Awarded Grant
Evaluation of State Policies for Aligning Behavioral Health Coverage between Medicaid and State Health Insurance (December 2016)
Principal Investigator: Alexander Cowell, PhD, RTI International
The goal of this research is to inform state policy discussions around access to and continuity of behavioral health care in Medicaid and the exchanges for those who transition between these sources of coverage. The research team will analyze documents from state Medicaid plans and health insurance exchanges to assess the extent of alignment between Medicaid and private insurance in terms of the scope, level of coverage, and formulary design for behavioral health care. They will also assess whether alignment for behavioral health is different from that for general medical coverage.
Awarded Grant
State Benchmarking, Healthcare Outcomes, and Implications for People with Disabilities (December 2016)
Principal Investigator: Kathleen Thomas, PhD, University of North Carolina Chapel Hill
The goal of this study is to improve the physical and economic health of people with disabilities using evidence on state insurance benchmarking strategies that support improved access and quality healthcare for people with disabilities. The researchers will use data from the Health Reform Monitoring Survey (HRMS), a nationally representative online survey of approximately 7,400 non-elderly adults that is designed to allow rapid cycle monitoring of changes in coverage, health care access, and affordability under the ACA to accomplish the following:
- Combine state benchmarking strategies for Medicaid, expansion coverage, marketplace, and employer-sponsored plans with the HRMS.
- Test the impact of ACA insurance benchmarking reforms on access to care and employment for people with disabilities.
Awarded Grant
The Effect of State Minimum Wage Laws on Medicaid Expansion Outcomes (December 2016)
Principal Investigator: Christine Eibner, PhD, RAND Corporation
The goal of this study is to inform state-level policy discussions around whether minimum wage changes could have unintended consequences for workers’ health insurance access and to enable state policymakers to begin thinking about potential solutions. Over the past several years, there has been significant policy action regarding state minimum wage laws—with the federal minimum wage increasing by 40 percent between 2007 and 2010, and 15 states increasing their minimum wages above the federal requirement between 2010 and 2015. Higher minimum wages may affect employer-sponsored insurance enrollment if employers respond to wage increases by reducing benefit generosity, increasing employee contributions, or eliminating insurance entirely. Using data from the Current Population Survey, the researchers will estimate whether state minimum wage changes that occurred since 2007 were associated with reduced employer-sponsored insurance enrollment, and whether this effect was modified by Medicaid expansion.
Publications
The Effect of the 2014 Medicaid Expansion on Insurance Coverage for Newly Eligible Childless Adults
(2016, Report)
Do Minimum Wage Changes Affect Employer-Sponsored Insurance Coverage?
(June 2018, Presentation)
Blog & News
SHARE Research at APPAM: A State Perspective on the Coverage, Access, & Cost Impacts of the ACA
November 02, 2016:The 2016 Fall Research Conference of the Association for Public Policy Analysis & Management (APPAM) begins tomorrow and runs through Friday in Washington, DC. The conference, which is mutli-displinary in nature, focuses on a range of current and emerging policy and management issues, including health policy. This year's conference theme is "The Role of Research in Making Government More Effective."
Findings from several SHARE-funded studies will be featured during the conference on a panel titled, "State-Level Impacts of the Affordable Care Act: Coverage, Access, and Costs." The panel includes four presentations that examine the effects of the federal Affordable Care Act (ACA) on a range of outcomes, including health insurance coverage, access to care, service utilization, and costs and affordability. In each study, the researchers examine outcomes as a function of state health policy decisions and attributes.
SHARE funded three of these four studies and organized this panel with a state policy lens in mind – recognizing that the impacts of the ACA hinge on individual state decisions and that the ACA, because of its federal scope, provides a unique opportunity to study state variation in a systematic way. The systematic nature of these analyses subsequently supports the generation of evidence that can meaningfully inform and facilitate federal and state policymaking and public management in the areas of health insurance coverage and insurance market regulation.
Click on the links below to learn more about the panel and/or the individual panel presentations.
Panel Details
State-Level Impacts of the Affordable Care Act: Coverage, Access, and Costs
Thursday, November 3, 2016, 1:15PM – 2:45PM
Room: Columbia 9 (Washington Hilton)
Chair: Sharon Long, Urban Institute
Discussants: Kathleen Call, State Health Access Data Assistance Center, and Lisa Dubay, Urban Institute
To Expand Medicaid or Not to Expand Medicaid? Effects of State ACA Medicaid Expansion Decisions on Coverage, Access, Utilization, and Health Status of Low-Income Adults
Speaker: Laura Wherry, University of California, Los Angeles
The Medicaid Expansion States: Effects of Medicaid Coverage on Access, Affordability, Utilization, and Health Status for Newly Eligible and Previously Eligible Adults*
Speaker: Michael Dworsky, RAND Corporation
Early Evidence on Employment Responses to the Affordable Care Act: Employer Coverage Offers*
Speaker: Jean Abraham, University of Minnesota
Specialty Drug Benefit Design and Patient Out-of-Pocket Costs in the ACA Health Insurance Exchanges*
Speaker: Erin Taylor, Pardee RAND Graduate School
*Research supported by SHARE funding
Blog & News
Lynn Blewett on Health Affairs Blog: Capping Enrollment in Minnesota’s Individual Market
April 18, 2017:In a new piece on the Health Affairs Blog, SHADAC Principal Investigator Lynn Blewett discusses the recently announced plan, brokered by the Minnesota Department of Commerce, to cap enrollment in Minnesota’s individual market in an effort to prevent the market from collapsing.
The Caps
The enrollment caps, along with significant rate increases, are aimed at preventing a market collapse following the announcement that Blue Cross Blue Shield (BCBS) would leave the individual market—an announcement that sparked concerns about other insurers doing the same—and are meant offer some insulation against an influx of the enrollees from BCBS, which had a higher risk profile than other insurers in the state. The caps include each plan’s current enrollment (from 2016) plus a small number of openings for new enrollees and apply to all but one narrow-network HMO plan, called Blue Plus, that is owned by BCBS.
The Implications
Dr. Blewett points out a key problem with the new policy: There will be no plan option for the five counties in which Blue Plus is not offered (Benton, Morrison, Crow Wing, Mille Lacs, and Stearns counties) once the state-wide caps in the other plans are met. As Dr. Blewett explains, the enrollment caps create conditions in which the ACA core principle, guaranteed issue, will not apply to everyone, and the rate increases for remaining plans “are likely to make coverage unaffordable for many.” Potentially exacerbating this problem is that there are 18,000 remaining uninsured in the counties where Blue Plus is not available. These and other remaining uninsured throughout the state (234,000 people total) will also be looking for affordable coverage, and “accommodations will need to be made to ensure access to plan coverage once…caps have been met.”
Dr. Blewett points to additional areas of concern surrounding Blue Plus, including potential problems accessing major providers in certain areas of the state and the incentive for Blue Plus to recruit the healthiest of its current enrollees (for whom BCBS has health status information). She notes that it will be critical to inform people of their choices (or lack of choices) during this transition.
Possible Solutions
Among other policy options and solutions for these issues, Dr. Blewett identifies the following:
- Hold a special legislative session to address large premium increases through a rebate program.
- Establish a state-based reinsurance system for its entire individual market.
- Provide access to a public option such as the Minnesota Care Program for those living in counties with no plan options after enrollment caps are met.