June 2010
Lewin Contact: John Sheils
In this study we provide estimates of the cost and coverage impacts of the Patient Protection and Affordable Care Act (PPACA). We estimate the program’s impact on sources of health insurance coverage and spending for the federal government, state and local governments, private employers, consumers and providers. We estimated the impact of the Act over a 10 year period from 2010 through 2019, which is consistent with the “budget window” used by the Congressional Budget Office (CBO). However, we also provide estimates for 2020 through 2029.
We developed these estimates using the Group Health Benefits Simulation Model (HBSM) developed by the Lewin Group. Our revenue and spending estimates over the 20-year period reflect the actual phase in of coverage provisions and expected lags in enrollment for newly eligible people. However, to illustrate the program’s impact on sources of coverage and family spending, we present estimates assuming that Act is fully implemented and that enrollment has fully matured in 2011.
Expertise Area: Health Reform
March 2010
Lewin Contact: John Sheils
Expertise Area: Health Reform
February 2010
Lewin contact: John Sheils
The purpose of this analysis was to compare the effects of two major proposals to reform the U.S. health care system. These include the Senate “Patient Protection and Affordable Care Act” and the “Affordable Health Care for America Act” passed by the House of Representatives. This study provides estimates of the programs' impact on coverage and spending for the federal government, state and local governments, private employers, consumers and providers. We estimated the impact of both bills on federal spending over a 20 year period from 2010 through 2029. The Congress uses 10-year forecasts for budgeting purposes, which is currently 2010 through 2019. To better understand the long-term budget implications of the bill, we present spending estimates for both the 2010 through 2019 budget window and the 2020 through 2029 period.
Expertise Area: Health Reform
January 2010
Lewin Contact: John Sheils
Expertise Area: Health Reform
December 2009
Affordable Healthcare for America Act (H.R. 3962) as passed by the U.S. House of Representatives, and the Patient Protection and Affordable Care Act (H.R. 3590, being considered in the U.S. Senate)
Lewin Contact: John Sheils
The Lewin Group does not advocate for or against any legislation, and maintains editorial independence with respect to all work products. This document provides further clarifications about the recent study.
Expertise Area: Health Reform
December 2009
Long Term Costs for Governments, Employers, Families and Providers
Lewin Contact: John Sheils
The appendices for the main report.
Expertise Area: Health Reform
December 2009
Long Term Costs for Governments, Employers, Families and Providers
Lewin Contact: John Sheils
Prepared for: The Peter G. Peterson Foundation
The purpose of this analysis was to compare the effects of two major proposals to reform the U.S. health care system. These include the Senate Leadership “Patient Protection and Affordable Care Act” and the “Affordable Health Care for America Act” passed by the House of Representatives.
In this study we provide estimates of the program’s impact on coverage and spending for the federal government, state and local governments, private employers, consumers and providers. We estimated the impact of both bills on federal spending over a 20 year period from 2010 through 2029. The Congress uses 10-year forecasts for budgeting purposes, which is currently 2010 through 2019. To better understand the long-term budget implications of the bill, we present spending estimates for both the 2010 through 2019 budget window and the 2020 through 2029 period.
Expertise Area: Health Reform
November 2009
Lewin Group Analysis of Long Term Costs of The America’s Healthy Future Act of 2009
Lewin Contact: John Sheils
Expertise Area: Health Reform
October 2009
Prepared for The Peter G. Peterson Foundation
Lewin Contact: John Sheils
The Lewin Group released a study of the impact on the federal budget and deficit of the Senate Finance bill, America's Healthy Future Act of 2009 ("the Act"). The report was commission by the Peter G. Peterson Foundation, which also released its analysis and commentary on the Act, drawing upon the Lewin report.
Expertise Area: Health Reform
October 2009
Searching for Low-Hanging Fruit in the Garden of Health System Reform
Lewin Contact: Carol Simon
In this paper, we examine the recent literature documenting the major drivers of health care costs in
the U.S. and identify where new policies and initiatives could reduce costs without adversely affecting quality or access to medically necessary care.
Expertise Area: Health Reform
October 2009
American Affordable Health Choices Act of 2009
Lewin Contact: John Sheils
Updated October 22, 2009
Expertise Area: Health Reform
September 2009
Peter G. Peterson Foundation Report
Lewin Contact: John Sheils
In this study for the Peter G. Peterson Foundation, we estimate the impact of The American Affordable Health Choices Act of 2009 (H.R. 3200) (Act) as amended by the Energy and Commerce (E&C) Committee in August of 2009. We provide estimates of the program’s impact on coverage and spending for the federal government, state and local governments, private employers and consumers. To demonstrate the long-term impact of the Act, we provide estimates for a 20-year period from 2010 through 2029.
Expertise Area: Health Reform
July 2009
Lewin contact: John Sheils
Note: This analysis covers the bill as it appeared on July 15, 2009. The bill has been amended since then, and a final bill was released on July 31.
Expertise Area: Health Reform
July 2009
Lewin Contact: John Sheils
This document addresses several technical questions regarding the estimates in the recent Lewin Group report, “Analysis of the July 15 draft of The American Affordable Health Choices Act of 2009” prepared for The Heritage Foundation.
