Health policy research roundup

Nov 20 2009

Urban Institute: Progress Enrolling Children in Medicaid/CHIP: Who Is Left And What Are The Prospects For Covering More Children? - This policy brief examines the characteristics of the estimated 5 million uninsured children who are eligible for CHIP/Medicaid in 2007 (64 percent of all uninsured children; 88 percent of all low-income uninsured children), but not enrolled. "Nationwide, over 80 percent of eligible children participated in Medicaid/CHIP, but participation rates, as well as the characteristics of uninsured eligible children, varied dramatically across areas," the authors write. Additional analyses revealed that more than "90 percent of low-income parents say they would enroll their uninsured child if they knew he or she was eligible, but around half do not know that their child is eligible, do not know how to apply, or find the application processes difficult."

"These findings suggest that expanding Medicaid as a part of health care reform will be a successful strategy for reducing uninsurance, but that careful attention must be given to enrollment and retention processes so as to minimize gaps in coverage"  (Kenney, Cook and Dubay,  11/13).

Commonwealth Fund: How Can Medicare Lead Delivery System Reform? - "U.S. health care would be better and more efficient if the system as a whole functioned the way top-performing providers do, with greater accountability for specific populations and for the totality of care delivered," write the authors of this brief who present several policies that "could begin to move away from the adverse incentives embedded in the current payment system to incentives that encourage better care and better value." The recommend adopting the methods of "top-performing providers," with "greater accountability for specific poulations and for the totality of care delivered"(Crosson, Guterman, Taylor, Young and Tollen, 11/13).

Kaiser Family Foundation: The Role Of Health Coverage For Communities Of Color - This issue brief examines the variation in rates of health insurance among different racial and ethnic groups in the U.S., and how health care reform would impact such groups. "Despite wide variation in the rates of health insurance coverage by race and ethnicity in the U.S., people of color—who make up one-third of the U.S. population—comprise over half of the 45.7 million nonelderly uninsured and are less likely to have health coverage than Whites. This is primarily due to the fact that people of color are more likely than Whites to be low-income and work for low-paying jobs that are less likely to offer health insurance. Low-wage jobs, along with higher unemployment rates, contribute to wealth gaps that can make coverage less affordable even when offered," write the authors of this brief.

"While expansions in coverage are insufficient to eliminate racial and ethnic disparities in access to health care, health coverage is, at the very least, one important factor that helps to facilitate access to the health system thereby serving to reduce disparities in access to care" (Thomas and James, 11/17).

Commonwealth Fund/Urban Institute: Racial and Ethnic Disparities In The Use Of High-Volume Hospitals - A recent study published in the journal Inquiry found "[m]inority patients in the New York City area are significantly less likely than whites to be treated at high-volume hospitals for cancer surgeries, cardiovascular procedures, and other services for which high volume and positive outcomes are related," according to a Commonwealth Fund description of the study. The findings, based upon patient discharge records from hospitals in New York City and its adjacent counties, between 1995-1996 and 2001-2002, raise questions about the ways minority patients gain access to care (Gray, Schlesinger, Siegfried and Horowitz, 11/16).

Kaiser Family Foundation: Access To Abortion Coverage And Health Reform - This issue brief examines current federal and state laws regarding insurance coverage for abortion, and explores some of the issues being debated regarding abortion coverage in the House and Senate. The brief also looks at the impact that the House health overhaul, H.R. 3962, could have on women with private insurance as well as women covered by Medicaid (11/18).

George Washington University (.pdf): An Analysis Of The Implications Of The Stupak/Pitts Amendment For Coverage Of Medically Indicated Abortions - This paper examines the impact that the Stupak/Pitts Amendment to the House reform bill, H.R. 3962, could have on the "health benefits services industry" and the market for private or public supplemental coverage of "any type of abortion for which there is a medical indication of need." The authors write, "In view of how the health benefit services industry operates and how insurance product design responds to broad regulatory intervention aimed at reshaping product content, we conclude that the treatment exclusions required under the Stupak/Pitts Amendment will have an industry-wide effect, eliminating coverage of medically indicated abortions over time for all women, not only those whose coverage is derived through a health insurance exchange." They add, "In our view, the terms and impact of the Amendment will work to defeat the development of a supplemental coverage market for medically indicated abortions" (Rosenbaum, Cartwright-Smith, Margulies, Wood and Mauery, 11/16)