Publicly-funded programs that cover medical and long-term care for low-income adults, children, and people with disabilities. Medicaid expansion is one of the central tools to increase insurance coverage rates through the Affordable Care Act.

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


Impact Of Medicaid Expansion On Women With Gynecologic Cancer: A Difference-In-Difference Analysis

Sep. 7, 2020

Benjamin B. Albright, Dimitrios Nasioudis, Stuart Craig, Haley A. Moss, Nawar A. Latif, Emily M. Ko, Ashley F. Haggerty

Abstract [from journal]

Background: Women with gynecologic cancer face socioeconomic disparities in care that impact survival outcomes. The Affordable Care Act offered states the option to expand Medicaid enrollment eligibility criteria as a means of improving timely and affordable access to care for the most vulnerable. Variable uptake of expansion by states created a natural experiment, allowing for quasi-experimental methods, which offer more unbiased estimates of treatment effects from retrospective data than traditional regression


Achieving Better Postpartum Care

Jul. 30, 2020

The year after giving birth is an important one for mothers and their infants. Care delivered during this period is critical to improving mother and infants’ long-term health and reducing future health risks. However, a recent study shows that all too often, this is a missed opportunity to deliver important preventive care to adult women.

Economic Outcomes Of Insurer-Led Care Management For High-Cost Medicaid Patients

Jul. 13, 2020

Jordan M. Harrison, Arman Oganisian, David T. Grande, Nandita Mitra, Manik Chhabra, Krisda H. Chaiyachati

Abstract [from journal]

Objectives: To evaluate the impact of the Community-Based Care Management (CBCM) program on total costs of care and utilization among adult high-need, high-cost patients enrolled in a Medicaid managed care organization (MCO). CBCM was a Medicaid insurer-led care coordination and disease management program staffed by nurse care managers paired with community health workers.

Study design: Retrospective cohort analysis.

Methods: We obtained deidentified health plan claims


What Do We Know About Health Insurance Choice?

Issue Brief
Jun. 30, 2020

From choosing a doctor to selecting an insurance plan, choices pervade nearly all aspects of our health care system. However, there is little agreement among policymakers and the public about what constitutes “choice,” which choices are important, and how and whether patients should be asked to make various health care choices. Although Americans claim to value having health insurance choices, research shows that when presented with options, people do not actually like to choose. Other studies suggest that people frequently make health insurance decisions that leave them worse off, or not much better than before. At Penn LDI’s Medicare for All and Beyond conference, a panel of researchers and policy experts discussed the current evidence around health insurance choice and implications for future health care reform efforts. This brief summarizes the panel’s key takeaways.

Payment and Pricing Decisions in Health Care Reform

Issue Brief
Jun. 23, 2020

Any effort to reform health insurance in the United States must tackle the prices we pay for health care. There are many complex challenges to addressing prices. Some proposals build on the existing Medicare fee schedule, while others suggest promoting alternative payment mechanisms—or even starting from scratch. The stakes are substantial, as many reform proposals rely on reining in prices to achieve the savings necessary to expand health insurance to the uninsured. At Penn’s LDI Medicare for All and Beyond conference, a panel of researchers, hospital administrators, and policy experts considered issues related to health care payment and pricing that any health care reform proposal must address, including the implications of rate setting for providers and patients. At what level should these rates be set to assure access and quality of care, while incentivizing innovation and rewarding excellence?

Setting Standards for Affordable Health Care

Issue Brief
Jun. 16, 2020

In the run-up to the presidential election, the affordability of health care remains a top concern of the American voting public. But how do we know when health care is affordable? On a policy level, how do we set a standard for affordability that can be implemented in a reformed system? Sometimes policy debates about affordability focus only on whether insurance premiums are affordable, although consumers tend to be concerned about both premiums and out-of-pocket costs. At Penn LDI’s Medicare for All and Beyond conference, a panel of researchers, policy experts, and consumer advocates discussed and debated affordability in theory and practice. This issue brief summarizes the panel’s insights.

Association of State Medicaid Expansion With Hospital Community Benefit Spending

May. 29, 2020

Genevieve P. Kanter, Bardia Nabet, Meredith Matone, David M. Rubin

Abstract [from journal]

Importance: Medicaid expansion was widely expected to alleviate the financial stresses faced by hospitals by providing additional revenue in the form of Medicaid reimbursements from patients previously receiving uncompensated care. Among nonprofit hospitals, which receive tax-exempt status in part because of their provision of uncompensated care, Medicaid expansion could have released hospital funds toward other community benefit activities.

Objective: To examine changes in nonprofit hospital spending on...