Expertise Area: Health Reform
July 2009
Lewin Contact: John Sheils
In this memorandum for The Heritage Foundation, originally published July 17, 2009 and revised July 23, 2009 , we present estimates of the impact of the Act on sources of insurance coverage and provider incomes. We present our results in the following sections:
- Insurance exchanges and the public plan;
- Medicare payment reforms;
- Coverage effects;
- Detailed physician impacts analysis; and
- Detailed hospital impacts analysis.
Client Area: Foundations
Expertise Area: Health Reform
June 2009
Lewin Contact: John Sheils
Submitted by: John Sheils, Vice President, The Lewin Group
Date: June 25, 2009
The House bill includes a public plan as part of a broad health reform proposal that would expand health insurance coverage. The program expands increases Medicaid eligibility to 133 percent of the federal poverty level (FPL) and provides individual subsidies for the purchase of insurance for people between 133 percent and 400 percent of the FPL. Tax credits are available to small employers who purchase coverage, while larger employers are also required to contribute to the cost of coverage for workers. Individuals who do not have coverage would be fined 2.0 percent of their income up to the national average premium amount.
The bill would permit individuals and employers to purchase health insurance from a newly created “public plan” modeled on Medicare. The public plan would compete for enrollment with private insurers in a newly formed network of “exchanges” that present a selection of competing health plans to consumers. The public plan would be required to follow the same rules concerning pre-existing conditions and premium rating practices that apply to private plans.
We estimate that the public plan under the House bill would have premiums that are 20 percent to 25 percent less than for comparable private coverage.
Expertise Area: Health Reform
June 2009
Presentation to Capitol Hill Briefing with NCOA 19 June 2009
Lewin Contact: Lisa Alecxih
Consumers in Control: Cost-Effective Chronic Care Strategies for Health Reform
Friday, June 19, 2009
9:30-11:00 am
Lisa
Alecxih, Vice President of the Lewin Group, spoke today at a briefing
on Capitol Hill sponsored by the not-for-profit National Council on
Aging (NCOA), along with other leading health care experts. The
briefing discussed the results of NCOA's national survey of adults with
multiple chronic health conditions. The Capitol Hill briefing
highlighted the day-to-day challenges Americans face in managing their
chronic conditions in a fragmented health system, and showcased models
that are helping consumers regain control of their health.
Expertise Area: Chronic Disease / Cost of Illness, Health Reform
June 2009
Lewin contact: John Sheils
Expertise Area: Health Reform
May 2009
Lewin contact: John Sheils
Statement for the Senate Committee on Finance
Submitted by: John Sheils, Vice President, The Lewin Group
May 12, 2009
Health reform can be funded with new revenues and savings to existing federal programs. In this analysis we examine two tax-based options that would both raise revenues and reduce health spending. These include placing limits on the tax exclusion for employer health benefits and a large increase in the tax on tobacco products. We also discuss potential savings to existing federal safety-net programs under expansions in coverage that could be redirected to help pay for health reform.
We estimate that these three proposals would raise about $1.25 trillion in revenues and savings to federal programs over the 2010 through 2019 period. This is roughly equal the amount of funding required to pay for the health reform program proposed by President Obama in the 2008 campaign ($1.17 trillion). These provisions would also reduce national health spending by about $461.0 billion over this period.
Expertise Area: Health Reform
April 2009
Lewin contact: John Sheils
The Cost and Coverage Impacts of a Public Plan
Testimony before the House Ways and Means Committee Hearing on Health Reform in the 21st Century: Employer Sponsored Insurance
Submitted by: John Sheils, Vice President, The Lewin Group
April 29, 2009
President Obama and Senator Baucus have proposed to create an “exchange” offering individuals and employers a selection of health plans. They also propose to create a new “public plan” that would compete for enrollment with private insurance plans in the exchange.
Premiums under the public plan would be up to 30 percent less than private insurance plans if Medicare payment levels are used. Due to this substantial cost advantage, we estimate that up to 119.1 million of the 171.6 million people who now have private employer or non-group coverage would move to the public plan (70 percent).
Expertise Area: Health Reform
April 2009
Lewin Contact: John Sheils
Combined Baucus And Wyden Plan Meets President's Health Reform Goals, Controls Costs And Expands Coverage To All Without Increasing Federal Deficit
This report identifies similarities and differences of the coverage provisions of the Healthy Americans Act (HAA, led by Senators Wyden and Bennett, with 14 bipartisan co-sponsors) and the proposal offered by Senator Baucus, and presents ideas on how these differences could be resolved. Lewin Group researchers identify the specific elements of both proposals taken together that would meet President Obama’s eight health reform goals stated in the budget proposal to Congress, forming a bill that achieves universal coverage and controls cost in the public and private sectors, without increasing the federal deficit. Finally, due to the complexity of reform, the paper discusses how the coverage provisions could be phased-in over a period of four years as suggested in the Baucus report.
Expertise Area: Health Reform
April 2009
Lewin contact: John Sheils
The Lewin Group released a report today titled “The Cost and Coverage Impacts of a Public Plan: Alternative Design Options.” This report examines potential impacts that a “public health plan” might have in competing for enrollment with the private insurance industry. A public plan is currently being considered in a number of health reform proposals being considered by President Obama and the U.S. Congress. This analysis enhances prior work done by The Lewin Group of the major party presidential candidate health reform proposals during the 2008 campaign, as well as more recent analyses of Congressional plans being considered. The report estimates the impact on cost and coverage based on different levels of eligibility and reimbursement rates.
