221 results match your criteria: "Center for Financing[Affiliation]"

High-Deductible Health Plan Enrollment Increased From 2006 To 2016, Employer-Funded Accounts Grew In Largest Firms.

Health Aff (Millwood)

August 2018

Patricia S. Keenan is a senior researcher in the Division of Research and Modeling, Center for Financing, Access, and Cost Trends, AHRQ.

Over the past decade, employers have increasingly turned to high-deductible health plans (HDHPs) to limit health insurance premium growth. We used data from private-sector establishments for 2006 and 2016 from the Medical Expenditure Panel Survey-Insurance Component to examine trends in HDHP enrollment and heterogeneity in HDHPs by firm size. We studied insurance plan offerings along the following dimensions: whether employers fund accounts to help defray employees' out-of-pocket health care spending, the availability of non-HDHP plan choices, and single and family deductible levels.

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Logistic regression with a continuous exposure measured in pools and subject to errors.

Stat Med

November 2018

Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.

In a multivariable logistic regression setting where measuring a continuous exposure requires an expensive assay, a design in which the biomarker is measured in pooled samples from multiple subjects can be very cost effective. A logistic regression model for poolwise data is available, but validity requires that the assay yields the precise mean exposure for members of each pool. To account for errors, we assume the assay returns the true mean exposure plus a measurement error (ME) and/or a processing error (PE).

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This population-based study examines the changes in enrollment in Medicaid and the Children’s Health Insurance Program since institution of the Affordable Care Act.

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No Association Found Between The Medicaid Primary Care Fee Bump And Physician-Reported Participation In Medicaid.

Health Aff (Millwood)

July 2018

Sandra L. Decker ( ) is a senior fellow in the Division of Research and Modeling, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, in Rockville, Maryland.

On average, state Medicaid programs paid 59 percent of what Medicare paid for primary care services in 2012. The Affordable Care Act required states in 2013 and 2014 to raise Medicaid payment rates to primary care physicians for certain services to the level of Medicare rates. The result was an average 73 percent increase in primary care Medicaid payments for qualifying physicians.

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Duration Of Uninsured Spells For Nonelderly Adults Declined After 2014.

Health Aff (Millwood)

June 2018

Joel W. Cohen is director of the Center for Financing, Access, and Cost Trends at the Agency for Healthcare Research and Quality.

Using longitudinal data from the Medical Expenditure Panel Survey-Household Component (MEPS-HC), we found that nonelderly respondents in 2014-15, following implementation of ACA coverage provisions, experienced shorter periods of being uninsured than did respondents in 2012-13 and 2013-14. This was particularly true for people with preexisting (or "high-risk-pool") health conditions.

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Objective: To estimate the relative health risk of Medicare Advantage (MA) beneficiaries compared to those in Traditional Medicare (TM).

Data Sources/study Setting: Medicare claims and enrollment records for the sample of beneficiaries enrolled in Part D between 2008 and 2015.

Study Design: We assigned therapeutic classes to Medicare beneficiaries based on their prescription drug utilization.

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Has inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates has widened?

Int J Health Econ Manag

December 2018

Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD, 20857, USA.

The past decade witnessed a dramatic increase in inpatient hospital payment rates for patients with private insurance relative to payment rates for those covered by Medicare. A natural question is whether the widening private-Medicare payment rate difference had implications for the hospital care received by patients just before and after turning 65-the age at which there is a substantial shift from private to Medicare coverage. Using a large discharge dataset covering the period 2001-2011, we tracked changes at age 65 in the following dimensions of hospital care: overall hospitalization rates, case mix, referral-sensitive surgeries, length of stay, full established charges, number of procedures, mortality, and composite measures of inpatient quality and patient safety.

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The purpose of this study is to understand self-rated health (SRH) trajectories by social location (race/ethnicity by gender by social class) among married individuals in the United States. We estimate multilevel models of SRH using six observations from 1980 to 2000 from a nationally representative panel of married individuals initially aged 25-55 (Marital Instability Over the Life Course Study). Results indicate that gender, race/ethnicity, and social class are associated with initial SRH disparities.

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Simulating Variation in Families' Spending across Marketplace Plans.

Health Serv Res

August 2018

Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD.

