Browsing by Subject "Affordable Care Act"

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The coordination and implementation of the Affordable Care Act in Texas : Medicaid eligibility and the environmental context
(2012-08) Daneel, Asha Staudt; Warner, David C.; Travis, Dnika J.
The Affordable Care Act (ACA) seeks to increase the low-income population’s access to health care coverage by expanding Medicaid eligibility and providing subsidies to individuals meeting certain income thresholds. The citizens of Texas would benefit greatly from the ACA provisions, as the state offers limited opportunities for individuals to access insurance, evidenced by the 6.3 million residents without health care coverage. But political leaders in Texas have a long-standing commitment to limited government, low taxes, and states’ rights in a federal system of government. In the 1990s, Texas legislators, with bipartisan support, laid the groundwork over the last decade for the minimal, yet significant preparations that administration used to coordinate ACA implementation. Yet legislators’ commitment to limited government and states’ rights placed additional constraints on the ability of the Texas Health and Human Services Commission (HHSC) to implement ACA provisions by refusing to utilize the 82nd legislative session to prepare the state for impending deadlines. Instead, administrators developed an interagency effort, the Eligibility Modernization Project (EMP), to streamline eligibility determinations and increase clients’ access to information and services. EMP’s initiatives mirror ACA provisions, but also seeks to achieve policy goals that both Republican and Democratic legislators support, such as providing effective and efficient eligibility determinations. Nevertheless, legislators and administrators must go beyond EMP’s efforts to adequately prepare the eligibility system for impending ACA deadlines. Policy recommendations include further streamlining and integrating the health subsidy system with a state-based health insurance exchange, increasing access to coverage by expanding Medicaid eligibility, adequately preparing the workforce for changes, and promoting long-term planning. These solutions will provide a sounder infrastructure for HHSC to prepare for ACA coordination and implementation, while increasing access to health care coverage for the low-income population.
Essays in health economics
(2022-05) Stripling, Sam; Geruso, Michael; Cabral, Marika; Oettinger, Gerald
The three chapters of this dissertation explore the effects of two of the largest policy levers in the United States, Medicare and Medicaid, on health and hospitals. My first chapter examines the effects of Medicare on short-run mortality. Despite being at the forefront of policy debates, credibly estimating whether health insurance reduces mortality remains empirically elusive. The key challenge is creating research designs that have the statistical power to reliably detect the effects of health insurance on mortality. This chapter presents new, population-level estimates of the impact of Medicare on short-run mortality. I use restricted-access Census data to link complete, administrative death records to individual survey responses for nearly 30% of the US population. To understand the effects of Medicare on mortality, I use a regression discontinuity design, comparing the mortality of individuals just above and below the age-65 eligibility threshold. I also consider whether the impact of Medicare on mortality differs by demographics, previous health insurance status, and income-level. I find no statistically significant effects of Medicare on mortality for the full population, previously uninsured, or low-income individuals. The second chapter of my dissertation looks at the effects of the Affordable Care Act Medicaid Expansion on mortality. Given that Medicaid and Medicare are two of the largest policy levers for improving health in the United States, it is important to compare the mortality effects of Medicare to those of Medicaid. This chapter examines whether Medicaid eligibility reduces mortality for near-elderly individuals. I begin by using CDC data and a differences-in-differences design to analyze whether the ACA Medicaid Expansion reduced the mortality rate for individuals aged 55-64. I note several potentially important limitations in using CDC data for studying the effects of Medicaid on mortality. I discuss the merits of circumventing these limitations by using the restricted Census infrastructure to link survey data to administrative death records. I conclude with a cross-study comparison of the effects of Medicare and Medicaid on mortality, and discuss the policy relevance of my findings. The third chapter of my dissertation studies how hospitals respond to the Affordable Care Act Medicaid Expansions. While the first two chapters of the dissertation focus on the benefits of public health insurance for insurance recipients, public health insurance can also significantly benefit health care providers. Hospitals frequently provide health care to uninsured patients without receiving compensation. ACA Medicaid expansions reduced hospitals’ uncompensated care burdens by providing the uninsured with a means of payment in the form of insurance. Anecdotal evidence from hospital administrators suggests hospitals in expansion states respond to their improved financial positions by increasing capacity, purchasing equipment, and hiring more workers. I investigate such claims using hospital financial report data from CMS. Using a differences-in-differences regression framework, I find no evidence that hospitals in expansion states increased bed capacity, capital expenditures, or FTEs relative to hospitals in non-expansion states.