Expertise Area: Health Reform
March 2009
Lewin contact: John Sheils
The purpose of this document is to describe the data and methods used to develop the Lewin Group Health Benefits Simulation Model (HBSM).
The Health Benefits Simulation Model is a micro-simulation model of the U.S. health care system. HBSM is a fully integrated platform for simulating policies ranging from narrowly defined Medicaid coverage expansions to broad-based reforms such as changes in the tax treatment of health benefits. The model is also designed to simulate the impact of numerous universal coverage proposals such as single-payer plans and employer mandates. The use of a single modeling system for these analyses helps assure that simulations of alternative proposals are executed with uniform and internally consistent methodologies.
Expertise Area: Health Reform
March 2009
Lewin contact: John Sheils
This report provides estimates of the cost and coverage impacts of the Healthy Americans Act as introduced on February 5, 2009 (S. 391). It provides estimates of cost effects for the federal government, state and local governments, private employers and families, assuming the program is fully implemented in 2011. It also provides estimates of the average cost impacts of the Act for families by income, age and current coverage status.
Client Area: Federal Government
Expertise Area: Health Reform
February 2009
The Commonwealth Fund
Lewin contact: John Sheils
This document presents the approach used by The Lewin Group to estimate the impact of the Commonwealth Fund’s health reform proposal entitled “Path to a High-Performance Health Care System.” The report describe the provisions of the plan and explains how Lewin simulated the plan’s impact on coverage and costs for households, employers, the federal government and state and local governments. It also presents the methodology used to estimate the cost impacts of a series of system savings initiatives included in the proposal.
The primary analytic tool used in the analysis is The Lewin Group Health Benefits Simulation Model (HBSM). The model is designed to show the impact of major health reform plans on major stakeholder groups. It provides estimates of enrollment and costs under alternative health reform plans that reflect the impact of financial incentives created under the plan. Lewin supplemented the model with separate analysis of the various system savings proposals. For each initiative, the report provides a description of the proposal, a review of the available research and evidence on the options and Lewin's estimates of the program’s impact over five-, ten- and fifteen-year periods.
Client Area: Foundations
Expertise Area: Health Reform
February 2009
Lewin contact: John Sheils
Presentation by John Sheils to Senate Republicans and Staff February 11, 2009.
Client Area: Federal Government
Expertise Area: Health Reform
January 2009
The Commonwealth Fund
Lewin contact: John Sheils
The Commonwealth Fund commissioned The Lewin Group to estimate the cost and coverage impacts for each of the proposals examined in this report.
Client Area: Foundations
Expertise Area: Health Reform
December 2008
Lewin contact: John Sheils
In this paper the authors show that bold comprehensive reforms offering immediate coverage for all Americans are actually less expensive than incremental efforts to build upon the existing system. It is possible to cover all Americans without increasing national health spending and without rationing care. Costs can be reduced for American consumers in general and the federal government in particular under broad-based universal coverage reforms. To demonstrate this the paper compares the cost of two comprehensive health reform plans -- the “Healthy Americans Act” developed by Senator’s Wyden and Bennett t and a government-based approach that would cover all Americans under an expanded Medicare program -- to the cost of the incrementally-based health reform proposals introduced by President-elect Obama and Senator McCain in the 2008 presidential election.
Expertise Area: Health Reform
October 2008
Lewin contact: John Sheils
On October 8, 2008, The Lewin Group released an in-depth assessment of the health care reform policies proposed by the 2008 presidential nominees. The analysis incorporated publicly available information as well as information provided by the campaigns and from interviews with McCain and Obama health policy advisors. The report details how much these policies would cost if implemented, who will be affected, and more.
Expertise Area: Health Reform
June 2008
The Commonwealth Fund
Lewin contact: John Sheils
This document is a compilation of the technical documentation developed for the Commonwealth Fund analysis of options for reducing health spending growth entitled “Bending the Curve.” In this analysis, we provided cost analyses for 15 alternatives for reducing health care costs. We developed these analyses with the Lewin Group Health Benefits Simulation Model (HBSM) and the best available data. For each of the 15 options, we provide a narrative summary of the proposal, a review of the available research and evidence on the option and our estimates of the program’s impact over five- and ten-year periods.
Client Area: Foundations
Expertise Area: Health Reform
April 2008
Testimony before the Senate Special Committee on Aging
Lewin contact: John Sheils
On April 3, 2008John Sheils testified before the Senate Special Committee on Aging. The subject of his testimorny was the likely impacts of health reform proposals on coverage and costs for people age 55 to 64, often referred to as the “near-elderly.”
Expertise Area: Health Reform
January 2008
Economic Policy Institute
Lewin contact: John Sheils
For the Economic Policy Institute, The Lewin Group estimated the cost impact of the Health Care for America Proposal. Under the Proposal, employers would be required to provide coverage or pay a payroll tax to have their workers covered under a newly created national health insurance pool called Health Care for America (HCA). Modeled on Medicare, Health Care for America would offer a single Medicare-like fee-for-service option and a selection of Health Maintenance Organizations or other private managed care plans. People who do not have employer-sponsored insurance would be covered under HCA, including those now covered under Medicaid and the State’s Children’s Health Insurance Program. The Lewin Group's analysis estimates that the Health Care for America Proposal would cover 46.5 million uninsured people without increasing national spending for health care, largely through lower provider reimbursement, administrative simplification and other features of the proposal.
