeconomic status (SES) separately, but not often together. The purpose of the study was to assess the separate effects of race/ethnicity and SES on health status, health behaviors, and health care utilization. Cross-sectional analyses were conducted using the 2008 National Health Interview Survey (n = 17,337 non-elderly adults). SES disparities within specific racial groups were examined, as were race disparities within high and low SES groups. Within each racial/ethnic group, a greater proportion of low versus high SES individuals were in poor health, a lower proportion had healthy behaviors, and a lower proportion had access to care. In both SES groups, blacks and Hispanics had poorer health outcomes than whites. While whites were more likely to exercise than blacks and Hispanics, they are more likely to be smokers and less likely to have no or moderate alcohol consumption. Blacks had similar or better health care use than whites, especially for cancer screening; Hispanics had lower use within each SES group. Race/ethnicity disparities among adults of similar incomes, while important, were dwarfed by the disparities identified between high- and low-income populations within each racial/ethnic group. © 2012, Baywood Publishing Co., Inc.
Long S.K.,Urban Institute
Health Affairs | Year: 2013
The expansion of insurance coverage under the Affordable Care Act is expected to put considerable pressure on the capacity of the primary care workforce to meet the needs of the Medicaid population beginning in 2014. The results from a 2011 survey and focus-group sessions with Washington State primary care physicians suggest that doctors welcome planned increases in Medicaid reimbursement rates. However, the data also show that other approaches could be even more effective in increasing physicians' willingness to see Medicaid patients. Those approaches include lowering the costs of participating in Medicaid by simplifying administrative processes, speeding up reimbursement, and reducing the costs associated with caring for those patients. In focus groups, physicians were cautiously optimistic about the potential of the Affordable Care Act to make a difference in each of these areas, with electronic health records, medical homes, and accountable care organizations all seen as promising developments © 2013 Project HOPE-The People-to-People Health Foundation, Inc.
Berenson R.,Urban Institute
Journal of Health Politics, Policy and Law | Year: 2015
Prices are the major driver of why the United States spends so much more on health care than other countries do. The pricing power that hospitals have garnered recently has resulted from consolidated delivery systems and concentrated markets, leading to enhanced negotiating leverage. But consolidation may be the wrong frame for viewing the problem of high and highly variable prices; many "must-have" hospitals achieve their pricing power from sources other than consolidation, for example, reputation. Further, the frame of consolidation leads to unrealistic expectations for what antitrust's role in addressing pricing power should be, especially because in the wake of two periods of merger "manias" and "frenzies" many markets already lack effective competition. It is particularly challenging for antitrust to address extant monopolies lawfully attained. New payment and delivery models being pioneered in Medicare, especially those built around accountable care organizations (ACOs), offer an opportunity to reduce pricing power, but only if they are implemented with a clear eye on the impact on prices in commercial insurance markets. This article proposes approaches that public and private payers should consider to complement the role of antitrust to assure that ACOs will actually help control costs in commercial markets as well as in Medicare and Medicaid. © 2015 by Duke University Press.
Agency: NSF | Branch: Standard Grant | Program: | Phase: | Award Amount: 319.12K | Year: 2014
Social and economic policy increasing involves changes in both benefit programs and the tax systems, yet methods to assess program impacts and interactions are limited, and the available approaches provide primarily federal-level information. This project will develop a complete substantive and technical plan for a new tool for assessing government policies-an Internet-accessible microsimulation model of tax and benefit policies able to estimate the impacts of policy changes at the state level. A microsimulation model is a complex computer program that mimics the operations of government programs using either actual program rules or hypothetical rules. Changes in federal tax and benefit policies are often assessed using microsimulation models developed by or for federal government agencies; this project will lay the groundwork for a tool that will allow microsimulation analysis at the state level, and that will be accessible to anyone with Internet access. With the envisioned model, state government analysts could estimate the cost or caseload impact of a legislatively-proposed change in a tax or benefit program, an academic researcher could assess the impact of a package of changes on state poverty, students could conduct analyses to better understand how programs operate, non-profit policy organizations with competing philosophies could discuss a state policy proposal using quantitative estimates from the same source, and an individual could see how changing programs would affect different families.
The design for the new model will be based on an existing simulation model-the TRIM3 microsimulation model, which is funded and copyrighted by the Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (HHS/ASPE) and developed and maintained by the Urban Institute. The data source will be the American Community Survey, conducted by the Bureau of the Census, which provides large samples for state-level analysis. TRIM3 already includes detailed state-level simulations, but it primarily uses a different data source, and its computer architecture and user interface do not allow extensive public access. The planning for the new model will include three inter-related activities. First, the researchers will hold meetings and webinars with prospective users, including state government staff, academics, and other individuals interested in state-level policies. Participants will be asked what modeling capabilities are most important, the type of user interface that is needed, and the types of modeling results that would be most helpful. Second, the research team will develop prototype designs for the user interface and for results in various formats. These designs will be shared with the potential community to obtain their reactions and suggested improvements. Finally, the research team will determine what computer architecture will best support this type of model, allowing multiple users to simultaneously set up and run simulations, with very fast run speeds. The final written product will be a complete plan for the implementation of the new model. The work will also result in the development of a community of researchers and policymakers who have applied or who want to apply microsimulation techniques to the analysis of policy options in their states.
Sommers B.D.,Harvard University |
Long S.K.,Urban Institute |
Baicker K.,Harvard University
Annals of Internal Medicine | Year: 2014
Background: The Massachusetts 2006 health care reform has been called a model for the Affordable Care Act. The law attained near-universal insurance coverage and increased access to care. Its effect on population health is less clear. Objective: To determine whether the Massachusetts reform was associated with changes in all-cause mortality and mortality from causes amenable to health care. Design: Comparison of mortality rates before and after reform in Massachusetts versus a control group with similar demographics and economic conditions. Setting: Changes in mortality rates for adults in Massachusetts counties from 2001 to 2005 (prereform) and 2007 to 2010 (postreform) were compared with changes in a propensity score-defined control group of counties in other states. Participants: Adults aged 20 to 64 years in Massachusetts and control group counties. Measurements: Annual county-level all-cause mortality in age-, sex-, and race-specific cells (n = 146 825) from the Centers for Disease Control and Prevention's Compressed Mortality File. Secondary outcomes were deaths from causes amenable to health care, insurance coverage, access to care, and self-reported health. Results: Reform in Massachusetts was associated with a significant decrease in all-cause mortality compared with the control group (-2.9%; P = 0.003, or an absolute decrease of 8.2 deaths per 100 000 adults). Deaths from causes amenable to health care also significantly decreased (-4.5%; P < 0.001). Changes were larger in counties with lower household incomes and higher prereform uninsured rates. Secondary analyses showed significant gains in coverage, access to care, and self-reported health. The number needed to treat was approximately 830 adults gaining health insurance to prevent 1 death per year. Limitations: Nonrandomized design subject to unmeasured confounders. Massachusetts results may not generalize to other states. Conclusion: Health reform in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care. Copyright © 2014 American College of Physicians. All Rights Reserved.