Health insurance coverage of noncitizens and the exclusion of undocumented immigrants
(2020-05-14) Arboleda, Juan Sebastian; Olmstead, Todd; Wasem, Ruth E
Federal policies enacted over the last 50 years have created barriers for noncitizens to access the health care system in the United States. The outcomes are disparities in health insurance coverage based on citizenship and immigration status. This report first focuses on the history of statutes and regulations that have created these barriers for noncitizens, including the impacts of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), the Patient Protection and Affordable Care Act (ACA), and the most recent amended regulations to the public-charge ground of inadmissibility. Although the implementation of the (ACA) has overall been successful in reducing the number of uninsured in the U.S., it continued the trend from previous statutes to exclude certain groups of noncitizens. This report uses data for the periods 1999-2017 from the Current Population Survey to analyze the impact of the ACA on insurance coverage among U.S. natives, naturalized citizens, and noncitizens. For noncitizens, the expansion of Medicaid and the ability to purchase insurance through private health insurance exchanges have played the biggest role in the uninsured rate dropping from 38 percent in 2013 to 24 percent in 2017. While the drop has been significant, the uninsured rate for noncitizens is more than three times the rate for citizens. Furthermore, the exclusion of some noncitizen groups from the ACA has created a disparity of health insurance coverage between legal permanent residents (LPRs) and undocumented immigrants. Lastly, the report analyzes the unique circumstances that undocumented immigrants experience with respect to health insurance. Statutes have excluded undocumented immigrants from accessing federal health benefits such as Medicaid, CHIP, and the ACA. Furthermore, undocumented immigrants often work in industries that pay low wages and do not offer health insurance coverage to their workers. As a result, the uninsured rate for undocumented immigrants is more than five times the rate for citizens. Although the options for undocumented immigrants are limited, safety-net health care institutions that serve low-income patients have become pivotal in their access to the health care system. Additionally, 17 states are using their own funding to offer undocumented immigrants additional health benefits.
Healthcare policy: Cost versus solutions
(2012) Woolheater, Katelyn
Healthcare is a dynamic policy issue, encompassing a number of multifaceted problem areas such as insurance, cost-efficiency, equity, and recourse allocation. As a result, legislation often addresses the broader problem piecemeal, on a one-issue-at-a-time basis. This project aims to examine this piecemeal process, with regard to the proportion of legislation devoted to amending prior bills and the proportion of legislation advancing novel solutions to pressing healthcare problems. Further, because legislation has often historically targeted specific populations, I examine which populations are most often targeted in reform efforts, and how targeted efforts play a role in legislative success. I analyzed major health care legislation through data gathered from the Policy Agendas Project as well as other policy databases, with a focus on three essential reform efforts including the successful New Deal implementation of Medicare and Medicaid, the failed Clinton effort, and the controversial Patient Protection and Affordable Care Act. Using an original coding system to categorize the provisions bills and enable a clear breakdown of their content, I look at the proportions of each bill that are amendments to prior legislation and the proportions that are targeted to special populations. By accumulating enough data, I develop an average threshold of these proportions by comparing legislation that pass and that failed. My analysis reinforces the idea that policy makers often function as pluralists, and special populations will amass the most awareness, impeding more universal reform.
Improving end-of-life care
(2016-08) Plocher, Susannah Townsend; Olmstead, Todd; Jones, Barbara
The purpose of this report is to examine our attitudes towards end-of-life care and assess the systems of reimbursement and quality measurement that support and sustain it. This report is divided into two primary sections: the first, Culture, explores the culture of end-of-life care, from its historical roots and development to its slow integration into modern medicine. The second, Infrastructure, focuses on the Medicare Hospice Benefit and quality measurement under the Affordable Care Act. Under healthcare reform, reimbursement is now more than ever tied to quality and as such the two systems operate in close concert. Their influence on the provision and assessment of end-of-life care is significant, and this report analyzes flaws in each that undermine their potential to truly advance quality, person-centered care. This report ends with recommendations for improvement for both reimbursement and quality measurement, with the sincere hope that by strengthening the structures that support end-of-life care, we will better support patients and their families.
The Obama Administration and digital content : a case study of Healthcare.gov
(2016-05) Gant, Alia; Wickett, Karen M.; Towery, Stephanie
The United States government has made enormous strides to adapt and evolve with the digital era in the 21st century. Initially the Clinton Administration in the 1990s showed a sense of acceptance and willingness to work with the changing times in regards to technology. The subsequent administrations also continued to support platforms that utilized digital programs such as the Internet. This Master’s Report will examine government websites under the Obama Administration, in particular Healthcare.gov, however through the perspective of information professionals. The report will describe and analyze the information pertinent to users to accessing health needs for insurance plans. The report will discuss and apply frameworks from information studies, including metadata, digital libraries and community informatics Lastly, the report will provide critiques, suggestions, and ways to research this topic in the future.