Expertise Area: Health Reform
December 2007
Colorado Blue Ribbon Commission for Health Care Reform
Lewin contact: John Sheils
The Lewin Group was engaged by the Colorado Blue Ribbon Commission for Health Reform to assist in developing and analyzing alternative proposals to expand health insurance coverage and reform the Colorado health care system. Lewin first developed a “baseline” projection of what health care coverage and costs would be in Colorado in 2008 under current law for major stakeholder groups, including governments, providers, employers and families. Lewin then estimated the cost and coverage effects of several proposals to expand insurance coverage for major stakeholder groups in Colorado.
Client Area: State and Local Governments
Expertise Area: Health Reform
July 2007
Association for Community Affiliated Plans (ACAP)
Lewin contact: Joel Menges
The Lewin Group was engaged by the Association of Community Affiliated Plans to study the role of Medicaid and Medicaid health plans in reforms to cover the uninsured. This paper discusses the experiences of two programs that provide and/or subsidize coverage directly: The Massachusetts-run Commonwealth Care Health Insurance Program, which links eligible residents with approved insurance plans and helps them pay for the plans, and the county-administered children’s health initiatives (CHIs) in California, which cover low-income children who are not eligible for Medicaid or SCHIP. This report, based on discussions with Medicaid health plans that participate in these programs, discusses the use of Medicaid health plans as vehicles for expansion efforts in state and county health coverage expansion reform initiatives. This paper presents case studies of their experiences and lessons learned for both health plans and for purchasers.
Client Area: Associations
Expertise Area: Health Reform, Medicaid and CHIP
June 2007
Wisconsin Health Project
Lewin contact: John Sheils
This study provides a detailed analysis of the economic impact of a proposal to provide health insurance coverage to residents of Wisconsin called the “Wisconsin Health Plan (WHP).” The Lewin Group estimated the cost of the program and its impact on health spending for major stakeholder groups in the state including governments, employers, families and providers.
Expertise Area: Health Reform
January 2007
Lewin contact: John Sheils
The Lewin Group conducted an independent analysis of the impact of President Bush's health insurance proposal. The analysis was conducted using The Lewin Group Health Benefits Simulation Model (HSBM). HSBM is a micro-simulation model of the U.S. health care system designed to estimate the impact of alternative health reform models on coverage and expenditures for employers, governments and households.
The study found that President Bush’s health insurance proposal would save families money and reduce the number of uninsured, but the major tax reductions would go to families with incomes above $50,000. The Bush plan would also increase the U.S. budget deficit by $61.8 billion in the first year. The increase in the deficit would decline over the following decade. One key aspect of the plan is the number of uninsured who would be covered under this new plan. The Lewin Group study shows that the President’s proposal would reduce the number of uninsured – projected to be 48.4 million people in 2009 – by about 9.2 million people. One unintended consequence would force about 2.3 million workers and dependents to become uninsured, when they would lose employer coverage.
The Lewin Group study shows that the government stands to lose money because tax revenues would be reduced - tax filers would count employer health care spending as taxable income but would receive a deduction, whether they have employer coverage or private non-group coverage. Replacing the existing tax exclusion with the deduction would increase the federal deficit by $61.8 billion in 2009. This is an average federal expenditure of $6,720 per newly insured person. However, the impact on the federal deficit would decline from an increase of $61.8 billion in 2009 to a net reduction in the deficit of $45.3 billion in 2018. The net cost of the program over the 2009 to 2018 period would be $153.8 billion.
Please click on the following links to view the detailed analysis tables or the summary of the Health Benefits Simulation Model.
Expertise Area: Health Reform
December 2006
Lewin contact: John Sheils
The “Healthy Americans Act” (HAA) establishes a centrally financed system of private health insurance for all Americans not covered by Medicare, that is at least as comprehensive as the coverage provided to members of Congress. Employers give the money they now spend for health insurance to the worker as wages. Participants would chose from a selection of private plans offered through regional purchasing pools called “Health Help Agencies” (HHA's) on the basis of price. The competitive incentives created under the bill would reduce health spending by about 4.5 percent over the next 10 years.
Client Area: Federal Government
Expertise Area: Health Reform
December 2006
United Hospital Fund; The Commonwealth Fund
Lewin contact: John Sheils
For the United Hospital Fund and The Commonwealth Fund, The Lewin Group estimated the cost and coverage impacts of a variety of options to achieve universal health insurance coverage in New York. The Lewin Group analyzed the expansion scenarios using its Health Benefits Simulation Model.
The full report of the project, A Blueprint for Universal Health Insurance Coverage in New York, is available on The Commonwealth Fund's website.
Client Area: Foundations
Expertise Area: Health Reform
June 2006
Mississippi Office of the Governor, Division of Medicaid
Lewin contact: John Sheils
The Lewin Group developed an analysis of options to expand coverage to the uninsured in the state of Mississippi and estimated their impact on government spending, employers and households. The policy options included in the analysis were selected to cover the range of policy recommendations developed under the Mississippi State Planning Grant project. These policy options include expanding coverage under public programs, expanding private insurance coverage and universal coverage options.
Client Area: State and Local Governments
Expertise Area: Health Reform
June 2006
The Hawai'i Uninsured Project
Lewin contact: John Sheils
The Lewin Group was hired by the Hawai’i Institute for Public Affairs (HIPA), an independent non-partisan organization, to perform a comprehensive evaluation of the costs and benefits of a single-payer system as outlined in HB 1617. The evaluation is intended to assist the Hawai’i Health Care Task Force in developing a comprehensive health care coverage plan for the citizens of Hawai’i.
