Browsing by Subject "Medicare"

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A Better Life for Low-Income Elders in Austin, PRP 188
(LBJ School of Public Affairs, 2016) Angel, Jacqueline
This report describes a policy research project conducted in the 2015-16 academic year with support from the St. David’s Foundation and Central Health, and government client the Texas Health and Human Services Commission. The study addresses how to care for elderly, vulnerable county residents in the community. As baby boomers approach retirement age nationwide, the share of Austin’s elderly population is growing as well. Austin and Travis County are facing new challenges in providing services to a growing share of frail and disabled older residents. The core objective of this project is to offer options for community-based long- term care in an equitable and cost-effective manner. As part of this objective, the project team examined existing community-based, long-term care and social services programs in Texas and California for dually eligible Medicaid and Medicare enrollees, including Texas’s managed care option, STAR+PLUS, and the Program of All Inclusive Care for the Elderly (PACE). PACE provides comprehensive medical care and social services to persons 55 and older who require nursing home care, but prefer to live in the community. The study examines other community-based long-term care alternatives that could be introduced in Austin and the characteristics of what makes PACE and other alternatives work for dual-eligible older persons. The study includes a cost analysis from the perspectives of the state and program provider, an analysis of participant satisfaction in each program, and an in- depth qualitative analysis of the barriers to success for PACE sites in Texas and California. The study also explores ways of leveraging community resources in Austin.
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.
Essays on public and labor economics
(2024-05) Son, Jinyeong; Cabral, Marika; Tuttle, Cody; Magdalena, Bennett; Murphy, Richard
This dissertation comprises three chapters in the fields of public and labor economics. Specifically, they address questions in two areas: (i) the determinants of children’s human capital accumulation, particularly from the perspective of health status, and (ii) the consequences of public policy interventions in health insurance markets. Chapter 1 examines the effects of pregnancy timing among teenagers aged 15–18 on their short- and long-run educational and labor market outcomes. Specifically, I estimate the marginal impact of a one-year difference in pregnancy timing for each age interval—15–16, 16–17, and 17–18—leveraging linked administrative data from Texas. To identify the effect of pregnancy timing, I examine both within-individual changes in outcomes surrounding pregnancy and across-individual comparisons in outcomes after pregnancy, among matched individuals who are balanced on a wide range of characteristics but differ in the timing of pregnancy. The results indicate that experiencing pregnancy one year earlier increases absences and the likelihood of leaving school, particularly during the postpartum year. Further, the results indicate that becoming pregnant one year earlier has adverse long-term consequences: it reduces high school graduation by age 20, decreases college enrollment and completion in the early 20s, and leads to lower employment and earnings in the mid-20s, with these detrimental effects being most pronounced for the youngest group. Finally, I present suggestive evidence that providing parental support to teenage mothers during the postpartum year could mitigate the short-term disruptions they face, such as increased absences and higher dropout rates. Chapter 2, previously published in the Journal of Public Economics, explores whether and to what extent state-mandated health insurance benefits improve health outcomes in the context of diabetes mandates. Specifically, in Chapter 2, I use data from the restricted-use Multiple Cause of Death Mortality database and the Behavioral Risk Factor Surveillance System to investigate the effects of diabetes mandates on diabetes-related mortality rates, along with the underlying mechanisms behind the estimated effects. Using a difference-in-differences framework that leverages variation in the enactment of mandates both across states and over time, I find that approximately 3.1 fewer diabetes-related deaths per 100,000 occur annually in mandate states than in non-mandate states. The mechanism analysis suggests higher utilization of the mandated medical benefits caused these mortality improvements. These findings can inform the ongoing policy debate on strengthening or weakening coverage mandates, including Essential Health Benefits under the Affordable Care Act. Chapter 3, co-authored with Marika Cabral and Colleen Carey, investigates the determinants of health insurance choice in Medicare—a setting with vast geographic variation in the share of individuals selecting the public option versus private alternative. We analyze insurance decisions among individuals who move to quantify the relative importance of individual-specific factors (such as preferences or income) and place-specific factors (such as local health insurance options) on insurance decisions. We find roughly 40% of the geographic variation in the share selecting private coverage is due to place-based factors, while the remainder is explained by individuals. Our findings highlight the importance of individual factors in these decisions and may inform discussions about the use of policy to address geographic disparities.
