Diane Rowland

• Kaiser Family Foundation

Policy Points • Twelve states have yet to expand Medicaid under the Affordable Care Act (ACA). Louisiana offers a model of steps that states and counties can take to rapidly enroll eligible persons while balancing eligibility integrity and doing so within a limited administrative budget. • In a post-COVID-19 health care landscape, Medicaid expansi...

Medicaid coverage matters for millions of low-income Americans, and especially for those with ongoing and serious health challenges. A source of comprehensive and affordable coverage, Medicaid has long been a cornerstone of federal and state efforts to improve access and health outcomes for very poor and medically vulnerable populations. The Afford...

Policy makers are moving rapidly to develop and test reforms aimed at doing a better job of managing the costs and care for people dually eligible for Medicare and Medicaid. This commentary underscores the importance of pursuing new initiatives to address care coordination and spending concerns. It then focuses on key issues raised by proposals tha...

For every increase of 1 percentage point in the national unemployment rate, it is estimated that an additional 1 million Americans turn to Medicaid for coverage and another 1.1 million go uninsured. Diane Rowland writes that the number of uninsured is probably approaching 50 million as we continue to weather this recession.

This article defines the problem of the uninsured. It begins with an overview of why health insurance matters and presents a profile of the uninsured. It then discusses the roles and limits of private and public health insurance as sources of coverage for the nonelderly population. The article concludes with reflections on the current health insura...

Full title: Covering America's uninsured. Weighing the options.

Before Hurricane Katrina struck in August 2005, New Orleans had a largely poor and African American population with one of the nation's highest uninsurance rates, and many relied on the Charity Hospital system for care. The aftermath of Katrina devastated the New Orleans health care safety net, entirely changing the city's health care landscape and...

Medicaid is the nation's largest health care program providing assistance with health and long-term care services for millions of low-income Americans, including people with chronic illness and severe disabilities. This article traces the evolution of Medicaid's now-substantial role for people with disabilities; assesses Medicaid's contributions ov...

The key to making Medicaid more sustainable is to make it less necessary: By addressing coverage for the uninsured. By having Medicare offer more comprehensive coverage and long-term care assistance to its low-income beneficiaries. By providing an alternative to Medicaid's spend-down to impoverishment to gain assistance with long-term care costs.

This article examines Medicaid's evolution over the last four decades in its role as a health insurer for low-income families, a source of health and long-term care (LTC) coverage for people with disabilities, and as the supplement to Medicare for low-income aged and disabled Medicare beneficiaries. Medicaid's role and impact on each of these benef...

This article has no abstract; the first 100 words appear below. Today, Medicaid helps to finance health and long-term care for more than 55 million low-income children and parents, people with severe disabilities, and elderly Americans, at an annual cost of nearly $300 billion to the federal and state governments. The program currently provides hea...

This paper documents the availability, enrollment, premiums, and cost sharing for high-deductible health plans that are offered with a health reimbursement arrangement (HRA) or are health savings account (HSA)-qualified plans. Almost 4 percent of employers that offer health benefits offer one of these arrangements in 2005, covering about 2.4 millio...

This paper reports findings on the state of job-based health insurance in spring 2005 and how it has changed during recent years. Premiums rose 9.2 percent, the first year of single-digit increases since 2000. The percentage of firms offering health benefits has fallen from 69 percent in 2000 to 60 percent in 2005. Cost sharing did not grow appreci...

This paper reports changes in employer-based insurance during the past year and since 2001. From spring 2003 to spring 2004, premiums increased 11.2 percent (compared with 13.9 percent last year). Since 2000, premiums have increased 59 percent. Since 2001, employee contributions have grown by 57 percent for single coverage and 49 percent for family...

Lack of health insurance coverage is a large and growing problem for millions of American families. Rising health care costs and economic insecurity continue to threaten the bedrock of the health insurance system - employer-sponsored coverage - while states’ fiscal situations and the escalating federal deficit complicate any efforts at reform. Prov...

Although Medicaid was not designed as a mental health program, it is now a major source of financing for mental health services and care, especially for the chronically mentally ill. This paper examines the role Medicaid plays today for the low-income population with mental health needs and then reviews some of the current pressures and challenges...

This paper reports changes in job-based health insurance from spring 2002 to spring 2003. The cost of health insurance rose 13.9 percent, the highest rate of increase since 1990. Employers required larger contributions from employees for the monthly cost of health insurance. Separate copayments and deductibles for hospital services have become comm...