Expertise Area: Health Reform
May 2006
Coalition to Protect Access to Affordable Health Insurance
Lewin contact: John Sheils
In this study, The Lewin Group estimated the cost and coverage impacts of the Health Insurance Marketplace Modernization and Affordability Act (S. 1955) sponsored by Senator Enzi of Wyoming and adopted by the Health, Education, Labor and Pension Committee of the U.S. Senate. The bill would establish a new optional regulatory standard that insurers in the small group market could choose to follow instead of state regulations. This standard would permit carriers to set rates according to the National Association of Insurance Commissioner’s (NAIC) 1993 Small Group Rating Model legislation, which permits premiums to vary with health status and other factors. Carriers electing this option also would be exempt from state mandated benefits requirements.
Client Area: Associations
Expertise Area: Health Reform
April 2006
The California Endowment
Lewin contact: John Sheils
The California Endowment engaged The Lewin Group to provide cost estimates and coverage impacts of four proposals to expand health insurance coverage in California, focusing in particular on the effect that the approaches would have on children. This report provides detailed estimates of the program costs and number of children who would become covered under these proposals, including changes in both public and private coverage.
Client Area: Foundations
Expertise Area: Health Reform
January 2006
Louisiana Hospital Association
In an effort to develop a unified policy framework for redesigning Louisiana’s healthcare services in the wake of Hurricane’s Katrina and Rita, the Louisiana Hospital Association engaged The Lewin Group to conduct a series of interviews with healthcare, education, business and government leaders across the state to gather information regarding both short-term and long-term needs of the industry. The resulting report describes a series of proposed federal and state policy initiatives that would facilitate cost-effective redesign of Louisiana's healthcare delivery system.
Client Area: Associations
Expertise Area: Health Reform
February 2005
Healthcare Financial Management Association (HFMA)
The Lewin Group helped the Healthcare Financial Management Association (HFMA) Patient Friendly Billing Project develop the report, Hospitals Share Insights to Improve Financial Policies for Uninsured and Underinsured Patients. The report explores key questions that hospital leaders may find useful to keep in mind when reviewing their financial assistance policies. It also provides tools and practical ideas to help hospitals and health systems revise their policies and procedures and implement those revisions quickly and effectively. Effective financial policies for uninsured and underinsured patients are an essential component of the community benefits hospitals provide.
Client Area: Associations
Expertise Area: Health Reform
January 2005
Health Care for All Education Fund
Lewin contact: John Sheils
In this study The Lewin Group estimated the impact of covering all California residents under a single health plan. The proposal analyzed is the "Health Care for All Californians Act: SB 921", introduced in February of 2003, with clarifications provided by the authors' staff through April 30, 2004. The program would cover a broad range of health services for all California residents, including an estimated 4.7 million Californians who are currently uninsured. Premium payments to insurers would be eliminated for employers and individuals, except for coverage of services not covered by the program. Instead, the system would be funded with current spending for government health programs and new taxes to replace the premiums eliminated under the program. Lewin estimated the amount of health spending in California under current law in 2006 for the various payers in California including employers, households, the federal government and state and local governments. Lewin then estimated health expenditures for each of these payer groups assuming the Act is implemented in 2006. The difference between estimated spending in 2006 under the Act and the estimated amounts spent in 2006 under current law, provide estimates of the impact of the program on spending for each payer group. Estimates of the cost impacts of the Act are provided for employers by firm size, industry, households, by age, income level and other demographic characteristics.
Client Area: Associations
Expertise Area: Health Reform
September 2004
Lewin contact: John Sheils
This report presents an independent comparative analysis of the proposed health plans of President George W. Bush and Senator John F. Kerry. It was released on September 21, 2004, at the National Press Club in Washington, DC. The Lewin analysis centered on two key questions: How many people who currently lack health insurance would become covered under each candidate's program? How much money would each program cost the federal and state governments, consumers and other financial contributors over the 10-year span following implementation in 2006?
To view documents summarizing how Lewin's estimates differ from prior estimates click on comparison of estimates or presentation of comparison.
Expertise Area: Health Reform
June 2004
Families USA
Lewin contact: Lisa Alecxih
On June 16th, 2004, Families USA released a report entitled "One in Three: Non-Elderly Americans without Health Insurance, 2002-2003." The report was based on an analysis of Census Bureau data conducted by The Lewin Group, and provides estimates of the number of people under age 65 who lacked insurance for at least one month over the two-year period of 2002-2003. The report provides national and state-level estimates, as well as a breakdown by selected population characteristics. Some of the highlights from the report include:
Approximately 81.8 million Americans -- one out of three people under 65 years of age -- were uninsured at some point of time during 2002-2003.
Almost two-thirds (65.3 percent) of this 81.8 million were uninsured for six months or more, and about half (50.6 percent) were uninsured for at least nine months.
States with the highest proportion of non-elderly individuals with insurance gaps during the 2002-2003 period include Texas (43.4%), New Mexico (42.4%), and California (37.1%). States with the lowest proportion of individuals with insurance gaps include Minnesota (22.4%), New Hampshire (23.0%), and Vermont (24.9%).