Objective: To examine variations in premium and cost-sharing across marketplace plans available to eligible families.

Data Sources: 2011-2012 Medical Expenditure Panel Survey (MEPS), 2014 health plan data from healthcare.gov, and the 2011 Medicare Part D public formulary file.

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Health Literacy Universal Precautions Are Still a Distant Dream: Analysis of U.S. Data on Health Literate Practices.

Health Lit Res Pract

October 2017

Senior Health Case Researcher, Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality.

Background: Experts have recommended the adoption of health literacy universal precautions, whereby health care providers make all health information easier to understand, confirm everyone's comprehension, and reduce the difficulty of health-related tasks. The U.S.

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Public And Private Payments For Physician Office Visits.

Health Aff (Millwood)

December 2017

Thomas M. Selden is director of the Division of Research and Modeling, Center for Financing, Access and Cost Trends, at the Agency for Healthcare Research and Quality.

We used data for 2014-15 from the Medical Expenditure Panel Survey to estimate standardized payments for nonelderly adults' physician office visits by type of insurance. Adults with public insurance, especially Medicaid, had substantially lower provider payments, out-of-pocket spending, and third-party payments than their peers with employer-sponsored or Marketplace insurance. Quantifying public-private payment differences can help clarify choices for financing health care among low-income Americans.

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Medicaid Expansion And Marketplace Eligibility Both Increased Coverage, With Trade-Offs In Access, Affordability.

Health Aff (Millwood)

December 2017

Sandra L. Decker ( ) is a senior fellow in the Division of Research and Modeling, Center for Financing, Access and Cost Trends, at AHRQ.

Article Synopsis
  • The Affordable Care Act (ACA) allowed states to expand Medicaid in 2014, providing low-income adults with increased access to health insurance and healthcare services depending on their state's decision to expand Medicaid or not.
  • Data from 2008-2015 show that both groups in expansion and nonexpansion states saw significant declines in uninsurance rates (22 and 18 percentage points, respectively) and improvements in access to care.
  • However, while those in expansion states had lower out-of-pocket costs, they encountered more challenges accessing physician care compared to those in nonexpansion states.
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Impact of Recent Medicaid Expansions on Office-Based Primary Care and Specialty Care among the Newly Eligible.

Health Serv Res

August 2018

Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD.

Objective: To quantify the effect of Medicaid expansions on office-based care among the newly eligible.

Data Source: 2008-2014 Medical Expenditure Panel Survey.

Study Design: The main sample is adults age 26-64 with incomes ≤138% of poverty who were not eligible for Medicaid prior to the Affordable Care Act.

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Association of Insurance Gains and Losses With Access to Prescription Drugs.

JAMA Intern Med

October 2017

Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland.

Using longitudinal data from the nationally representative Medical Expenditure Panel Survey, this study examines the association of insurance gains and losses with prescription drug access.

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Medicaid Expansion For Adults Had Measurable 'Welcome Mat' Effects On Their Children.

Health Aff (Millwood)

September 2017

Asako S. Moriya is an economist in the Division of Research and Modeling, Center for Financing Access and Cost Trends, AHRQ.

Before the implementation of the Affordable Care Act (ACA), most children in low-income families were already eligible for public insurance through Medicaid or the Children's Health Insurance Program. Increased coverage observed for these children since the ACA's implementation suggest that the legislation potentially had important spillover or "welcome mat" effects on the number of eligible children enrolled. This study used data from the 2013-15 American Community Survey to provide the first national-level (analytical) estimates of welcome-mat effects on children's coverage post ACA.

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Substantial Churn In Health Insurance Offerings By Small Employers, 2014-15.

Health Aff (Millwood)

September 2017

Philip F. Cooper is a senior economist in the Division of Research and Modeling, Center for Financing, Access, and Cost Trends, at AHRQ.

New data for 2014-15 from the Medical Expenditure Panel Survey-Insurance Component longitudinal survey show substantial churn in insurance offers by small employers (those with fifty or fewer workers), with 14.6 percent of employers that offered insurance in 2014 having dropped it in 2015 and 5.5 percent of those that did not offer it adding coverage.