America's public health insurance programs reflect a deeply rooted commitment to caring for low-income families and children. This article chronicles the evolution of Medicaid and the State Children's Health Insurance Program (SCHIP), two public programs designed to provide free or low-cost health coverage to low-income children who do not have acc...

Drawing on a decade of analysis and examination of the Medicaid program, this paper assesses what we have learned about Medicaid--its role, its successes, and its setbacks. In the absence of universal coverage for health and long-term care, Medicaid is a critical component of our social safety net, taking on the highest-risk, sickest, and often mos...

Based on a national survey of 2,014 randomly selected public and private firms with three or more workers, this paper reports changes in employer-based health insurance from spring 2001 to spring 2002. The cost of health insurance rose 12.7 percent, the highest rate of growth since 1990. Employee contributions for health insurance rose in 2002, fro...

In this article, we seek to inform the debate over providing assistance to workers who lose their jobs during the recession by assessing the potential impact of an economic downturn on health insurance coverage and reviewing available approaches to secure coverage for unemployed workers and their families. We also summarize recent research and anal...

Drawing on the results of a national survey of 1,907 firms with three or more workers, this paper reports on several facets of job-based health insurance, including the cost to employers and workers; plan offerings and enrollments; patient cost sharing and benefits; eligibility, coverage, and take-up rates; and results from questions about employer...

This paper examines health coverage and access to care among working-age adults using the Kaiser/Commonwealth 1997 National Survey of Health Insurance. One in three (52 million) working-age adults were either uninsured at the time of the survey or had a recent gap in their health coverage in the past two years. Having even a temporary gap in health...

In a new administration and Congress, any health insurance cover- age initiative will focus on some, rather than all, Americans. Because lack of affordability is the main reason people lack coverage, most observers acknow- ledge that government-financed subsidies are needed to expand coverage. But there is considerable disagreement about how these...

To assess the public’s perceptions and attitudes about racial and ethnic differences in health care, the Kaiser Family Foundation surveyed a nationally representative sample of 3,884 whites, African Americans, and Latinos in 1999. The survey found that the majority of Americans are uninformed about health care disparities—many were unaware that bla...

Over its 35-year history, Medicaid has grown from a program to provide health insurance to the welfare population to one that provides health and long-term care (LTC) services to 40 million low-income families and elderly and disabled individu- als. Despite its accomplishments in improv- ing access to health care for low-income pop- ulations, Medic...

To assess the public's perceptions and attitudes about racial and ethnic differences in health care, the Kaiser Family Foundation surveyed a nationally representative sample of 3,884 whites, African Americans, and Latinos in 1999. The survey found that the majority of Americans are uninformed about health care disparities--many were unaware that bl...

Meeting the health care needs of millions of elderly and disabled Americans is central to the debate over Medicare's future. Using data from a nationally representative survey of 3,309 beneficiaries, Medicare's most vulnerable beneficiaries were profiled, examining variations in coverage, satisfaction, access, and financial difficulties. A substant...

Medicaid is the nation's major public financing program for providing health insurance coverage and long-term care services to the poor. This article assesses Medicaid's contributions over the last three decades to improving the coverage, access to care, and health of low-income children and women. The article reviews Medicaid's impact on the low-i...

Using survey data from 2,000 low-income adult respondents in each of five states, this DataWatch assesses how uninsured, low-income adults differ from low-income adults who have public or private insurance and how Medicaid expansions have affected insurance coverage patterns across states with different eligibility policies. Findings show that the...

The extent of unmet need, or the extent to which needed assistance is unavailable for insufficient, is an important issue in public policy and financing of health and support services. This article reviews the research of literature to assess how unmet method is measured, and the extent of unmet needs among elderly people in the community. Measurem...

FOUR YEARS AGO, in the presidential campaign, in major medical journals and medical associations, in the media, and in civic groups, our nation was engaged in a great debate about the best way to provide health insurance coverage to all Americans. By contrast, these debates have been conspicuous spicuous their absence in this election year, The hea...

As we reached the 30th anniversary of the enactment of Medicare, widespread national debate about the future of the program continues. The controversy involves strong disagreements over Medicare's short-term future as well as the shape the program should take in the next century. Health policy experts, national politicians, and opinion leaders have...

Since its enactment in 1965, Medicaid has been on the front lines in meeting the health needs of our nation's most vulnerable populations. It has evolved from the companion legislation to Medicare that provided health financing to states for coverage of their welfare population, to a program that now finances health and long-term care services for...

