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Issues in Estimating the Coverage and Cost Impacts of Public Insurance Expansion

Issues in Estimating the Coverage and Cost Impacts of Public Insurance Expansion. John Holahan November 10, 2004. Establishing the Baseline. Eligibility – State-specific rules applied to Current Population Survey Enrollment – CPS, as adjusted for Medicaid undercount

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Issues in Estimating the Coverage and Cost Impacts of Public Insurance Expansion

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  1. Issues in Estimating the Coverage and Cost Impacts of Public Insurance Expansion John Holahan November 10, 2004

  2. Establishing the Baseline • Eligibility – State-specific rules applied to Current Population Survey • Enrollment – CPS, as adjusted for Medicaid undercount • Issues – how much of an undercount, how to adjust • Need to Grow the Baseline to Reflect Current Law and Current Economy • Eligibility – did rules change? • Enrollment – estimate effect of rules change on enrollment – estimate effect of demographic or economic change

  3. Need to Organize Population by Important Variables • Key demographics – children, parents, childless adults; income • Current coverage – employer sponsored, non group, Medicaid/SCHIP, other government, uninsured • Current eligibility for public coverage • Need to separate from those currently ineligible

  4. Take Up Rates – How will Behavior Change in Response to New Policy • Uninsured – previously ineligible – use take-up models to estimate share of new eligibles that would enroll • Previously eligible • Non Group – previously ineligible • Previously eligible • ESI – employer dropping • Firm drops • Firm continues to offer – employee dropping • Use crowd out literature

  5. Other Issues • Behavioral responses • To premiums – participation and price elasticity literature • To different benefit packages • To higher provider payments, access • To reduced stigma • To firewalls

  6. Cost Per Person • Medicaid cost per capita is high because of adverse selection and health status, broad benefits and low rates • Expansion population will likely be healthier; benefit package may be better, provider payment rates higher • Estimate equation to explain relationship between expenditures and health status, type of insurance coverage and other factors • Use health status coefficients to adjust Medicaid cost per enrollee • Adjust for administrative costs and inflation

  7. Table 1Incremental Reform Alternative Options for Expanding Medicaid/SCHIP

  8. Table 2Incremental ReformExpand Coverage to All Adults to 200% FPL

  9. Table 3Incremental ReformExpand Coverage to All Adults to 200% FPL

  10. Table 4Incremental ReformExpand Coverage to 200% FPL Effects by Income

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