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Articles by Karina Wagnerman
New Study Finds Evidence of a “Chilling Effect” in 2016 Marketplace Enrollment
There have been reports in the news of immigrant families decreasing their use of health care services and safety net programs because they fear that their information may be used to identify undocumented family members. A new study in the National Bureau of Economic Research explores this topic.
Medicaid’s Vital Role for Schools and Students
It feels like summer just arrived, but back-to-school time is near! Before the back-to-school bell rings, we wanted to take stock of health coverage for school-age children. As SayAhhh! readers are well aware, Medicaid and CHIP, the primary public health coverage sources for children, have worked together in recent decades to bring the rate of uninsured children to historic lows. Our new report unpacks health coverage for school-age children using data from the American Community Survey.
Research Update: Evidence Continues to Build on Medicaid’s Role Promoting Economic Security
I previously wrote about the primary role of health insurance, which is to protect against economic insecurity, medical debt, and bankruptcy. Recently, I have been reading new studies that continues to build on this body of work. Using consumer credit data, the authors examine the financial distress of non-elderly adults in expansion and non-expansion states.
Research Update: How Has Medicaid Expansion Impacted Workers?
This week, I am reading research showing that there may be links between the Medicaid expansion and trends in employer-sponsored insurance, labor force participation and employment. Urban Institute researchers used data from the Health Reform Monitoring Survey between July 2013 and March 2017 to analyze trends in employer-sponsored insurance (ESI) in expansion and non-expansion states for non-elderly adults.
Medicaid Expansion Brings Improvements in Coverage and Utilization to Rural CHC Patients
We previously blogged on research showing that the Medicaid expansion helps keep rural hospitals open and that the Medicaid expansion disproportionately benefited rural communities. We came to a similar conclusion in our own research when we analyzed Medicaid coverage in small towns and rural America. We found that the rate of uninsured adults in expansion states decreased 11 percentage points in small towns and rural areas between 2008-2009 and 2014-2015.
New Data Show Progress Covering Uninsured Children Stalled
I previously wrote about the growing gap between the rate of uninsured adults living in non-expansion states and expansion states. Next, I am analyzing the rate of uninsured children using the same data source, the National Health Interview Survey (NHIS). We are anxiously waiting for the release of the American Community Survey in the fall to complete our annual report on uninsured children and to have a better sense of the coverage trends for children.
Disparities exist in children’s coverage by race/ethnicity, income and maternal health
CCF recently updated our Snapshot of Children’s Coverage by Race and Ethnicity. The updated fact sheet includes the percentage of children residing in each state by race and ethnicity and the percentage of children covered by Medicaid and CHIP in each state by race and ethnicity for the year 2016.
Research Update: Uninsured Rate for Adults in Non-Expansion States Continues to Increase, Expanding Medicaid Could Reverse The Trend
Readers of SayAhhh! may have noticed the press coverage about the uninsured rate holding steady through 2017. While it is true that progress reducing the rate of uninsured children and the overall population has effectively stalled, there are some groups lagging behind. This week, I am reading studies about (1) the growing gap in the uninsured rate of adults in non-expansion states compared to expansion states, and (2) how non-expansion states could reverse the trend.
Snapshot of Children’s Coverage by Race and Ethnicity
Medicaid and the Children’s Health Insurance Program (CHIP) are primary sources of health coverage for children. These programs are particularly important to children of color, who are disproportionately represented among beneficiaries because they are more likely to be economically disadvantaged. (View our 2017 snapshot of children’s coverage by race and ethnicity.)
Proposed Changes to Medicaid Access Rule Could Lead to Deep Cuts in EPSDT Services
We have been busy working on our comments on the proposed rule that would make significant changes to the Medicaid Access Rule. As my colleague, Andy Schneider, wrote last month, one of the major changes in the proposed rule is to allow states to make fee-for-service payment cuts of 4% a year (6% over two years, 12% over four, etc.) without reviewing their impacts on access and regardless of whether the payment rates being cut are already too low.
Proposed Changes to Medicaid Access Rule Would Exempt 18 States
In March, CMS proposed changes to the Medicaid Access Rule. That Rule, in effect only since 2016, establishes procedures that states must meet to demonstrate that they are complying with the Medicaid statute’s requirement that provider payment rates be sufficient to ensure Medicaid beneficiaries have access to care. We recently shared our comments on the proposed changes.
Research Update: The Young Child Undercount in the Census
It was announced last week that an immigration question was going to be added to the decennial census for the first time since 1960, leading to concerns of an undercount among immigrant and minority groups. Researchers are tracking hard-to-count communities from the last census (here is a map and explainer). The map considers a census tract “hard-to-count” if the self-response rate to the 2010 census was 73% or under.
