Public Insurance and the Uninsured Featured Topics in Inquiry's 2013 Spring Issue

ROCHESTER, NY (05/13/2013)(readMedia)-- Public health expansions and income, the effect of consumer incentives on health care compliance, spillover effects from the uninsured population, and states' commitment to Medicaid prior to reform are all explored in Inquiry's spring issue:

"How Do Public Health Expansions Vary by Income Strata? Evidence from Illinois' All Kids Program," by James Lo – Using expansion of the Illinois All Kids program to examine "crowd-out" from public insurance among higher income populations, this study found that among children with family incomes between 200 and 300 percent of the federal poverty level (FPL), 35 percent of those covered by All Kids would have retained private health insurance in the absence of the All Kids program. Substitution of public insurance for private insurance was even greater among children with family incomes between 300 and 400 percent FPL. Surprisingly, among those with family incomes between 400 and 500 percent FPL, the All Kids expansion produced "crowd-in" --- that is, an increase in private health coverage. All Kids, Illinois' State Children's Health Insurance Program (SCHIP), extended public coverage to children of all income levels in 2006.

"The Effect of Consumer Incentives on Medicaid Beneficiaries' Compliance with Well-Child Visit Guidelines," by John A. Nyman, Jean M. Abraham, and William Riley – This study evaluated the effectiveness of an incentive --- a Target gift card --- offered by a Minnesota health plan to Medicaid beneficiaries for complying with preventive care recommendations. The study suggests that the Target gift card increased significantly the likelihood that a youngster would have a well-child visit, and the likelihood was greater the closer a Medicaid beneficiary lived to a Target store.

"Spillover Effects of the Uninsured: Local Uninsurance Rates and Medicare Mortality from Eight Procedures and Conditions," by Stacey McMorrow – While the presence of a large uninsured population may change incentives for providers regarding offered services and thus affect a health care market's quality of care and outcomes, this study found no large or widespread negative "spillover" effects of the uninsurance rate on mortality for Medicare beneficiaries. However, the evidence was not so clear-cut for smaller markets, and suggests that the link between the uninsurance rate and Medicare mortality varies by market size.

"States' Commitment to Medicaid Before the Affordable Care Act: Trends and Implications," by Joel C. Cantor, Frank J. Thompson, and Jennifer Farnham – Looking at historical trends, this paper notes that nearly all states ratcheted up their Medicaid effort in the period 1992 to 2009, when changes in federal law gave states more flexibility in running Medicaid programs. While this holds promise that most states will sustain their programs and ultimately participate in the expansions authorized by the Affordable Care Act (ACA), the authors say Medicaid growth did not curtail geographic disparities in program benefits and variation among state Medicaid programs will not disappear even if all states eventually participate in the ACA.

Also featured in INQUIRY's Spring issue:

"Perspective: Medical Loss Ratio Regulation under the Affordable Care Act," by Scott E. Harrington – Under the ACA, health insurance plans must spend a specific percentage of the insurance premium income on medical care and certain activities to improve health care quality; plans that fail to meet this medical loss ratio (MLR) requirement must rebate the shortfalls to their enrollees. This paper analyzes potential unintended consequences and effects of the regulations, such as: higher medical costs and premiums for some insurers; less innovation to align consumer, provider, and health plan incentives; less consumer choice and increased market concentration; and the risk that insurers will pay rebates because actual claim costs differ from projections due to market volatility. The author offers some modifications and alternatives to help the MLR achieve its goals with fewer adverse effects.

"The View from Here: A Matter of Trust," by Alan C. Monheit – In this column, INQUIRY's editor points to some of the recent medical and food safety scandals that have plagued our nation to emphasize the importance of trust, not only in regard to health care providers and institutions, but more broadly as an essential component of an effective system of economic transactions.

INQUIRY, the journal of health care organization, provision, and financing, is entering its 50th year. The nonprofit Excellus Health Plan, Inc., publishes INQUIRY; the journal maintains a freelance editorial staff and is run as an independent, peer-reviewed, quarterly academic journal. Press releases and article abstracts are available on the INQUIRY website at www.inquiryjournal.org under "Current Issue Table of Contents."