Extending Medicare to Mexico: Impact on Mexican-Born Beneficiaries
(LBJ School of Public Affairs, The University of Texas at Austin, 2010) Warner, David C.
This report presents the results of a policy research project conducted during the 2009-2010 academic year that examined the availability of health coverage in Mexico for Mexican-born persons who are or soon will be Medicare beneficiaries. This project included developing a questionnaire in English and Spanish and administering it to a number of individuals in Dallas, Austin, and the state of Guanajuato, Mexico. This report also presents information on patterns of immigration to the U.S. from Mexico, changes in naturalization law, and a close look at a number of Congressional districts in greater Los Angeles and the Dallas-Fort Worth metroplex. The portability of Medicare benefits from the U.S. to Mexico is compared to the portability of benefits within the European Union. The report also examines coverage by both the Canadian and European health systems of emergencies abroad. The report concludes with a discussion of a possible Medicare waiver which would permit Medicare to pay for emergency medical services when beneficiaries were either visiting or retired there. This project was funded in part by the IC² Institute.
Extending Medicare to Mexico: Impact on Mexican-Born Beneficiaries, PRP 168
(LBJ School of Public Affairs, 2010) Warner, David C.
A Generation at Risk: When the baby boomers reach Golden Pond
(Hogg Foundation for Mental Health, 1984) Butler, Robert N.
Getting What You Paid For: Extending Medicare to Eligible Beneficiaries in Mexico (U.S.-Mexican Policy Report 10)
(LBJ School of Public Affairs, 1999) Warner, David C.
This volume is the result of a year-long Policy Research Project at the LBJ School of Public Affairs. It is the result of an ongoing investigation of the feasibility of extending Medicare coverage in some form to beneficiaries of the program who live in Mexico. This is the fourth in a series of research projects that have touched on this topic over the last nine years. The first project surveyed retirees in San Miguel, Guadalajara-Chapala, Mexico City, and Cuernavaca and also looked at hospitals and other facilities in these communities as well as surveying the literature on cross-border utilization. Our conclusion at that time was that such coverage would be advantageous to Americans living in Mexico and possibly could save the Medicare program funds as well. Subsequent research related to this study included an examination of the ways in which the U.S. and Mexico could cooperate in providing health services in the future and a study of NAFTA and trade in medical services between the U.S. and Mexico. Although the second and third studies were somewhat tangential to the issue one might legitimately ask why we have undertaken the current study. The reason is simply that in spite of our conclusions eight years ago, there has been no appreciable movement toward examining the issue of Medicare coverage in Mexico. It has also become fairly clear that the Health Care Financing Administration (HCFA) would be unlikely to undertake such a significant change in coverage without a trial, such as a demonstration project. Because of the dispersed nature of the potential beneficiaries, their limited sophistication regarding reimbursement and health policy matters, and the lack of knowledge about the Mexican health system and U.S. retirees to Mexico in Washington, it has become clear that further investigation and fact-finding would be necessary to get this issue to the discussion stage. This report is the first part of that process. During 1998-1999, a second project will take place that will include a conference at which these findings and suggestions will be presented to an audience that will include retirees, health insurers, HCFA, providers, and other interested parties. Our goal with this project and the one to follow are to provide the background and to identify the relevant issues so that one or more demonstration projects can be initiated to test the impact of alternative changes in reimbursement policy.
A Guide to Understanding Mental Health Systems and Services in Texas
(Hogg Foundation for Mental Health, 2012-11) Hogg Foundation for Mental Health
The purpose of this report is to provide a general overview of the behavioral health care delivery system and the services provided under various state agencies that are funded in full or in part with state appropriations. To ensure this document is a useful reference tool, it does not provide significant detail on the various programs but instead focuses on the general infrastructure, funding and services provided. The report is designed to provide the reader with a basic understanding of how behavioral health services are provided, the population that is served, and the challenges of meeting the growing and often unmet needs of Texans with mental health or substance use conditions. For policymakers who struggle with many complex matters and decisions, we hope this report will be a useful guide, providing practical and accurate information on mental health services in Texas.