A significant proportion of the middle class experienced insurance gaps. For example, among people with incomes between 300 and 400 percent of the federal poverty level (between $55,980 and $74,640 in annual income for a family of four in 2003), more than one out of four were uninsured for all or part of the two year period.
Researchers Note: In March 2003, The Lewin Group completed a similar analysis for Families USA that provided estimates of lack of insurance over the period 2001-2002. That analysis relied on Census Bureau data from 1998-1999, the most recent data available at the time, projected forward based on known population and economic trends. More recently available Census Bureau data for 2001-2002 indicate that these earlier 2001-2002 uninsured estimates were conservative. Therefore, the new 2002-2003 estimates should not be directly compared to the previous estimates for 2001-2002.
Client Area: Associations
Expertise Area: Health Reform
June 2004
Save Our ERs Coalition
Lewin contact: Terry West
In recent years, Harris County's emergency care system has become increasingly overburdened by growing emergancy department volume. The Lewin Group was commissioned by the Save Our ERs coalition to assist them in creating a framework for revisioning the organization and delivery of health care services in Harris County be developing and examining three conceptually distinct and credible options for reconfiguring care to safety net populations in Harris County, arrayed by degree of system reorganization and resources required.
Client Area: State and Local Governments
Expertise Area: Health Reform
June 2004
Georgians for a Common Sense Health Plan
Lewin contact: John Sheils
In this analysis, submitted to Georgians for a Common Sense Health Plan (GCSHP) in October 2003 and publicly released on June 21, 2004, The Lewin Group estimated the cost and coverage impacts of Georgia SecureCare, a proposed single payer health insurance program developed by GCSHP. The program would cover a broad range of services for all Georgia residents, including an estimated 1.1 million Georgians who are currently uninsured. SecureCare would replace public and private health insurance plans in the state, and would be financed by a consolidation of funding for current health care programs, a payroll tax to replace employer benefit plans and other dedicated revenues. The Lewin Group's analysis indicates that SecureCare would achieve universal coverage while reducing total health spending for Georgia by about $716 million annually.
Client Area: Associations
Expertise Area: Health Reform
May 2004
The Rapides Foundation
In 2003, The Rapides Foundation contracted with The Lewin Group to conduct an intensive assessment of the programmatic and financial environment of primary and hospital services for the medically indigent and describe options for an affordable and more effective system of delivery.
Client Area: Foundations
Expertise Area: Health Reform
February 2004
The tax expenditure for health benefits is the amount of revenues that the federal government foregoes by exempting health benefits and spending from the federal income and Social Security taxes, including (1) employer health benefit contributions for workers and retirees, (2) health benefit deductions for the self-employed, (3) health spending under flexible spending plans, and (4) the tax deduction for health expenses. In this article, The Lewin Group estimated the amount of the tax expenditure in 2004 using its Health Benefits Simulation Model (HBSM), a microsimulation model of the U.S. health care system.
Expertise Area: Health Reform
December 2003
New York State Insurance Department
The State of New York launched the Healthy New York program in January 2001 to give working families access to affordable health insurance coverage. The Lewin Study examines the impact of Healthy NY and analyzes the enrollment, premium costs, cost experience by the HMOs, surveys the enrollees and gathers input from participating employers and participating health plans.
Client Area: State and Local Governments
Expertise Area: Health Reform
October 2003
Maryland Citizens' Health Initiative Education Fund
Lewin contact: John Sheils
In December of 2002, the Maryland Citizens' Health Initiative Education Fund Inc., released a plan to provide health insurance coverage to all Marylanders. The program requires all Maryland residents to obtain a minimum level of health insurance coverage for themselves and their children or pay a substantial tax penalty. To assist the low-income population, the program also provides subsidized coverage to adults living below 350 percent of the Federal Poverty Level (FPL), and children living below 400 percent of the FPL. In addition, the program requires that all insurers in the individual and small group market provide at least a minimum level of coverage with guaranteed issue, no pre-existing condition limitations, and with no variation in premiums by health status.
Client Area: Associations
Expertise Area: Health Reform
October 2003
Robert Wood Johnson Foundation
Lewin contact: John Sheils
The Covering America project, made possible by a grant from the Robert Wood Johnson Foundation and directed by the Economic & Social Research Institute (ESRI), promotes serious thinking and debate about comprehensive policies to extend health care coverage to uninsured Americans. In June 2001 the project published a set of 10 comprehensive health coverage proposals. The Robert Wood Johnson Foundation commissioned The Lewin Group to analyze the 10 proposals and prepare estimates of the number of people who would be covered by public and private health insurance and the costs of extending coverage.
Appendices to the summary report provide a detailed explanation of the methodology used for the study, and detailed cost and coverage estimates for each proposal. Additional publications prepared for the Covering America project are posted on the ESRI website.
