Health Insurance

Financial and structural characteristics of the public and private programs that cover medical costs. LDI analyzes how to expand and improve coverage through insurance exchanges, employer-sponsored insurance, and public programs.

ACA Dependent Coverage & Young Adults with Cancer

Dec. 2, 2020

As the Supreme Court mulls yet another challenge to the constitutionality of the Affordable Care Act (ACA), we have new evidence of the law’s positive impact on young adults, who were allowed to stay on their parents’ insurance until age 26 under the Dependent Coverage Provision (DCP). The ACA helped young adults with cancer maintain continuous coverage, which is key to maintaining access to cancer treatment.

How Do Claims-Based Measures Of End-Of-Life Care Compare To Family Ratings Of Care Quality?

Nov. 9, 2020

Thomas J. Christian, Andrea Hassol, Gabriel A. Brooks, Qian Gu, Seyoun Kim, Mary Beth Landrum, Nancy L. Keating

Abstract [from journal]

Objectives: Assess whether frequently-used claims-based end-of-life (EOL) measures are associated with higher ratings of care quality.

Design: Retrospective cohort study.

Setting/participants: Deceased fee-for-service Medicare beneficiaries with cancer who underwent chemotherapy during July 2016 to January 2017 and died within 12 months and their caregiver respondents to an after-death survey (n = 2,559).

Measurements: We examined claims-based


Spillover Effects Of Mandatory Hip And Knee Replacement Surgery Bundles In Medicare

Amole Navathe, MD, PhD
Oct. 28, 2020

Joshua M. Liao, Robin Wang, Akriti Mishra, Ezekiel J. Emanuel, Jingsan Zhu, Deborah S. Cousins, Amol S. Navathe

Abstract [from journal]

Background: Medicare used the Comprehensive Care for Joint Replacement (CJR) Model to mandate that hospitals in certain health care markets accept bundled payments for lower extremity joint replacement surgery. CJR has reduced spending with stable quality as intended among Medicare fee-for-service patients, but benefits could "spill over" to individuals insured through private health plans. Definitive evidence of spillovers remains lacking.

Objective: To evaluate the association between CJR


Impact Of Dependent Coverage Provision Of The Affordable Care Act On Insurance Continuity For Adolescents And Young Adults With Cancer

Jeffrey H. Silber, MD, PhD
Oct. 22, 2020

Lena E. Winestone, Lauren L. Hochman, James E. Sharpe, Elysia Alvarez, Laura Becker, Eric J. Chow, Joseph G. Reiter, Jill P. Ginsberg, Jeffrey H. Silber

Abstract [from journal]

Purpose: The 2010 Dependent Coverage Provision (DCP) of the Affordable Care Act (ACA) allowed enrollees to remain on their parents' health insurance until 26 years of age. We compared rates of insurance disenrollment among patients with cancer who were DCP-eligible at age 19 to those who were not eligible at age 10.

Methods: Using OptumLabs Data Warehouse, which contains longitudinal, real-world, de-identified administrative claims for commercial enrollees, we examined


Who Joins The Franchise, Affiliation Model Of Hospital Networks? An Analysis Of Hospital And Market Characteristics Of Members

Ingrid Nembhard, PhD
Oct. 19, 2020

Bonnie Jin & Ingrid M. Nembhard

Abstract [rfom journal]

Joining nonownership based, organization-driven networks and alliances is a common strategy for hospitals to pursue yet little is known about what types of hospitals join these collaborations, due in part to challenges in identifying members. One novel network form that has recently emerged, and made identification feasible, is franchise-like "affiliation networks" in which affiliate hospitals pay an annual membership fee that allows access to the clinical expertise and resources of high-status, nationally ranked sponsor hospitals.


The Design Of A Randomized Controlled Trial To Evaluate Multi-dimensional Effects Of A Section 1115 Medicaid Demonstration Waiver With Community Engagement Requirements

Oct. 7, 2020

Kristin A. Linn, Kristen Underhill, Erica L. Dixon, Elizabeth F. Bair, William J. Ferrell, Margrethe E. Montgomery, Kevin G. VolppAtheendar S. Venkataramani

Abstract [from journal]

Section 1115 demonstration waivers provide a mechanism for states to implement changes to their Medicaid programs. While such waivers are mandated to include evaluations of their impact, randomization - the gold standard for assessing causality - has not typically been a consideration. In a critical departure, the Commonwealth of Kentucky opted to pursue a two-arm randomized controlled trial (RCT) for their controversial 2018 Medicaid Demonstration waiver, which included work requirements as a condition for the subset of


Oral Health in the Global Push for Universal Health Coverage

Sep. 29, 2020

The essential nature of dental care was evident when many dental clinics across the United States closed in Spring 2020 due to the pandemic. Patients with dental emergencies (commonly tooth infections with painful orofacial abscesses) were triaged via telemedicine or given temporary solutions, such as antibiotics and analgesics, until dental offices could be reopened and provide more permanent solutions (i.e., root canal treatment or extraction).

Drug Reimbursement Regulation In 6 Peer Countries

Sep. 28, 2020

Ezekiel J. Emanuel, Cathy Zhang, Aaron Glickman, Emily Gudbranson, Sarah S. P. DiMagno, John W. Urwin

Abstract [from journal]

The US has nearly 4.5% of the world's population but accounts for more than 40% of global drug spending. With the upcoming 2020 election, a top priority of many voters is to better control drug prices and reform the pharmaceutical market. In this Special Communication, the drug price mechanisms and government regulations used in 6 representative peer countries are evaluated: Australia, France, Germany, Norway, Switzerland, and the United Kingdom. Drug price regulation is compared with that currently used in the US


Medicaid Expansion And Ventricular Assist Device Implantation

Sep. 14, 2020

Sameed Ahmed M. Khatana, E. Wilson Grandin, J. Eduardo Rame, Changyu Shen, Robert W. Yeh and Peter W. Groeneveld

Abstract [from journal]

Durable ventricular assist device (VAD) therapy improves survival in patients with refractory heart failure with reduced ejection fraction, but is inaccessible to uninsured patients due to high cost. Medicaid expansion under the Affordable Care Act increased health insurance coverage for low-income

Differences In Health Care Utilization, Process Of Diabetes Care, Care Satisfaction, And Health Status In Patients With Diabetes In Medicare Advantage Versus Traditional Medicare

Norma Coe, PhD
Sep. 10, 2020

Sungchul Park, Eric B. Larson, Paul Fishman, Lindsay White, Norma B. Coe

Abstract [from journal]

Objective: The objective of this study was to determine differences in health care utilization, process of diabetes care, care satisfaction, and health status for Medicare Advantage (MA) and traditional Medicare (TM) beneficiaries with and without diabetes.

Methods: Using the 2010-2016 Medicare Current Beneficiary Survey, we identified MA and TM beneficiaries with and without diabetes. To address the endogenous plan choice between MA and TM, we used an instrumental variable approach. Using


Assessment Of Receipt Of The First Home Health Care Visit After Hospital Discharge Among Older Adults

Sep. 1, 2020

Jun Li, Mingyu Qi, Rachel M. Werner

Abstract [from journal]

Importance: Home health care is one of the fastest growing postacute services in the US and is increasingly important in the era of coronavirus disease 2019 and payment reform, yet it is unknown whether patients who need home health care are receiving it.

Objective: To examine how often patients referred to home health care at hospital discharge receive it and whether there is evidence of disparities.

Design, setting, and participants: This cross-sectional study used