Patricia Ketsche

Lower-Income Families Pay A Higher Share Of Income Toward National Health Care Spending Than Higher-Income Families Do

All health care spending from public and private sources, such as governments and businesses, is ultimately paid by individuals and families. We calculated the burden of US health care spending on families as a percentage of income and found that at the national level, lower-income families pay a larger share of their incomes toward health care than do higher-income families. Specifically, we found that payments made privately, such as those for health insurance or out-of-pocket spending for care, and publicly, through taxes and tax expenditures, consumed more than 20 percent of family income for families in the lowest-income quintile but no more than 16 percent for families in any other income quintile. Our analysis provides a framework for considering the equity of various initiatives under health reform. Although many effects remain to be seen, we find that, overall, the Affordable Care Act should reduce inequities in the burden of paying for national health care spending.

Employment-based health insurance: analysis of rural-urban differences in one state.

This study estimates the propensity of firms to offer health insurance in a simultaneous equation model to control for the endogeneity between wages and health insurance. Previous research finds differences in rural and urban employer behavior with respect to health insurance benefits fully explained by differences in wages and firm size. In contrast, this study finds residual unexplained differences in the propensity to offer coverage that may be attributable to differences in plan supply, plan distribution, or differences in availability of substitutes for coverage (safety net care). Rural worker participation in offered coverage is more responsive to wage level than is the participation decision of urban workers. Together, these results imply that some of the differences in health insurance coverage rates for rural workers could be amenable to policy interventions.

The Role of Public and Private Insurance Expansions and Premiums for Low-Income Parents: Lessons From State Experiences.

Background: Numerous states have implemented policies expanding public insurance eligibility or subsidizing private insurance for parents. Objectives: To assess the impact of parental health insurance expansions from 1999 to 2012 on the likelihood that parents are insured; their children are insured; both the parent and child within a family unit are insured; and the type of insurance. Design: Cross-sectional analysis of the 2000–2013 March supplements to the Current Population Survey, with data from the Medical Expenditure Panel Survey—Insurance Component and the Area Resource File. Methods: Cross-state and within-state multivariable regression models estimated the effects of health insurance expansions targeting parents using 2-way fixed effect modeling and difference-in-difference modeling. All analyses controlled for household, parent, child, and local area characteristics that could affect insurance status. Results: Expansions increased parental coverage by 2.5 percentage points, and increased the likelihood of both parent and child being insured by 2.1 percentage points. Substantial variation was observed by type of expansion. Public expansions without premiums and special subsidized plan expansions had the largest effects on parental coverage and increased the likelihood of jointly insuring both the parent and child. Higher premiums were a substantial deterrent to parents’ insurance. Conclusions: Our findings suggest that premiums and the type of insurance expansion can have a substantial impact on the insurance status of the family. These findings can help inform states as they continue to make decisions about expanding Medicaid under the Affordable Care Act to cover all family members.

Examining the potential of information technology to improve public insurance application processes: enrollee assessments from a concurrent mixed method analysis

Objective To assess the perceived readiness of Medicaid and Childrens Health Insurance Program (CHIP) enrollees to use information technologies (IT) in order to facilitate improvements in the application processes for these public insurance programs. Methods We conducted a concurrent mixed method study of Medicaid and CHIP enrollees in a southern state. We conducted focus groups to identify enrollee concerns regarding the current application process and their IT proficiency. Additionally, we surveyed beneficiaries via telephone about their access to and use of the Internet, and willingness to adopt IT-enabled processes. 2013 households completed the survey. We used χ2 analysis for comparisons across different groups of respondents. Results A majority of enrollees will embrace IT-enabled enrollment, but a small yet significant group continues to lack access to facilitating technologies. Moreover, a segment of beneficiaries in the two programs continues to place a high value on personal interactions with program caseworkers. Discussion IT holds the promise of improving efficiency and reducing barriers for enrollees, but state and federal agencies managing public insurance programs need to ensure access to traditional processes and make caseworkers available to those who require and value such assistance, even after implementing IT-enabled processes. Conclusions The use of IT-enabled processes is essential for effectively managing eligibility and enrollment determinations for public programs and private plans offered through state or federally operated exchanges. However, state and federal officials should be cognizant of the technological readiness of recipients and provide offline help to ensure broad participation in the insurance market.

Who Really Pays for Medicaid

The goal of the Medicaid intergovernmental matching grant is to stimulate state spending while achieving some level of beneficiary and taxpayer equity. This study uses the Current Population Survey data on 174,031 families to estimate federal and state Medicaid tax burdens per family, net of tax exporting. Of the total US

The stigma of public programs: Does a separate S-CHIP program reduce it?

305 billion spent on Medicaid in 2004, US

Access and Satisfaction Among Children in Georgia's Medicaid Program and SCHIP: 2000 to 2003

29.9 billion is redistributed through the grant’s Federal Medical Assistance Percentage, as residents of low-income states export federal tax burdens to higher-income states. Another US

An Analysis of the Effect of Tax Policy on Health Insurance Purchases by Risk Group

4.5 billion in state taxes is exported via business flows and tourism with the bulk, US

The Distribution of the Burden of US Health Care Financing

3.2 billion, being exported internationally. Some states pay as little as US

Effect of Subsidized Premiums on Family Insurance Choices

.55 in “own” tax revenues while residents in states importing the burden pay up to US