New Estimates of Gaps and Transitions in Health Insurance

Short, Pamela Farley; Graefe, Deborah Roempke; Swartz, Katherine; Uberoi, Namrata K.

doi:10.1177/1077558712454195

Cited by 27 publications

(32 citation statements)

References 8 publications

(15 reference statements)

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“…However, our focus on patients aged <65 years means that our description of patients switching from private to public insurance may not be generalizable to older transplant recipients becoming eligible for Medicare on the basis of age ≥65 years. Although as many as 1 in 3 nonelderly American adults experience discontinuity in health insurance coverage over a 4-year period, 24 few patients in the study cohort had multiple transitions among insurance types. Multiple insurance transitions were associated with worse long-term survival in univariate analysis, but not after multivariable adjustment.…”

Section: Discussionmentioning

confidence: 94%

Health Insurance Trajectories and Long-Term Survival After Heart Transplantation

Tumin

Foraker

Smith

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Background-Health insurance status at heart transplantation influences recipient survival, but implications of change in insurance for long-term outcomes are unclear. Methods and Results-Adults aged 18 to 64 receiving first-time orthotopic heart transplants between July 2006 and December 2013 were identified in the United Network for Organ Sharing registry. Patients surviving >1 year were categorized according to trajectory of insurance status (private compared with public) at wait listing, transplantation, and 1-year follow-up. The most common insurance trajectories were continuous private coverage (44%), continuous public coverage (27%), and transition from private to public coverage (11%). Among patients who survived to 1 year (n=9088), continuous public insurance (hazard ratio =1.36; 95% confidence interval 1.19, 1.56; P<0.001) and transition from private to public insurance (hazard ratio =1.25; 95% confidence interval 1.04, 1.50; P=0.017) were associated with increased mortality hazard relative to continuous private insurance. Supplementary analyses of 11 247 patients included all durations of post-transplant survival and examined post-transplant private-to-public and public-to-private transitions as time-varying covariates. In these analyses, transition from private to public insurance was associated with increased mortality hazard (hazard ratio =1.25; 95% confidence interval 1.07, 1.47; P=0.005), whereas transition from public to private insurance was associated with lower mortality hazard (hazard ratio =0.78; 95% confidence interval 0.62, 0.97; P=0.024). Conclusions-Transition from private to public insurance after heart transplantation is associated with worse long-term outcomes, compounding disparities in post-transplant survival attributed to insurance status at transplantation. By contrast, post-transplant gain of private insurance among patients receiving publicly funded heart transplants was associated with improved outcomes. (Circ Cardiovasc Qual Outcomes. 2016;9:576-584.

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Section: Discussionmentioning

confidence: 94%

Health Insurance Trajectories and Long-Term Survival After Heart Transplantation

Tumin

Foraker

Smith

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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“…1,2 Instability in the source of insurance frequently leads to short spells of uninsurance, and prior research shows that insurance instability has adverse consequences for access to primary care. 3,4 Much of this literature has focused on Medicaid, the Children's Health Insurance Program (CHIP), and other public programs, however, and less is known about how seamless insurance transitions from one insurance carrier to another (those with little or no transitory uninsurance) affect utilization of or access to care.…”

mentioning

confidence: 99%

Using All-Payer Claims Databases to Study Insurance and Health Care Utilization Dynamics

Dworsky

2017

J GEN INTERN MED

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“…1,2,3,4,5 Recent research estimating the numbers of people whose Medicaid eligibility might change from year to year due to changes in income or family size has underscored how churning will continue under the Affordable Care Act (ACA). 6,7,8 Estimates based on data from 2004–2008 indicate that more than 30 percent of Medicaid eligibles lose eligibility within six months of enrollment and about half lose eligibility within twelve months. 7,8 These estimates should remain valid, as the ACA does not change the requirement that current monthly income serve as the basis for Medicaid eligibility.…”

mentioning

confidence: 99%

Reducing Medicaid Churning: Extending Eligibility For Twelve Months Or To End Of Calendar Year Is Most Effective

et al. 2015

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Medicaid churning - the constant exit and re-entry of beneficiaries as their eligibility changes - has long been a problem for both Medicaid administrators and recipients. Churning will continue under the Affordable Care Act, because despite new federal rules, Medicaid eligibility will continue to be based on current monthly income. We developed a longitudinal simulation model to evaluate four policy options for modifying or extending Medicaid eligibility to reduce churning. The simulations suggest that two options, extending Medicaid eligibility either to the end of a calendar year or for twelve months after enrollment, would be far more effective in reducing churning than the other options of a three-month extension or eligibility based on projected annual income. States should consider implementation of the option that best balances costs, including both administration and services, with improved health of Medicaid enrollees.

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New Estimates of Gaps and Transitions in Health Insurance

Cited by 27 publications

References 8 publications

Health Insurance Trajectories and Long-Term Survival After Heart Transplantation

Health Insurance Trajectories and Long-Term Survival After Heart Transplantation

Using All-Payer Claims Databases to Study Insurance and Health Care Utilization Dynamics

Reducing Medicaid Churning: Extending Eligibility For Twelve Months Or To End Of Calendar Year Is Most Effective

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