People uninsured for any part of 2008 spend about $30 billion out of pocket and receive approximately $56 billion in uncompensated care while uninsured. Government programs finance about 75 percent of uncompensated care. If all uninsured people were fully covered, their medical spending would increase by $122.6 billion. The increase represents 5 percent of current national health spending and 0.8 percent of gross domestic product. However, it is neither the cost of a specific plan nor necessarily the same as the government's costs, which could be higher, depending on plans' financing structures and the extent of crowd-out. [Health Affairs 27, no. 5 (2008): w399-w415 (published online 25 August 2008; 10.1377/hlthaff.27.5.w399)] E x pan d i n g h e a lt h i n s u r an c e c ov e r age is a major issue in the 2008 presidential campaign. This study addresses three sets of questions that are critical to the policy debate. First, how much care do the uninsured receive? Second, how much of their care is "uncompensated," and who pays for that care? Third, if the uninsured were covered, what would be the cost of the additional medical care they would use? The first two questions set the baseline for the policy debate and identify payment sources that might be tapped to help fund expanded insurance coverage. The third question focuses on the additional resource cost to society. Importantly, this cost is not the cost of a specific plan to expand coverage, nor is it a measure of the cost to government.n Study data and methods. Following earlier studies, we used two distinct and independent methodologies to develop estimates of the uninsured's current medical U n i n s u r e d I n 2 0 0 8

No abstract

No abstract

Objective. To provide an assessment of how well the Medicaid program is working at improving access to and use of health care for low‐income mothers. Data Source/Study Setting. The 1997 and 1999 National Survey of America's Families, with state and county information drawn from the Area Resource File and other sources. Study Design. Estimate the effects of Medicaid on access and use relative to private coverage and being uninsured, using instrumental variables methods to control for selection into insurance status. Data Collection/Extraction Method. This study combines data from 1997 and 1999 for mothers in families with incomes below 200 percent of the federal poverty level. Principal Findings. We find that Medicaid beneficiaries' access and use are significantly better than those obtained by the uninsured. Analysis that controls for insurance selection shows that the benefits of having Medicaid coverage versus being uninsured are substantially larger than what is estimated when selection is not accounted for. Our results also indicate that Medicaid beneficiaries' access and use are comparable to that of the low‐income privately insured. Once insurance selection is controlled for, access and use under Medicaid is not significantly different from access and use under private insurance. Without controls for insurance selection, access and use for Medicaid beneficiaries is found to be significantly worse than for the low‐income privately insured. Conclusions. Our results show that the Medicaid program improved access to care relative to uninsurance for low‐income mothers, achieving access and use levels comparable to those of the privately insured. Our results also indicate that prior research, which generally has not controlled for selection into insurance coverage, has likely understated the gains of Medicaid relative to uninsurance and overstated the gains of private coverage relative to Medicaid.

No abstract

The nearly nine million people who receive Medicare and Medicaid benefits, known as dual eligibles, constitute one of the nation's most vulnerable and costly populations. Several initiatives authorized by the Affordable Care Act are intended to improve the health care delivered to dual eligibles and, at the same time, to achieve greater control of spending growth for the two government programs. We examined the 2007 costs and service use associated with dual eligibles. Although the population is indeed costly, we found nearly 40 percent of dual eligibles had lower average per capita spending than non-dual-eligible Medicare beneficiaries. In addition, we found that about 20 percent of dual eligibles accounted for more than 60 percent of combined Medicaid and Medicare spending on the dual-eligible population. But even among these high-cost dual eligibles, we found subgroups. For example, fewer than 1 percent of dual eligibles were in high-cost categories for both Medicare and Medicaid. These findings suggest that decision makers should tailor reform initiatives to account for subpopulations of dual eligibles, their costs, and their service use.

States have broad latitude in designing their Medicaid programs; this has important implications for access to care. To understand the consequences of state variation, we evaluate, for the nation and for thirteen study states, how well the program is providing access for beneficiaries, using the level of access available to low-income privately insured people in the local health care market as our benchmark. Overall, we find that Medicaid beneficiaries' access matches that of the low-income privately insured for most of the ambulatory outcomes examined but is worse for dental services and prescription drugs. State-level analyses revealed some variation in the access gap.

The 1981-1982 National Long-Term Care Channeling Demonstration Project data revealed that the mean annual cost per capita for home and institutional care for cognitively impaired persons was +18,500. The equivalent figure for cognitively intact persons was +16,650. Cognitively impaired persons used nursing homes at twice the rate of cognitively intact persons. Use differences for other health services were slight. A pre- and post-nursing home admission analysis indicated that for the cognitively impaired the annual cost of community care was +11,700, whereas the cost of nursing home care was +22,300.