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.

Did the Affordable Care Act Contain Costs?

Issue Brief
Feb. 20, 2020

The Affordable Care Act was designed to curb the growth of health care costs as it broadly expanded coverage. Through provider payment reductions, alternative payment models, and a commission to enforce growth targets, the ACA sought to rein in Medicare spending. Through a tax on high-cost employer plans and competition in individual marketplaces, it sought to influence spending in the private market as well. But a number of provisions were never implemented, limiting the ACA’s impact on costs. While statutory reductions in Medicare provider rates have slowed cost growth in Medicare, they are not likely to be sustainable in the long term. Changing the trajectory of cost growth remains a challenge for future reform efforts.

Revisiting CHIP Buy-In Programs for Children

Issue Brief
Feb. 14, 2020

States have a long history of providing families with the option to purchase Medicaid or Children’s Health Insurance Program (CHIP) coverage for their children, but these programs have dwindled in recent years. In a February 2020 Health Affairs blog post, we review states’ experiences with buy-in programs for children, present updated information on the four remaining CHIP buy-in programs, and compare them to child-only coverage on the individual market. This document provides an overview of our findings.

When Should Medicare Mandate Participation In Alternative Payment Models?

Amole Navathe19-head
Feb. 3, 2020

Joshua M. Liao, Mark V. Pauly, Amol S. Navathe

ABSTRACT [from journal]

The Centers for Medicare and Medicaid Services continues to propose and implement alternative payment models (APMs) to shift Medicare payment away from fee-for-service and toward approaches that emphasize health care value. As APMs expand in scope, one critical question is whether they should engage providers on a voluntary or a mandatory basis. Clinicians and


Medicare SNF Payment Policy: What a Difference a Day Makes

Dec. 19, 2019

It is hardly surprising that there’s a spike in the number of Medicare patients discharged from postacute care in a skilled nursing facility (SNF) the day before their copayment jumps from $0 to more than $150. However, the question remains whether this payment policy – which completely covers the first 20 days of a SNF stay – affects patient outcomes in any way.

Insurance Impacts Survival for Children, Adolescents, and Young Adults with Bone and Soft Tissue Sarcomas

Lena Winestone, MD,MS
Dec. 15, 2019

Neela L. Penumarthy, Robert E. Goldsby, Stephen C. Shiboski, Rosanna Wustrack, Patricia Murphy, Lena E. Winestone

Abstract [from journal]

Background: While racial/ethnic survival disparities have been described in pediatric oncology, the impact of income has not been extensively explored. We analyzed how public insurance influences 5‐year overall survival (OS) in young patients with sarcomas.

Methods: The University of California San Francisco Cancer Registry was used to identify patients aged 0‐39 diagnosed