Appendix A: The Health Benefits Simulation Model (HBSM): Uniform Methodology and Assumptions
Appendix B: Reforming the Tax Treatment of Health Care to Achieve Universal Coverage, by Stuart M. Butler
Appendix C: Assessing the Combination of Public Programs and Tax Credits, by Judith Feder, Larry Levitt, Ellen O'Brien, and Diane Rowland
Appendix D: A Private/Public Partnership for National Health Insurance, by Jonathan Gruber
Appendix E: Medicare Plus: Increasing Health Coverage by Expanding Medicare, by Jacob S. Hacker
Appendix F: Expanding Health Insurance Coverage: A New Federal/State Approach, by John F. Holahan, Len M. Nichols, and Linda J. Blumberg
Appendix G: A State-Based Proposal for Achieving Universal Coverage, by Richard Kronick and Thomas Rice
Appendix H: An Adaptive Credit Plan for Covering the Uninsured, by Mark V. Pauly
Appendix I: Near-Universal Coverage Through Health Plan Competition: An Insurance Exchange Approach, by Sara J. Singer, Alan M. Garber, and Alain C. Enthoven
Appendix J: The Medical Security System: A Proposal to Ensure Health Insurance for all Americans, by Alan R. Weil
Appendix K: A Plan for Achieving Universal Health Coverage: Combining the New with the Best of the Past, by Elliot K. Wicks, Jack A. Meyer, and Sharon Silow-Carroll
Client Area: Foundations
Expertise Area: Health Reform
July 2003
Wisconsin AFL-CIO
Lewin contact: John Sheils
The Lewin Group esimated the impact of adopting a Wisconsin Health Care Plan to provide health insurance to all workers and their dependents in Wisconsin. This paper describes the WHCP proposal and summarizes the assumptions used to estimate its effects. It proivdes presents estimates of the program's impact on health spending for households, emplyers, and the state and federal governments. A description of the data and methods used is presented in the report Appendices.
Expertise Area: Health Reform
December 2002
Office of Vermont Health Access
Lewin contact: John Sheils
The Lewin Group analyzed an 1115 waiver concept that would provide vouchers for the purchase of health insurance to people who are currently eligible under the Vermont Health Access Plan (VHAP) and State Children's Health Insurance Program (SCHIP). In this analysis, Lewin estimates the number of persons who would be covered under the voucher program and the cost of providing the benefits called for under the proposal. The paper also provides estimates of the impact of the waiver on the number of persons in the state of Vermont who do not have health insurance.
Client Area: State and Local Governments
Expertise Area: Health Reform, Medicaid and CHIP
October 2002
The Commonwealth Fund
Lewin contact: John Sheils
The Lewin Group developed an analysis of the cost and coverage impacts of a proposal to expand insurance coverage developed by the Commonwealth Fund. Results from the analysis were featured in a recent article in Health Affairs by Karen Davis and Cathy Schoen of the Commonwealth Fund. The proposal includes an expansion of employer sponsored coverage through a "pay-or-play" program in which employers must either provide coverage to their workers or pay a tax covering their workers under a new public program. The proposal also expands upon the existing Medicaid/SCHIP programs, provides premium subsidies to middle-income people for the purchase of insurance, creates a Medicare buy-in for people over age 60 and permits people to obtain coverage from health plans offered through the Federal Employees Health Benefits Program (FEHBP).
Client Area: Foundations
Expertise Area: Health Reform
April 2002
California Health and Human Services Agency
Lewin contact: John Sheils
The California Health and Human Services Agency engaged The Lewin Group to analyze the cost and coverage impacts of nine proposals to expand health insurance coverage in the state. The analysis included estimating the portion of the 6.6 million uninsured persons in California who would become insured under each proposal.
Client Area: State and Local Governments
Expertise Area: Health Reform
March 2002
South Dakota Department of Health
Lewin contact: John Sheils
In 2001 South Dakota was one of nine states awarded one-year grants from the federal Health Resources and Services Administration (HRSA) to conduct a survey and study of the state's uninsured population. The state contracted with The Lewin Group to conduct the survey which included statewide telephone surveys of more than 20,000 households and also of 401 South Dakota employers. Eight focus group interviews were also conducted with selected high-risk populations such as farmers and ranchers, Native Americans and low-income households.
Client Area: State and Local Governments
Expertise Area: Health Reform
October 2001
Vermont Agency of Human Services, Office of Vermont Health Access
Lewin contact: John Sheils
The Lewin Group assisted the state of Vermont in developing options to expand insurance coverage in the state under the recent State Planning Grant program funded through the Health Resources and Services Administration (HRSA). This report describes the activities conducted to research the characteristics of uninsured Vermonters and the current state of the insurance, employer, and health care provider marketplaces. Additionally, this report contains the findings of the research as well as a summary of the various options developed under the HRSA grant.
Client Area: State and Local Governments
Expertise Area: Health Reform
August 2001
Vermont Agency of Human Services, Office of Vermont Health Access
Lewin contact: John Sheils
For the state of Vermont, The Lewin Group explored the expected costs and impacts of a single-payer program in which all state residents are covered under a single public program funded primarily with an employer payroll tax.
This report presents The Lewin Group's analysis of the financial impact of a single-payer program on various payers for health care including state, local, and federal governments. It includes estimates of the financial impact of the proposal on employers by industry and firm size, and of the impact of the plan on household health spending by age, income level, and other characteristics.
Client Area: State and Local Governments
Expertise Area: Health Reform
September 2000
Robert Wood Johnson Foundation
In January of 2000, the Robert Wood Johnson Foundation (RWJF) sponsored the "Health Coverage 2000" conference at which eight major health care organizations and associations introduced proposals to expand health insurance coverage. Some of those proposals were introduced as the next steps toward universal health coverage and two of them would incrementally phase in universal insurance coverage by the middle of this decade. The incremental reform proposals included various expansions of Medicaid and the State Children's Health Insurance Programs (SCHIP), changes in tax subsidies for insurance including modifying the current tax exclusions and/or introducing tax credits for health insurance, and expansion of high-risk pools. Lewin was asked to estimate the cost and coverage impacts of the eight proposals. Assuming full implementation in 2001, Lewin estimated that the incremental reform proposals would cost between $15.4 billion and $59.1 billion and would reduce the number of uninsured by 7.3 million to about 19 million persons. Therefore, the incremental reform proposals would cover no more than about 40 percent of the uninsured. The universal coverage programs would cost between $324 billion and $454 billion per year. The incremental reform proposals specified no new revenue sources to cover the cost of the programs. However, the universal coverage proposals did include new revenues that would cover most if not all of the costs of the programs.