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Assessing Antiretroviral Use During Gaps in HIV Primary Care Using Multisite Medicaid Claims and Clinical Data.

J Acquir Immune Defic Syndr

September 2017

*Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD;†Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD;‡Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD;§Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX;‖Divisions of Adult and Pediatric Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD;¶Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY; and#Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.

Background: Some individuals who appear poorly retained by clinic visit-based retention measures are using antiretroviral therapy (ART) and maintaining viral suppression. We examined whether individuals with a gap in HIV primary care (≥180 days between HIV outpatient clinic visits) obtained ART during that gap after 180 days.

Setting: HIV Research Network data from 5 sites and Medicaid Analytic Extract eligibility and pharmacy data were combined.

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Trends over time in enrollment in non-group health insurance plans by tobacco use in the United States.

Prev Med Rep

September 2017

Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Rockville, MD, United States.

Healthcare.gov was created to facilitate the market for non-group insurance in states that did not establish their own marketplaces. In Healthcare.

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The Affordable Care Act (ACA) reformed the individual health insurance market. Because insurers can no longer vary their offers of coverage based on applicants' health status, the ACA established a risk adjustment program to equalize health-related cost differences across plans. The ACA also established a temporary reinsurance program to subsidize high-cost claims.

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Background: Youth have residual thymic tissue and potentially greater capacity for immune reconstitution than adults after initiation of combination antiretroviral therapy (cART). However, youth face behavioral and psychosocial challenges that may make them more likely than adults to delay ART initiation and less likely to attain similar CD4 outcomes after initiating cART. This study compared CD4 outcomes over time following cART initiation between ART-naïve non-perinatally HIV-infected (nPHIV) youth (13-24 years-old) and adults (≥25-44 years-old).

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Objective: To investigate the relationship between the percent uninsured in a county and expenditures associated with the typical emergency department visit.

Data Sources: The Medical Expenditure Panel Survey linked to county-level data from the American Community Survey, the Healthcare Cost and Utilization Project, and the Area Health Resources Files.

Study Design: We use a nationally representative sample of emergency department visits that took place between 2009 and 2013 to estimate the association between the percent uninsured in counties and the amount paid for a typical visit.

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In this study, we examine differences by firm size in the availability of dependent coverage and the incremental cost of such coverage. We use data from the Medical Expenditure Panel Survey - Insurance Component (MEPS-IC) to show that among employees eligible for single coverage, dependent coverage was almost always available for employees in large firms (100 or more employees) but not in smaller firms, particularly those with fewer than 10 employees. In addition, when dependent coverage was available, eligible employees in smaller firms were more likely than employees in large firms to face two situations that represented the extremes of the incremental cost distribution: (1) they paid nothing for single or family coverage or (2) they paid nothing for single coverage but faced a high contribution for family coverage.

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Eligibility for and enrollment in Medicaid can vary with economic recessions, recoveries, and changes in personal income. Understanding how Medicaid responds to such forces is important to budget analysts and policy makers tasked with forecasting Medicaid enrollment. We simulated eligibility for Medicaid for the period 2005-14 in two scenarios: assuming that each state's eligibility rules in 2009, the year before passage of the Affordable Care Act (ACA), were in place during the entire study period; and assuming that the ACA's expanded eligibility rules were in place during the entire period for all states.

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The availability of community health center services and access to medical care.

Healthc (Amst)

December 2017

Office of Quality Improvement Bureau of Primary Care Health Resources and Services Administration, 5600 Fishers Lane Rockville, MD 20852, United States. Electronic address:

Background: Community Health Centers (CHCs) funded by Section 330 of the Public Health Service Act are an essential part of the health care safety net in the US. The Patient Protection and Affordable Care Act expanded the program significantly, but the extent to which the availability of CHCs improve access to care in general is not clear. In this paper, we examine the associations between the availability of CHC services in communities and two key measures of ambulatory care access - having a usual source of care and having any office-based medical visits over a one year period.

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The Financial Burdens Of High-Deductible Plans.

Health Aff (Millwood)

December 2016

Patricia Keenan is a senior economist in the Office of the Director at the Agency for Healthcare Research and Quality.

The increased prevalence of high-deductible health plans raises concerns regarding high financial burdens from health care, particularly for low-income adults.

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