Kaiser Health Tracking Poll Finds 74% View Medicaid Favorably
The latest Kaiser health tracking poll found that roughly three-quarters of the public hold favorable views of Medicaid. The results do not vary drastically by political party. The poll also found that seven in ten Americans say they have ever had a connection to Medicaid, either through their own coverage, their child’s coverage, or indirectly through a family member or friend.
Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2018: Findings from a 50-State Survey
This 16th annual 50-state survey provides data on Medicaid and the Children’s Health Insurance Program (CHIP) eligibility, enrollment, renewal and cost sharing policies as of January 2018. It takes stock of how the programs have evolved as the fifth year of implementation of the Affordable Care Act (ACA) begins, discusses policy changes made during 2017, and looks ahead to issues that may affect state policies moving forward.
16th Annual Survey on Medicaid/CHIP Eligibility, Enrollment, Renewal and Cost-Sharing Policies
The Kaiser Family Foundation teamed with Georgetown University Center for Children and Families for the eighth year to conduct the annual 50-State Survey on Medicaid and CHIP. This 16th annual report reflects eligibility, enrollment, renewal, and cost-sharing policies in place as of January 2018. This year’s report takes stock of how the programs have evolved as the fifth year of implementation of the Affordable Care Act (ACA) begins.
Research Update: Medicaid Pulls Americans Out Of Poverty, Updated Edition
This week, I am reading studies about Medicaid’s poverty-fighting effects. In 2016, about 13% of the population lived in poverty. Children continue to live disproportionately in poverty: children represent 23% of the population, but 33% of the population living in poverty. Increasing access to Medicaid for families may be one way to reduce poverty. Research shows that Medicaid helps pull families out of poverty by providing access to affordable health coverage and lowering out-of-pocket costs.
Research Update: Early Evidence on the Medicaid Expansion’s Important Role Fighting Cancer
This week, I am reading studies showing new evidence that the Medicaid expansion is contributing to the fight against cancer. Medical Care’s Changes in Health Insurance Coverage Associated With the Affordable Care Act Among Adults With and Without a Cancer History: Population-based National Estimates The researchers examined coverage changes for adults with and without a cancer history after the ACA. They used data from the National Health Interview Survey between 2012 and 2015.
Research Update: Can Parents in Non-Expansion States Meet a Work Requirement and Remain Medicaid-Eligible?
This week, I am reading a study examining Medicaid work requirements in non-expansion states. My colleague, Joan Alker, recently wrote about Mississippi’s waiver request, which is currently up for public comment and includes a work requirement targeted at very poor parents and caretaker relatives with household incomes below 27% FPL.
Research Update: The Links Between Medicaid and Schools in the Data and Research
We recently updated our state-by-state data on the share of children with Medicaid coverage by school district. Medicaid spent about $4 billion on school based health care services in 2015. There was wide variation by state: Illinois, Michigan, New Jersey, New York, Pennsylvania and Texas each had at least $250,000,000 in Medicaid spending on school based health care services (see this appendix table for more state-by-state information).
Research Update: How Medicaid Coverage for Parents Benefits Children
This week, I am reading studies about the links between health coverage for parents and children. We are closely following new guidance from CMS on a Medicaid work requirement. Yesterday, Joan Alker explained how a work requirement will lead to coverage losses for parents and harm children. Indeed, the evidence is strong that Medicaid coverage for parents leads to coverage increases and improved health outcomes for children.
Research Update: Health Care Expenses from Families’ Budgets to Federal Budgets
This week, I am reading studies on how health coverage eases financial pressures on families’ budgets and how children fare in federal expenditures. Commonwealth Fund’s What’s at Stake: States’ Progress on Health Coverage and Access to Care, 2013–2016 This brief examines the progress made since the ACA, including increases in health coverage for children and adults and increasing access to affordable care. The Kaiser Family Foundation’s How do Health Care Costs fit into Family Budgets?
Research Update: Checking Up on Utilization and Providers After the ACA’s Medicaid Expansion
This week, I am checking up on Medicaid research regarding health care utilization and providers. There is evidence that the expansion increased access and utilization of health care, led to an increase in smoking cessation, and increased the share of patients that physicians saw covered through Medicaid.
Research Update: Medicaid Pulls Americans Out Of Poverty
This week, I am reading a study on one of my favorite topics: the poverty rate. In 2016, about 13% of the population lived in poverty. When broken out by age, children continue to have the highest poverty rate (18% under age 18, 12% ages 18 to 64, and 9% 65 and over). Children represent 23% of the population, but 33% of the population living in poverty. Children and families are struggling – how does Medicaid help them?
Research Update: Medicaid Pulls Americans Out Of Poverty
CCF’s last research update focused on families’ increase in economic security after the Medicaid expansion. This week, I would like to build on the research presented last time. Below are two additional studies that examine links between affordable, comprehensive health care and financial security. And of course, the role of Medicaid in it all.
