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.

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...

A Cautionary Tale About Medicaid Work Requirements

May. 14, 2020

In a new paper in JAMA Network Open, our team looked at the potential effects of Medicaid work requirements on Medicaid participation among those not actually subject to these requirements. We estimate that these “spillover effects” – which thus far have not been part of the conversation on work requirements – could be quite large. How we arrived at this answer is worth a bit of explanation.

Preventive Health Care Utilization Among Mother-Infant Dyads With Medicaid Insurance in the Year Following Birth

Mar. 6, 2020

Emily F. Gregory, Molly Passarella, Lisa D. Levine, Alexander G. Fiks, Scott A. Lorch

Abstract [from journal]

Background: Following birth, women may access preventive care in adult settings or, with their infants, in pediatric settings. Preventive care can improve future birth outcomes and long-term health, particularly for women with health risks.

Methods: This cohort study linked mother-infant Medicaid claims from 12 states for 2007-2011 births. Pregnancy claims identified health risk categories: maternal cardiovascular (diabetes, hypertension, pre-eclampsia, obesity), maternal mental health (depression, anxiety),


Medicaid Expansion’s Effects on Patients with Newly Diagnosed, Common Screenable Cancers

Feb. 24, 2020

In our study of nearly a million patients with newly diagnosed breast, colon, or lung cancer, the Affordable Care Act’s Medicaid expansion was associated with a decreased rate of uninsurance and a shift toward earlier-stage cancer diagnosis. Despite concerns that coverage expansions would result in longer wait times for treatment, my colleagues and I found no evidence that Medicaid expansion worsened access to timely cancer-directed therapies.

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.