Impact of Medicare Part D on prescription use, health care expenditures, and health services utilization : national estimates for Medicare beneficiaries and vulnerable populations, 2002 to 2009
(2012-08) Cheng, Lung-I; Rascati, Karen L.; Barner, Jamie C.; Lawson, Kenneth A.; Strassels, Scott A.; Warner, David C.
The purpose of this study was to investigate the impact of Medicare Part D on prescription utilization, health services utilization, and health care expenditures in the general Medicare population – as well as Medicare sub-populations, including non-Hispanic blacks (NHBs), Hispanics, near poor individuals, and persons with higher disease burden. A retrospective analysis of Medicare beneficiaries (N=32,228) was conducted using the Medical Expenditure Panel Survey 2002 to 2009 data. Multivariable quantile regression was used to estimate the following outcomes, adjusting for socio-demographic characteristics: 1) number of prescription fills; 2) out-of-pocket (OOP) drug expenditures; 3) total drug expenditures; 4) OOP health care expenditures; 5) total health care expenditures; 6) number of hospitalizations; and 7) number of emergency department (ED) visits between the pre-Part D (2002-2005) and post-Part D (2006-2009) periods. All expenditures were inflation-adjusted to 2009 dollars. The average age of the study sample was 71.0 (SD=14.5). In the general Medicare population, Part D was associated with decreases in OOP drug expenditures (-25.7% to -33.6%; p<0.0001) and OOP health care expenditures (-22.1% to -24.3%; p<0.0001) as well as increases in the number of prescription fills (5.8% to 8.4%; p<0.0001) and total drug expenditures (75th percentile: 5.5%; 90th percentile: 10.2%; p<0.0001). Part D was not associated with changes in total health care expenditures in the general Medicare population. Changes in hospitalizations and ED visits were tested at the 90th percentile, and the results were not statistically significant. In sub-group analyses based on race/ethnicity, non-Hispanic whites (NHWs) experienced more significant reductions in OOP drug and/or health care expenditures when compared with NHBs and Hispanics. Near poor beneficiaries experienced larger reductions in OOP drug expenditures than beneficiaries with middle- to high-income, while Medicare beneficiaries with three or more conditions experienced more substantial reductions in OOP drug and OOP health expenditures after Part D was introduced, compared with those with fewer than three conditions. Part D resulted in increases in medication utilization and reductions in OOP drug and OOP health care expenditures among Medicare beneficiaries. Part D was not associated with differences in total health care spending. The effects of Part D were more pronounced in Medicare subgroups, including NHWs, near poor individuals, and patients with higher chronic disease burden.
Letter to Medicare from Henryk B. Stenzel on 1968-02-28
(1968-02-28) Stenzel, Henryk B.
Medicare in Mexico: Innovating for Fairness and Cost Savings
(LBJ School of Public Affairs, The University of Texas at Austin, 2007) Warner, David C.
This publication presents the results of a policy research project conducted during the 2006-2007 academic year that examined the availability of health coverage for U.S. retirees in Mexico. The project surveyed more than 1,000 retirees in Mexico, and students visited five retirement locations in Mexico. The students also researched Medicare and TRICARE and developed information on licensure of hospitals and physicians in Mexico and on immigration rules and limitations. In addition to presenting this research, this volume also includes the proceedings of a day-long conference held in Austin, Texas, on March 30, 2007, which included health care providers, retirees, regulators, and insurers.
Medicare in Mexico: Innovating for Fairness and Cost Savings, PRP 156
(LBJ School of Public Affairs, 2007) Warner, David C.
Medicare in Mexico: Innovating for Fairness and Cost Savings, PRP 156
(LBJ School of Public Affairs, 2007) Warner, David C.