Assessment of experiences with health care will continue to be important given the rapid changes in the health care system and retreat from broad national attention on health reform. This paper reports on the findings of the 1993 Kaiser/Commonwealth Survey of Americans and their health insurance. The survey findings highlight the chronic problem of...

Medicaid offers important lessons about providing access to office-based physician services for the poor. First, differentials in physician fees between Medicaid and other payers compromise access to care and are difficult to reverse. Second, managed care alone is not enough to attain equity in access, especially if differentials in payment rates b...

Medicaid spending more than doubled from 1988 to 1992, reversing a long trend of cost containment in the program. Reasons for the cost explosion are severalfold. (1) Congress expanded eligibility to more children, pregnant women, and low-income elderly persons. (2) The recession has added more people to the Medicaid rolls. (3) Growing numbers of di...

Long-term care has been described as the "missing piece" in many healthcare reform proposals. Yet the cost of nursing home care often exceeds that of acute care, especially for the elderly with Alzheimer's disease. In this final installment of a three-part roundtable discussion, panelists discuss the options for providing long-term care, such as so...

Part 1 of this roundtable discussion [Geriatrics 1992; 47(Sept):34-48] examined the flaws in our current healthcare system and factors that are interfering with our nation's ability to achieve reforms. This month, the panelists discuss the benefits and drawbacks of the major healthcare reform proposals, including managed care, single-payer systems,...

During the summer of 1991, the Soviet people brought the Communist party to its knees, demanding an end to centralized control and autonomy for the Soviet republics. Even before these dramatic events took place, Soviet reformers were striving to reconstruct a health care system plagued by ''chronic underfunding, antiquated and deteriorating facilit...

Despite an overall decline in the rate of poverty among elderly people in recent decades, certain subgroups of the elderly still suffer from high poverty rates. These include elders living alone, minorities, the very old, and widows. The gap between these vulnerable subgroups and more affluent elders is expected to grow in the decades to come. The...

In Reply.— The testimony cited in our article summarized the findings of research studies undertaken by the Inspector General and General Accounting Office in 1988 and 1989 and was presented before the Subcommittee on Health of the Committee on Ways and Means of the US House of Representatives on June 1, 1989.1 Both studies involved primary data c...

The Soviet Union is undergoing a peaceful—but massive—revolution. Everywhere, old institutions are being challenged, and old beliefs are being rejected. Soviet society is beginning to ferment with entrepreneurial zeal, a thrust toward decentralization and democratization of decision making, and a blossoming of interest in competition and free enter...

This article reviews the existing literature on urban and rural differences for the uninsured population and presents new analyses to supplement earlier research to identify issues for future research. The extent of poverty in urban and rural areas and the scope of insurance coverage for the nonelderly population is discussed in the first section o...

Prologue: Five years ago, as a consequence of intense fiscal pressures on states and the federal government's new willingness to grant them broader flexibility in casting health policy, many states began to re- shape their Medicaid programs. The Omnibus Budget Reconciliation Act of 1981 was the first most sweeping in a continuing series of fed- era...

Most of the improvement--both absolute and relative--in the health status of black Americans over the past two decades can be traced to major gains in access to health care services. Public payment programs, most notably Medicaid and Medicare, have not only reduced financial barriers, but have also combatted those of racial discrimination. Other fe...

It has become fashionable in recent months to herald the reduction in rising health care costs-with many volunteers lining up to take the credit. The Reagan administration has pointed to the Medicare prospective payment system initiated in October 1983 as a major factor in the slowing trend. Avertisements taken out by the American Hospital Associat...

The original and continuing promise of Medicare can be preserved only through a complex package of fiscal reforms. Central to this should be a merger of Hospital Insurance and Supplementary Medical Insurance into a single Medicare trust fund, financed in part through income-related beneficiary premiums. Benefits could be expanded, while improving a...

The increasing lack of insurance-public and private-is inversely related to ability to bear the economic consequences of ill health. With economic recession, high unemployment, and declining revenues, state and local governments cannot offset federal cutbacks. In a health care industry that is becoming an entrepreneurial business there is little ro...

Drawing on a decade of analysis and examination of the Medicaid program, this paper assesses what we have learned about Medicaid—its role, its successes, and its setbacks. In the absence of universal coverage for health and long-term care, Medicaid is a critical component of our social safety net, taking on the highest-risk, sickest, and often most...