Research Update: Economic Security After the Medicaid Expansion
Readers of Say Ahhh! know that Medicaid coverage increases economic security for families. This week, I am reading studies specifically on the Medicaid expansion and how it contributes to economic security. The expansion is only a few years old; the data and the research are still in their beginning stages. Still, this new and expanding body of research continues to show how the expansion improves families’ economic security.
Research Update: Health Care in Rural and Urban America
CCF is starting a new series on research in health policy. I will regularly highlight some of the new research that I have been reading. This week, I am reading studies comparing health care and poverty in rural and urban parts of the country. The report shows trends and snapshots of health care quality and disparities from 2000-2014/2015.
Estimated CHIP Enrollment by Congressional District, 2016
The following workbook estimates the number of children ever enrolled in CHIP in 2016 by congressional district. See the notes tab in the workbook for information on data sources and methodology.
The Medicaid Expansion is Good for Parents AND Good for Children
Parents and children are more likely to have health coverage now than they were before the Affordable Care Act took effect. The Urban Institute released new research that shows the rate of insurance coverage for parents and children increased significantly between June/September 2013 and March 2017. During the time period, the rate of coverage increased 6.2 percentage points for parents (from 83.2 percent to 89.3 percent) and 1.9 percentage points for children (from 94.8 percent to 96.7 percent).
Who Are the Uninsured Adults?
Last week we posted a piece about the shrinking pool of uninsured adults, based on a Health Affairs study showing that the rate of adults without insurance dropped from 16 percent to 7 percent in states that took the Affordable Care Act’s Medicaid expansion. Hidden at the end of this Health Affairs study, is a look at the remaining uninsured adults as of the first quarter of 2017. More than 60 percent of those adults live in states that didn’t accept the Medicaid expansion.
Medicaid Expansion Enrollees Drive Down the Uninsured Rate, Cost Less to Cover
The Medicaid expansion has been particularly successful at covering uninsured adults. According to new research in Health Affairs that used data from the Health Reform Monitoring Survey, expansion states saw a decrease in their rate of uninsured adults from about 16% during the third quarter of 2013 to 7% in the first quarter of 2017. During the same time period, the rate of uninsured adults in states that did not expand Medicaid dropped from 20% to 15%.
Medicaid Caps Put Children at Risk
Some recent health policy proposals have included converting Medicaid into a block grant and cutting funding levels. Policymakers that support these proposals are citing the success of the Children’s Health Insurance Program (CHIP), funded by a block grant, as justification for the idea.
Children’s Coverage in Florida: A Closer Look at Medicaid and the Children’s Health Insurance Program
Florida’s uninsured rate for children, while still higher than the national average, is at an all-time low of 6.2 percent. This progress is the result of many years of work through Medicaid and the Children’s Health Insurance Program. However, Federal funding for the Children’s Health Insurance Program (CHIP) is due to expire on September 30, 2017. Florida’s CHIP program is the fourth largest in the nation, thus much is at stake for the state.
Recent Research Shows Disparities in Health Care Access Reduced After The ACA
We know that access to health care is correlated with many demographic and socioeconomic characteristics. The Affordable Care Act, through the Medicaid expansion and the marketplace, extended coverage to uninsured populations with the hope of reducing disparities in access to health care. After the first couple of years of the insurance expansions, research shows that those disparities are narrowing, though they still persist.
Medicaid Expansion Reduced Unpaid Medical Debt, Improved Financial Well-Being for Families
As readers of Say Ahhh! know, we are always interested in new Medicaid research on access to care and economic security. Two recent studies focus on these topics, examining Medicaid enrollees’ satisfaction with health care and the financial aspects of having Medicaid. The first study uses new data from the first-ever national Medicaid Consumer Assessment of Healthcare Providers and System (CAHPS) administered by CMS to examine the experiences of adults with Medicaid.
Coverage Trends for American Indian and Alaska Native Children and Families
Coverage Trends for American Indian and Alaska Native Children and Families July 14, 2017 Joan Alker, Karina Wagnerman, Andy Schneider Uninsured rates for children in American Indian and Alaska Native (AI/AN) families have dropped quickly in the past eight years, but they still remain high and will likely rise if substantial cuts are made to the Medicaid program, according to the report, Coverage Trends for American Indian and Alaska Native Children and Families.
Medicaid’s Role for Seniors Living in Small Towns and Rural America
Medicaid is a lifeline for millions of older adults (age 65+) who are likely also enrolled in Medicare. Medicaid is the primary payer for long-term services and supports that are not covered by Medicare, paying for more than 50 percent of these costs in 2015.