Client Area: Foundations
Expertise Area: Health Reform
May 2000
Maryland Citizens' Health Initiative Education Fund
Lewin contact: John Sheils
The purpose of this analysis was to explore the expected costs and impacts of two alternative universal health reform plans for Maryland. Both of these reform scenarios would greatly redistribute health care costs across families in various income groups by shifting from today's premium based system to a tax based system where individual payments for health coverage increase in proportion to income. In this report, we present our analyses of the financial impact of these health reform models on various payers for health care including state, local, and federal governments.
Client Area: Associations
Expertise Area: Health Reform
January 2000
Robert Wood Johnson Foundation
This report is designed to help the executive leadership of safety-net organizations assess the benefits of, and determine whether or not to invest in, care management programs. It also provides a "road map" for the design and implementation of care management programs. The report explains the business environment that supports investments in care management programs for the indigent, chronically ill, uninsured population. Additionally, it draws on the experiences of safety-net providers to help decision-makers assess the value of these programs in their environment. Using results from expert interviews, case studies, site visits, and the successes and challenges of 24 safety-net providers, the how-to guide specifically describes how care management programs are developed and provides a sampling of tools designed by health centers, hospital networks, and health plans to enable others to build on these efforts.
Client Area: Foundations
Expertise Area: Health Reform
October 1999
National Coalition on Health Care
In this report we analyzed several proposals to modify the current tax treatment of health benefits and expenditures. The current tax code will provide about $125.6 billion in tax subsidies for the purchase of health insurance and health services in 2000. While the current tax treatment of health benefits has encouraged employers to offer coverage, it has been criticized as inequitable and a major contributor to health care cost inflation. We examined various tax credit proposals and modifications to the current tax-exemption for health care and estimated the impacts of these proposals on health insurance coverage levels and costs to governments, employers and families.
Client Area: Associations
Expertise Area: Health Reform
July 1998
DHHS, Office of the Assistant Secretaryfor Planning and Evaluation (ASPE)
This report examines the relationships among health insurance, employment, and program participation of people with disabilities. An empirical analysis is conducted of the expansions in the income threshold for the Supplemental Security Income (SSI) work incentive program established by Section 1619 of the Social Security Act. This act allows many working SSI recipients to maintain Medicaid eligibility even after their incomes rise above the level that makes them ineligible for SSI payments. The empirical results indicate that some SSI recipients who work don't earn as much as they could in order to limit their Social Security earnings and stay below the 1619(b) threshold. The numbers and types of disabled people who adjust their earnings vary depending on their age, sex, medical condition, and the income threshold of each state. A separate analysis is also performed using data from the Survey of Income and Program Participation and National Health Interview Survey to generate estimates of the relationships between employment, health insurance, and program participation for a broader population of persons with disabilities. The findings show a large difference in the program participation and employment patterns of persons with less severe disabilities compared to those with severe disabilities.
Client Area: Federal Government
Expertise Area: Health Reform
October 1997
DHHS, Office of the Assistant Secretaryfor Planning and Evaluation (ASPE)
Summary: Health insurance access is an important factor in decisions to work or participate in public programs for single mothers, older workers and the elderly. Many DI and SSI beneficiaries say they are deterred from working for fear of losing their benefits. Recent legislative proposals are designed to address these issues through expanded eligibility for government provided health insurance programs.
Client Area: Federal Government
Expertise Area: Health Reform, Income Security
October 1996
American Hospital Association
Employer health coverage has continued to erode throughout this decade despite the success employers have had in controlling health care costs. Employers responded to the rapid growth in health care costs early in this decade by shifting workers to managed care plans that control costs through price competition and aggressive cost control. However, employers also adopted policies that have led to reductions in the number of covered individuals. For example, some large employers with generous benefits have outsourced many production and service jobs to outside contractors where health insurance is less common and benefits are less comprehensive. Some employers also have discontinued their retiree coverage programs which will ultimately reduce coverage among early retirees. To control costs, employers have also increased employee cost sharing under their health plans and have discontinued coverage for certain specialized services. For example, deductibles and copayments have increased under traditional indemnity plans, partly as an incentive for individuals to shift to managed care alternatives. Coverage for expensive specialty services such as infertility treatments has also declined despite a recent increase in the number of states requiring insurers to cover these services. In addition, employers have increased premium contribution requirements for family coverage, which may be partly responsible for the recent decline in employer coverage among dependents. Some of the reduction in employer coverage will be curtailed by the recently enacted "Health Insurance Portability and Accountability Act of 1996" which requires portability of employer coverage across jobs. However, the impact of this legislation is likely to be negligible since 45 states had already enacted similar legislation by 1995. Thus gaps in employer coverage are likely to continue to be the primary reason for becoming uninsured well into the future.
Client Area: Associations
Expertise Area: Health Reform
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