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Publications on Health/Healthcare

In its June 2008 Report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended revision of the prospective payment system (PPS) for skilled nursing facilities (SNFs). The proposed revisions consist of a new component to pay for non-therapy ancillaries (NTA) based on predicted NTA costs, an alternative therapy component that bases therapy payments on predicted therapy needs, and addition of an outlier policy for the PPS. This technical report to MedPAC provides detail on the data, methods, and specific predictive models that underlie the analysis in the Report to Congress.

Nearly one in three young adults ages 19 to 26 lacks health insurance coverage. This age group is at high risk of lacking insurance coverage because of low access to employer-sponsored insurance and subsidized public coverage. Given that so many uninsured young adults are low-income, significant public subsidies will be needed to address their uninsurance problem. Some policy options available include public program expansions, tax credits, direct subsidies, or individual mandates. Ultimately, decisions about allocating greater public subsidies for covering young adults or imposing mandates should be made in the context of considerations about broader health care reform.

The Reinsurance Institute provided quantitative modeling and qualitative analysis to states as they explored reinsurance as an element of health reform. The project estimated the impacts of reinsurance, including changes in premiums, employer offer and enrollee take-up of coverage, numbers of people insured, and costs to the state. Small numbers of high spenders account for a large share of health spending, but most spending occurs in lower corridors of expense. Medical spending varies widely by age and health status, creating pressure for risk segmentation. Lastly, defining the eligible population determined whether reinsurance would cover new enrollees or solidify current coverage.

The Reinsurance Institute simulated the effects of reinsurance on individual and employer behavior, observing state-specific characteristics. We constructed a baseline database for each state by reweighting and combining multiple data sources to create a profile of individual-level demographics and health expenditures, allowing for the computation of individual-level premiums. We grouped health insurance units together into risk pools consistent with state market rules to calculate the change a reinsurance subsidy would have on the premium levels faced by individuals and employers. These price changes drove simulated changes in premium and coverage levels, offer and take-up rates, and state costs.

As the nation grows older, it's time to find a better way to care for those who need help as they age. The financial, emotional, and physical costs of providing long-term care often overwhelm families. Unpaid family members supply most of it, struggling to balance these duties with work and other responsibilities. A year's stay in a nursing home averaged $78,000 in 2007, and public assistance is not generally available until residents have exhausted almost all of their financial resources. Policymakers should encourage Americans to prepare for their own long-term care needs or create a larger role for government financing