A selection of recent studies and surveys

Health Affairs: Uninsured Adults With Chronic Conditions Or Disabilities: Gaps In Public Insurance Programs  - This study examines patterns of uninsurance for low-income working-age adults with chronic health conditions or disabilities, as documented in the Medical Expenditure Panel Survey (MEPS). The authors report "two large and growing gaps in public insurance programs. The first was regional: Uninsurance rates were very high in the South and much lower in the Northeast. The second was categorical: Uninsurance rates were approximately doubled across the country for people not in federally mandated Medicaid eligibility categories compared to those in federal categories." They conclude, "Ultimately, if Congress decides not to eliminate categorical eligibility restrictions, our results indicate that the preservation of eligibility expansions for people with disabilities or chronic conditions would target a population that is particularly vulnerable to uninsurance and its deleterious effects on health" (Pizer, Frakt and Iezzoni, 10/20).

Health Affairs: Evidence Of An Emerging Digital Divide Among Hospitals That Care For The Poor - "As the nation moves toward greater use of [electronic health records] EHRs, it is important to determine whether or not there are gaps in adoption rates between hospitals that disproportionately care for the poor and those that do not," the authors write of this study that uses a survey to assess EHR adoption rates at hospitals across the country. "We found that although overall EHR adoption rates were quite low, many of the individual EHR functions were adopted less often by hospitals that serve a high proportion of poor patients," who cite "fiscal concerns as a major barrier to EHR adoption. ... While the Obama administration and Congress seek to craft effective policies to stimulate the adoption and use of health IT, it will be critical to ensure that institutions that care for the most vulnerable Americans are not left behind," the authors conclude (Jha, DesRoches, Shields, Miralles, Zheng, Rosenbaum and Campbell, 10/26).

Kaiser Family Foundation: The Community Living Assistance Services and Supports (CLASS) Act - This "issue brief" provides an overview of "a little-noticed but major provision in two leading health reform bills that would change the way that the U.S. pays for long-term care," known as the CLASS Act, according to the Foundation. "The provision … would establish a national voluntary insurance program that would allow for voluntary pre-financing of long-term care through payroll deductions and then provide a cash benefit to purchase services" (Kaiser Commission on Medicaid and the Uninsured, 10/20).

Robert Wood Johnson Foundation: Wisconsin's BadgerCare Plus Coverage Expansion and Simplification - This issue brief examines the enrollment success of Wisconsin BadgerCare Plus - the state's expanded state health insurance program - that began in February 2008. The brief finds "substantial increases in enrollment can be achieved by designing programs with key elements including: whole family coverage via expanded eligibility for lower-income parents and caretaker; targeted auto-enrollment; expanded income eligibility limits; relaxed anti-crowd-out provisions for lower income applicants; shift of employer insurance verification responsibilities away from applicants to program administrators; and aggressive outreach and enrollment strategies conducted with community partners" (Friedsam, Leininger, Bergum, Mok, Aksamitauskas, Oliver and DeLeire, Oct. 2009).