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Publications
Who Has Insurance and Who Does Not in the District of Columbia? (Policy Briefs/Health Policy Briefs) Author(s): Allison Cook, Barbara A. Ormond DC fares better than the nation as a whole in the share of its population that is uninsured. Lower rates of employer-sponsored coverage are more than offset by higher rates of public coverage. The District's relatively generous Medicaid eligibility standards, and the DC HealthCare Alliance, a locally funded coverage program, contribute to the high share of publicly insured residents. Although all low-income individuals are eligible for either Medicaid or the Alliance, some 66,000 residents remain uninsured. These are among the findings of this data brief on insurance status in DC by age, employment, income, family status, and health status.
Can California's Proposed Coverage Reform Be a Model for the District of Columbia? (Policy Briefs/Health Policy Briefs) Author(s): Stephen Zuckerman, Barbara A. Ormond The ongoing debate in California over two competing 2007 proposals for universal health coverage highlights both the strengths and weaknesses of the current insurance system in the District of Columbia as a platform for coverage expansion. The District's advantages include its relatively small uninsured population and existing mechanisms for administering a public coverage program tied to income. But its fiscal base is relatively small compared with California's, its largely unregulated insurance market could lead to severe adverse selection problems for new programs, and it is at much greater risk for border-crossing by both individuals and businesses in response to reform.
Are Children Accessing and Using Needed Mental Health Care Services? (Policy Briefs/Health Policy Briefs) Author(s): Louise Palmer, Brigette Courtot, Embry M. Howell This brief presents data on mental health coverage benefits and enrollees' access to and use of mental health services through the Healthy Kids program in San Mateo County, California. The prevalence of mental health conditions among enrollees is similar to national levels, but despite the generous mental health benefits offered under the program, only a small fraction of enrollees with mental health conditions receive care. Reasons why more children do not use mental health services are explored. The brief also shows that enrollees with mental health needs have higher use of other health services compared to all Healthy Kids members.
Quality of Early Childhood Health Care in the Los Angeles Healthy Kids Program (Research Report) Author(s): Moira Inkelas, Patricia Barreto The Los Angeles Healthy Kids program was created in 2003 to provide health insurance to uninsured children ages 0–5 years in families with household income below 300 percent of the federal poverty level (FPL) who are ineligible for SCHIP or Medicaid. A quality of care survey sampled parents of 538 children ages 12–72 months enrolled in the program for at least one year. Results show that quality of preventive care for children in Healthy Kids has similar patterns as care for children in low-income households, both in California and nationally. Content of preventive care is well below American Academy of Pediatrics (AAP) recommendations, although it is consistent with statewide and national levels of care.
Why Health Insurance Is Important (Policy Briefs/Health Policy Briefs) Author(s): Randall R. Bovbjerg, Jack Hadley Having health insurance is important for several reasons. Uninsured people receive less medical care and less timely care, they have worse health outcomes, and lack of insurance is a fiscal burden for them and their families. Moreover, the benefits of expanding coverage outweigh the costs for added services. Safety-net care from hospitals and clinics improves access to care but does not fully substitute for health insurance. These findings are supported by much research, although some cautions are appropriate in using these results.
Increasing Health Insurance Coverage of Workers in Small Firms: Challenges and Strategies (Testimony) Author(s): Linda J. Blumberg Small employers face substantial disadvantages relative to large employers when providing health insurance to their workers. These problems can largely be summarized as higher administrative costs of insurance, limited ability to spread health care risk, and a workforce with lower wages. But the primary barrier to coverage for workers in small firms is being low-income; workers in small firms are more than twice as likely as those in large firms to have family income below 200 percent of the federal poverty level. Significant inroads into reducing the uninsured in this population will require income-related subsidization of insurance coverage.
Differences in Pediatric Preventative Care Counseling by Provider Type (Article) Author(s): Cynthia Perry, Genevieve M. Kenney Cynthia Perry and Genevieve Kenney explore the rates at which providers offer advice on health behaviors and injury prevention during preventive care visits. They find that pediatricians are more likely to advise about healthy eating than other physicians and nonphysicians, and they are also more likely than nonphysicians to advise about exercise, the harmful effects of parental smoking, proper safety restraints in a car, and use of a bicycle helmet. Regardless of provider type, rates of advice were low, leading the authors to conclude that many pediatric providers, particularly those not trained as pediatricians, are missing opportunities to advise about health behaviors and injury prevention.
Can a Child Health Insurance Tax Credit Serve as an Effective Substitute for SCHIP Expansion? (Policy Briefs/Health Policy Online) Author(s): Linda J. Blumberg, Genevieve M. Kenney As the State Children's Health Insurance Program (SCHIP) has come up for reauthorization, the coverage of children with incomes above 200 percent of the federal poverty level (FPL) has become a contentious issue. Proposals have surfaced that would subsidizing the purchase of health insurance for children between 200 and 300 percent of the FPL using tax credits and the private insurance market, as an alternative to allowing states to continue enrolling these children in SCHIP coverage. This analysis compares the family financial burdens of covering children under SCHIP and under a refundable tax credit providing a $1400 per child subsidy.
Can the President's Health Care Tax Proposal Serve as an Effective Substitute for SCHIP Expansion? (Policy Briefs/Timely Analysis Health Policy Issues) Author(s): Linda J. Blumberg The Bush Administration has proposed using a tax deduction approach to expand health insurance coverage instead of expanding SCHIP coverage for more children. On October 3, the president vetoed the SCHIP reauthorization bill passed by Congress. This brief compares the financial burden for families associated with purchasing coverage for their children under the President's proposal and under the SCHIP reauthorization bill and discusses the likely impacts on uninsurance among children. We find that the financial burdens for families between 150 and 300 percent of the federal poverty level would be much higher under the tax deduction approach than under SCHIP.
The State Children's Health Insurance Program (SCHIP) and Pediatrics (Article) Author(s): Leona Cuttler, Genevieve M. Kenney A commentary by Leona Cuttler and Genevieve Kenney discusses the structure of state SCHIP programs, the program’s importance in increasing children’s access to care, and future challenges SCHIP faces. Topics covered include a comparison of SCHIP and Medicaid program structure and financing, how SCHIP varies among states, and issues surrounding the federal reauthorization of the program, including the level of federal funding, eligibility standards, and the allotment and redistribution of federal dollars to states. Archives of Pediatric and Adolescent Medicine 161:7 (July 2007)
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