The Program of All-Inclusive Care for the Elderly: A Qualitative Study on Three Sites in a Southwestern State
(2017-12) Asher, Lucas; Angel, Jacqueline
The PACE program offers an opportunity for states to deliver social and health services to its most vulnerable citizens using a capped number of state and federal funds. In my thesis, I examine whether PACE is an ideal model of care to serve this frail population by comparing and contrasting three operating PACE sites in a Southwestern state.
A structure by no means complete : a comparison of the path and processes surrounding successful passage of Medicare and Medicaid under Lyndon Baines Johnson and the failure to pass national health care reform under William Jefferson Clinton
(2009-08) Johnson, David Howard; DiNitto, Diana M.
In this comparative policy development analysis, I utilize path-dependence theory and presidential records to analyze President Lyndon Johnson's success in passing Medicare and Medicaid and President Bill Clinton's failure to pass national health care reform. Findings support four major themes from the Johnson administration: 1) President Johnson had a keen understanding of the importance of language in framing debate; 2) He placed control of the legislative process in the hands of a small, select group of seasoned political operatives and career policymaking professionals; 3) He paid considerable attention to the details of negotiations and the policy consequences; and 4) He had a highly developed sense of the political and legislative processes involved in passing major legislation. The case study of the Clinton administration reveals five major themes: 1) There is a lack of evidence that President Clinton remained actively engaged throughout the policy development and legislative processes, instead choosing to delegate the process to the First Lady; 2) There was a naiveté on the part of the Clintons and many administration staff members with regard to the legal and political ramifications of their decisions; 3) The Clintons tried to make the plan fully their own, sharing little credit for its development with Congress; 4) Their attempts to incorporate existing corporate health care delivery structures with their vision for universal coverage proved unworkable; and 5) The extended time from task force launch to bill delivery gave opponents ample time to marshal their opposition forces. I conclude that in developing health care legislation, Johnson had the advantages of: 1) a small group of key policymakers; 2) multiple, simultaneous legislative initiatives which diffused the attention of a more limited media; and, 3) national crises which promoted an environment conducive to sweeping policy change. I suggest that major, national health care reform will not occur until: 1) an economic or geopolitical crisis sets the stage for change; 2) business interests and progressive interests find common ground; and, 3) Americans achieve a new cultural understanding of universal health care as both economically just and economically necessary.
A Study of the Feasibility of Health Maintenance Organizations for Texas, PRP 11
(LBJ School of Public Affairs, 1975) Todd, Jerry D.; Haynie, Sarah; Collero, Monti; Anderson, Lynn F.
Transitioning to Medicare’s Value-Based Models within Primary Care: Business Practices for Success
(2021-05) Spradley, Parker; Nauert, Richard
The United States spends an estimated 18% of its GDP on healthcare, more than all other developed countries, but has worse outcomes than most of them. Americans agree healthcare requires reform. Primary care reform is particularly important because strong primary care systems are highly correlated with improved health outcomes and lower healthcare costs. Previously, Medicare clinicians were compensated through a volume-based model, which reimbursed clinicians based on the number of procedures or services they performed and lacked cost-control incentives. However, the Centers for Medicare & Medicaid Services (CMS) began pushing strongly towards value-based reform in 2008. In a recent effort to improve healthcare quality while lowering costs, the CMS passed legislation in 2015 that mandated participation of certain providers in their value-based payment models, Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). These models require providers to assume greater financial risk and to report patient outcomes in greater detail. Providers report a lack of guidance and a steep learning curve during the transition to a value-based system. This study analyzes the MIPS and APM models and proposes a set of guidelines for transitioning to Medicare’s value-based models. The business practices for success identified in these guidelines were obtained through a qualitative analysis of trends from value-based medical practice case studies. Primary care providers can best prepare for value-based reimbursement by coordinating and integrating with a network of hospitals and other providers, standardizing EHRs across the provider network, and generating real-time performance reports. They may also develop medical condition-specific protocols and create initiatives to boost patient and provider engagement.