Reviewing the Evidence on the Value of Health Insurance
Some of our favorite health researchers—Ben Sommers, Atul Gawande, and Katherine Baicker–published an article this week in the New England Journal of Medicine sharing the most recent evidence on the effects of health insurance coverage, especially Medicaid coverage, to inform the national debate on health care. They review the most rigorous studies on how health coverage affects access, utilization, outcomes, and mortality.
Rural Health Report
Medicaid is a vital source of health coverage nationwide, but the program’s role is even more pronounced in small towns and rural areas. Medicaid covers a larger share of nonelderly adults and children in rural and small-town areas than in metropolitan areas; this trend is strongest among children.
Snapshot of Children’s Coverage by Race and Ethnicity
Medicaid and the Children’s Health Insurance Program (CHIP) are primary sources of health coverage for children. These programs are particularly important to children of color, who are disproportionately represented among beneficiaries because they are more likely to be economically disadvantaged.
Medicaid And CHIP Help Address Racial/Ethnic Disparities In Children’s Health
Medicaid and CHIP are primary sources of health coverage for all children. These programs play a particularly important role for children of color, who are disproportionately represented among beneficiaries because they are more likely to be economically disadvantaged (see figure below). CCF’s new fact sheet unpacks child population and Medicaid/CHIP data by state.
New Maps Display Medicaid/CHIP Enrollment by Congressional District
We have a new interactive map feature on our website and are excited to share with you the first maps we have created with our new tool. The maps visually display how Medicaid and the Children’s Health Insurance Program (CHIP) are helping to meet the needs of children and families across the country. You can see how many children and adults rely on Medicaid (and in the case of children, CHIP) by congressional district.
Medicaid Is A Smart Investment in Children
Medicaid and the Children’s Health Insurance Program (CHIP) provide health coverage to more than one-third of the children in the United States. The vast majority of these children, more than 90 percent, are covered through Medicaid. A large body of research shows that access to Medicaid in childhood leads to longer, healthier lives, a better chance to finish high school and college, and more prosperous futures for our children.
Medicaid Provides Economic Security For Families
Our new fact sheet summarizes research on how Medicaid provides economic security for families. By making health insurance accessible to children and parents, Medicaid keeps families healthy and also protects them from financial hardship. That economic security has the added benefit of insulating children from some of the adverse experiences of growing-up in poverty that can influence later outcomes in health and well-being.
Medicaid: How Does It Provide Economic Security for Families?
Research shows that Medicaid coverage improves numerous indicators of economic security for beneficiaries. By making health insurance accessible to children and parents, Medicaid keeps families healthy and also protects them from financial hardship. For millions of families, Medicaid is a lifeline that keeps them living above the poverty threshold.
New CCF Fact Sheet Shows Medicaid Provides Needed Access to Health Care for Families
Our new fact sheet summarizes research on access to care in Medicaid. We find that children and parents who rely on Medicaid for health care receive coverage that is comparable to private insurance and far better than the access accorded uninsured families. Children covered by Medicaid and those with private insurance access health care services across a variety of measures at comparable rates, while children who are uninsured access health services at lower rates (see figure).
Medicaid Provides Needed Access to Care for Children and Families
Research shows that children and parents who rely on Medicaid for health care receive coverage that is comparable to private insurance and far better than the access accorded uninsured families. Children covered by Medicaid and those with private insurance access health care services across a variety of measures at comparable rates, while children who are uninsured access health services at lower rates.
Further State Funding Cuts and Uncertain Federal Landscape Threaten Care for Young Children in Texas with Disabilities and Developmental Delays
Texas’ early childhood intervention system has not kept pace with other states in the share of young children it serves. And with state policy changes and possible federal proposals, the program could find it more difficult to meet the needs of young children with disabilities and delays who need these critical services.
Research Documents Positive Impact of Medicaid Expansion
The future of the Affordable Care Act’s Medicaid expansion is unclear, but new research is making it quite clear that Medicaid expansion is a smart investment. In the last few weeks, researchers addressed several questions that many wondered about before most states implemented the expansion. Let’s take a trip down memory lane… Will expanding Medicaid in a state lead to significantly more insured people? Yes.
Council of Economic Advisers Reports Uninsured Rate Now at Lowest Point in History
Last month, the Council of Economic Advisers released a report demonstrating that historic progress on health insurance coverage is due, in large part, to the ACA. Since the ACA took effect, an estimated 20 million additional adults gained health insurance, the children’s uninsured rate fell by almost half, and the overall uninsured rate fell to the lowest point in history. The success in reducing the uninsured rate is shared across population groups.
Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2017: Findings from a 50-State Survey
This 15th annual 50-state survey provides data on Medicaid and Children’s Health Insurance Program (CHIP) eligibility, enrollment, renewal and cost sharing policies as of January 2017, and identifies changes in these policies in the past year.
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