Carter C. Price

For states that opt out of Medicaid expansion: 3.6 million fewer insured and

The US Supreme Courts ruling on the Affordable Care Act in 2012 allowed states to opt out of the health reform laws Medicaid expansion. Since that ruling, fourteen governors have announced that their states will not expand their Medicaid programs. We used the RAND COMPARE microsimulation to analyze how opting out of Medicaid expansion would affect coverage and spending, and whether alternative policy options-such as partial expansion of Medicaid-could cover as many people at lower costs to states. With fourteen states opting out, we estimate that 3.6 million fewer people would be insured, federal transfer payments to those states could fall by

8.4 billion less in federal payments.

8.4 billion, and state spending on uncompensated care could increase by

Examining the discharge practices of surgeons at a large medical center

1 billion in 2016, compared to what would be expected if all states participated in the expansion. These effects were only partially mitigated by alternative options we considered. We conclude that in terms of coverage, cost, and federal payments, states would do best to expand Medicaid.

The Close Enough Traveling Salesman Problem: A Discussion of Several Heuristics

We investigate the discharge practices at a large medical center. Specifically, we look for indications that patients are being discharged sooner because of hospital bed-capacity constraints. Using survival analysis techniques, we find statistically significant evidence to indicate that surgeons adjust their discharge practices to accommodate the surgical schedule and number of available recovery beds. We find higher discharge rates on days when utilization is high. We also find an increased discharge rate on days when more surgeries are scheduled. Our findings suggest that discharge decisions are made with bed-capacity constraints in mind. We discuss possible explanations for this, as well as the medical and managerial implications of our findings.

Air Attack Against Wildfires: Understanding U.S. Forest Service Requirements for Large Aircraft

The use of radio frequency identification (RFID) allows utility companies to read meters from a distance. Thus a meter reader need not visit every customer on his route, but only get within a certain radius of each customer. In finding an optimal route — one that minimizes the distance the meter reader travels while servicing each customer on his route — this notion of only needing to be close enough changes the meter reading problem from a standard Traveling Salesperson Problem (TSP) into a variant problem: Close Enough TSP (CETSP). As a project for a graduate course in network optimization various heuristics for finding near optimal CETSP solutions were developed by six groups of students. In this paper we survey the heuristics and provide results for a diverse set of sample cases.

A Comprehensive Assessment of Four Options for Financing Health Care Delivery in Oregon

A RAND study sought to help the U.S. Forest Service determine the composition of a fleet of airtankers, scoopers, and helicopters that would minimize the total social costs of wildfires, including the cost of large fires and aircraft costs. The research team developed two models to estimate the social costminimizing portfolios of firefighting aircraft. Both models favored a fleet dominated by scoopers for the prevention of large fires

Modeling Dr. Dynasaur 2.0 Coverage and Finance Proposals: Effects of the Expansion of Vermont's Dr. Dynasaur Program to All Individuals Through Age 25

This article describes four options for financing health care for residents of the state of Oregon and compares the projected impacts and feasibility of each option. The Single Payer option and the Health Care Ingenuity Plan would achieve universal coverage, while the Public Option would add a state-sponsored plan to the Affordable Care Act (ACA) Marketplace. Under the Status Quo option, Oregon would maintain its expansion of Medicaid and subsidies for nongroup coverage through the ACA Marketplace. The state could cover all residents under the Single Payer option with little change in overall health care costs, but doing so would require cuts to provider payment rates that could worsen access to care, and implementation hurdles may be insurmountable. The Health Care Ingenuity Plan, a state-managed plan featuring competition among private plans, would also achieve universal coverage and would sever the employer-health insurance link, but the provider payment rates would likely be set too high, so health care costs would increase. The Public Option would be the easiest of the three options to implement, but because it would not affect many people, it would be an incremental improvement to the Status Quo. Policymakers will need to weigh these options against their desire for change to balance the benefits with the trade-offs.

Oregon's Options to Overhaul Health Care Financing: Health Care Reform 2.0?

The authors assessed an expansion of Vermonts Dr. Dynasaur program that would cover all residents age 25 and younger. The current Dr. Dynasaur program combines Vermonts Medicaid program and Child Health Insurance Program for children ages 0 through 18 to provide a seamless insurance program for those with family incomes below 317 percent of the federal poverty level. The authors used RANDs COMPARE-VT microsimulation model with Vermont-specific demographic, economic, and actuarial data to estimate the effects on health insurance coverage, costs, and premiums. They also identified the new revenues required to fund the program expansion and explored three alternative financing strategies to raise those funds: (1) an increase in the Vermont income tax, (2) a Vermont payroll tax, and (3) a Vermont business enterprise tax. The authors found that enrollment would increase by more than 260 percent under the 100-percent enrollment scenario and by nearly 200 percent under the 70-percent enrollment scenario by 2019. Not surprisingly, the children and young adults who move off employer-sponsored insurance (ESI) and into Dr. Dynasaur 2.0 have considerably lower expected health care costs than those who remain on ESI, increasing the per-person premiums by nearly

Reducing boarding in a post-anesthesia care unit

1,000 for those remaining enrolled in ESI. Annual health care expenditures per person for children and young adults in 2019 are estimated at

Modeling Terrorism Risk to the Air Transportation System

4,325 with Medicare prices. The combination of increased reimbursement rates, large increases in enrollment, and relatively low Dr. Dynasaur premiums (no more than