The federal program that covers medical care for people age 65 or older, younger people with disabilities, and people with End-Stage Renal Disease. Medicare covers about 13% of the US population and makes up a fifth of national health expenditures.

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.

Risk Factors for Long-term Mortality and Patterns of End-of-Life Care Among Medicare Sepsis Survivors Discharged to Home Health Care

Feb. 5, 2020

Katherine R. Courtright, Lizeyka Jordan, Christopher M. Murtaugh, Yolanda Barrón, Partha Deb, Stanley Moore, Kathryn H. Bowles, Mark E. Mikkelsen

Abstract [from journal]

Importance: Despite a growing recognition of the increased mortality risk among sepsis survivors, little is known about the patterns of end-of-life care among this population.

Objective: To describe patterns of end-of-life care among a national sample of sepsis survivors and identify factors associated with long-term mortality risk and hospice use.

Design, Setting, and Participants: This cohort study assessed sepsis survivors who were Medicare fee-for-service beneficiaries discharged to


Do Incentive Payments Improve Home-Based Primary Care?

Feb. 4, 2020

After five years, a small experiment to improve care for frail elderly patients receiving primary care at home has delivered some savings to Medicare—although it might be too small to know for sure. Authorized by the Affordable Care Act, the Independence at Home (IAH) Demonstration is part of a broader strategy of testing innovative ways to pay for value in health care—tying additional payment to higher quality care and cutting wasteful spending.

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.

Sepsis Survivors Transitioned to Home Health Care: Characteristics and Early Readmission Risk Factors

Dec. 11, 2019

Kathryn Bowles,Christopher Murtaugh, Lizeyka Jordan, Yolanda Barrón, Mark Mikkelsen, Christina Whitehouse, Jo-Ana D.Chase, Miriam Ryvicker, Penny Hollander Feldman

Abstract [from journal]

Objective: To profile the characteristics of growing numbers of sepsis survivors receiving home healthcare (HHC) by type of sepsis before, during, and after a sepsis hospitalization and identify characteristics significantly associated with 7-day readmission.

Design: Cross-sectional descriptive study. Data sources included the Outcome and Assessment Information Set (OASIS) and Medicare administrative and claims data.


Could a Public Health Insurance Option Lead to More Competitive Markets?

Issue Brief
Dec. 10, 2019

Calls for the establishment of a “public option,” which emerged during the debate on the Affordable Care Act, have reemerged in this election season. Some proposals base the public option on Medicare, while others on Medicaid. In this article, Wharton professor and LDI Senior Fellow Mark Pauly discusses the likely effects of a public option on private markets, using experience in Medicare Advantage as a guide. Will the public option become the preferred one, sweeping away the private market? Or can the public and private options peacefully coexist?  

Association Between HIV Infection and Outcomes of Care Among Medicare Enrollees with Breast Cancer

Ravishankar Jayadevappa, PhD
Nov. 26, 2019

Sumedha Chhatre, Marilyn Schapira, David S. Metzger, Ravishankar Jayadevappa

Abstract [from journal]

Background: To assess the interaction of breast cancer, HIV infection, Medicare disability status, cancer stage and its implications for outcomes, after accounting for competing risks among female, fee-for-service Medicare enrollees.

Methods: We used data from Surveillance, Epidemiology and End Results (SEER) -Medicare (2000-2013). From primary female breast cancer cases diagnosed between 2001 and 2011, we identified those with HIV infection. We used Generalized Linear Model for phase-specific incremental cost


Disease-Specific Plan Switching Between Traditional Medicare and Medicare Advantage

Nov. 22, 2019

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

Abstract [from journal]

Introduction: Previous research has reported switching from traditional Medicare (TM) to Medicare Advantage (MA) plans increased from 2006 to 2011 at the aggregate level, and switching from MA plans to TM also increased. However, little is known about switching behavior among individuals with specific chronic diseases.

Objective: To examine disease-specific switching patterns between TM and MA to understand the impact on MA


Physician Consolidation and the Spread of Accountable Care Organizations

Research Brief
Nov. 4, 2019

Accountable Care Organizations (ACOs) are groups of physicians and hospitals that jointly contract to care for a patient population. ACO contracts incentivize coordination of care across providers. This can lead to greater consolidation of physician practices, which can in turn generate higher costs and lower quality. Given this, the study asks, as ACOs enter health care markets, do physician practices grow larger?