ROCHESTER, NY, September 19, 2006 - A new study appearing in the journal INQUIRY's summer issue presents results from analyses that helped frame the current health insurance debate in Massachusetts. Earlier in 2006, the Commonwealth of Massachusetts passed landmark legislation to expand health insurance for its residents. The legislation has multiple components that together will greatly reduce the number of the state's uninsured. How many will remain uninsured depends upon specific program design choices yet to be made.

"Toward Universal Coverage in Massachusetts," by Linda J. Blumberg, John Holahan, Lisa Clemans-Cope, Mattew Buettgens, Fredric Blavin and Stephen Zuckerman of the Urban Institute, and Alan Weil of the National Academy for State Health Policy, was funded by the Blue Cross Blue Shield of Massachusetts Foundation to develop alternatives for expanding the state's coverage.

The options to achieve universal coverage build upon a base that includes expansion of MassHealth (the state's Medicaid program), income-related tax credits, a purchasing pool to improve coverage access to those without employer-sponsored health insurance, and government-sponsored reinsurance.

The authors found that either an individual mandate by itself, or one combined with an employer mandate could obtain universal coverage with a relatively small increase in government costs relative to the state's gross domestic product and current health spending. The findings should be useful to other states considering health insurance expansions.

"Price and the Demand for Nongroup Health Insurance," by David Auerbach and Sabina Ohri - This study found that providing modest premium subsidies to individuals without employer-sponsored health insurance has only a small effect on the purchase of nongroup health coverage. The analysis considered health status and state regulations - factors important to determining premiums.

"The Influence of Medicare Home Health Payment Incentives: Does Payer Source Matter?" by David C. Grabowski, David G. Stevenson, Haiden A. Huskamp and Nancy L. Keating -- This study analyzed impact of the interim payment system (IPS), a 1990s experiment to constrain Medicare home health care spending. Results showed the IPS was associated with a decrease in care for the sickest patients, less agency assistance with activities of daily living and shorter length of use for both Medicare and non-Medicare patients. The changes, however, did not translate into worse outcomes at discharge.

"Do Report Cards Influence Hospital Choice? The Case of Kidney Transplantation," by David H. Howard and Bruce Kaplan - This study found some evidence that outcome reports from kidney transplant centers influence the hospital choices of younger and college-educated patients, but overall report cards for kidney transplantation do not appear to affect demand.

"On the Feasibility of Resolving the Organ Shortage," by David L. Kaserman - Focusing on the organ shortage debate, this paper offers the economically correct definition of a shortage and applies that definition to new data on the potential supply of organs from deceased donors.

"Access to Health Care after Welfare Reform," by Karen Seccombe, Jason Newsom, and Kim Hoffman -- This study followed Oregon families to see how their access to care fared after they left Temporary Assistance to Needy Families (TANF) -- and its accompanying Medicaid coverage - for work. Findings indicate that 18 months after leaving welfare, 40 percent of the families were uninsured, suggesting impediments to access to care which may be associated with poor health outcomes. The case study may suggest what is happening in other states.

"The McNerney Forum: Survival Skills for the Political Environment of Health Insurance" by William G. Weissert - This article chronicles the successful efforts of Blue Cross Blue Shield of Michigan to survive as a nonprofit company when challenged by a powerful governor and his supporters.
http://www.inquiryjournalonline.org/inqronline/?request=get-document
&issn=0046-9580&volume=043&issue=02&page=0089

"The View from Here: Big Digs Are Not Just in Boston - The Need for Government Oversight" - INQUIRY Editor Katherine Swartz calls for effective government oversight for Medicare Part D and rebuilding the public health infrastructure.
http://www.inquiryjournalonline.org/inqronline/?request=get-document
&issn=0046-9580&volume=043&issue=02&page=0087