More About Matt Broaddus

Matt Broaddus

Broaddus joined the Center in December 1999 and is a Research Analyst in the Health Division.

Full bio and recent public appearances | Research archive at CBPP.org


Census Data Show Improved Health Coverage in 2013

September 22, 2014 at 4:36 pm

We’ve posted our full analysis of the Census Bureau’s new data on health coverage, which show that the share and number of Americans with health insurance improved slightly last year.  (Because the results are for 2013, they don’t reflect the coverage gains in 2014 resulting from health reform’s major coverage provisions, which took effect on January 1 — namely, the Medicaid expansion and subsidized marketplace coverage.)

Census published data from both its Current Population Survey (CPS) and American Community Survey (ACS).  Although the CPS is the most widely used source of health coverage information, changes in its health coverage questions in 2013 — the result of a multi-year Census initiative to improve the reliability and accuracy of the survey’s health coverage estimates — mean the 2013 results can’t be compared to those for prior years.  Thus, for comparisons with earlier years, the ACS is the preferred data source this year.

The Census figures from the ACS show:

  • The share of Americans without health coverage fell slightly, from 14.8 percent in 2012 to 14.5 percent in 2013 (see chart).  The number of uninsured Americans also declined slightly, from 45.6 million in 2012 to 45.2 million in 2013.
  • The share of the population with private coverage remained stable at 65.0 percent in 2013 for the third consecutive year, while the share of the population with Medicaid or CHIP (Children’s Health Insurance Program) remained stable at 15.3 percent.
  • The share of the population enrolled in Medicare rose again in 2013 as another cohort of baby boomers aged into eligibility.
  • Some 14.1 percent of those living in states that have expanded Medicaid were uninsured in 2013, compared with 17.3 percent of residents of non-expansion states.  These results pre-date, and hence do not reflect, the coverage gains due to the Medicaid expansion.  This means that the coverage gap between expansion and non-expansion states will widen further in 2014.

 

Click here to read the full paper.

Coverage Gap Widening Between Medicaid Expansion States and Others

September 18, 2014 at 11:53 am

People in states that have adopted health reform’s Medicaid expansion had a lower uninsured rate in 2013 (before the expansion took effect) than people in non-expansion states — and non-expansion states are falling further behind in 2014, several recent government and independent surveys reveal.

Some 14.1 percent of the people in the 27 states (including Washington, D.C.) that have expanded Medicaid lacked health insurance in 2013, compared to 17.3 percent in the 24 non-expansion states, according to the Census Bureau’s American Community Survey (see chart).

Next year’s Census data, which will reflect the substantial coverage gains expected in expansion states in 2014 due to the expansion (which took effect January 1), should show a further widening of this coverage gap.

Results from several independent surveys — and this week from the Centers for Disease Control and Prevention (CDC), the first government survey data showing health reform’s early impacts — show that this is already happening.  For example, the Urban Institute’s Health Reform Monitoring Survey found that the uninsured rate for non-elderly adults in expansion states fell from 16.2 percent to 10.1 percent between the third quarter of 2013 and the second quarter of 2014, compared to a decline from 20.0 percent to 18.3 percent in non-expansion states.

Health reform’s Medicaid expansion creates a pathway to coverage for all non-elderly adults with incomes up to 138 percent of the poverty line, including, for the first time, low-income adults without children.  However, the 2012 Supreme Court decision upholding health reform made the expansion a state option.  States can opt in to the expansion at any time; the federal government will pick up all of the cost through 2016 and nearly all of the cost thereafter.

Census Data Show Continued Wide Disparities in Health Coverage

September 17, 2014 at 11:46 am

Certain groups of Americans continue to be uninsured at particularly high rates, the new Census Bureau data show.  African Americans and Hispanics, residents of the South and West, adults under age 35, and households with incomes under $50,000 had uninsured rates in 2013 well above the national average of 13.8 percent (see chart).  Hispanics’ 24.3 percent uninsured rate, for example, was nearly twice the national average.

These estimates, from the Current Population Survey (CPS), are the best source for comparing coverage rates among population groups in a single year but can’t be compared to CPS estimates from previous years because of changes to the CPS questions for 2013.  For health coverage trends over time, one should look instead to Census’ American Community Survey data, which we discussed yesterday.

Health reform’s major coverage expansions — the Medicaid expansion in many states to cover more low-income adults and the availability of subsidies for private marketplace coverage — will help reduce the disparities in health coverage among population groups.  But the expansions didn’t begin until 2014, so the new Census figures for 2013 don’t capture those coverage gains.  The Centers for Disease Control and Prevention released data yesterday covering the first quarter of 2014, and they show that the coverage gains in 2014 were greatest among some of the groups with the highest uninsured rates, including young adults, Latinos, and low-income households.

New CDC Figures Show Health Coverage Gains in the First Quarter of 2014

September 16, 2014 at 3:14 pm

Separate from the Census Bureau’s release today of official health coverage figures for 2013, the Centers for Disease Control and Prevention (CDC) issued preliminary data this morning showing that the ranks of the uninsured fell in the first quarter of 2014 by 3.8 million people.  The CDC data provide the first government survey data showing the early impacts of health reform’s major coverage expansions, which took effect in January 2014, in reducing the ranks of the uninsured.

The CDC figures are consistent with four independent surveys that also show significant gains in health coverage in 2014, particularly among states that have adopted health reform’s Medicaid expansion.

Some 13.1 percent of Americans were uninsured in the first quarter of 2014, the CDC data show, a 1.3 percentage-point decline from 2013 and the lowest uninsured rate since the CDC first collected these data in 1997.

Coverage gains were greatest among population groups historically least likely to have coverage.  The uninsured rate for adults under 26 plummeted from 26.5 percent in 2013 to 20.9 percent in the first quarter of 2014.  People in families under 200 percent of the poverty line, Latinos, African Americans, and people with less than a high school education also experienced disproportionately high coverage gains over this period.

The coverage gains among non-elderly adults were more than twice as large in states that have adopted the Medicaid expansion as in non-expansion states, widening the gap between the uninsured rates in the two groups of states from 4.3 percentage points to 5.8 percentage points.  (Expansion states have a non-elderly adult uninsured rate of 15.7 percent, compared to 21.5 percent for non-expansion states; see graph.)

The CDC data were collected in January-March and do not fully capture the significant enrollment growth in states’ Medicaid programs and health reform marketplaces that took place towards the end of this period, as the March 31 deadline for enrolling in marketplace coverage approached.  Data that include the second quarter of 2014 — as several of the independent surveys cited above did — will likely show even larger coverage gains.  For example, the Urban Institute’s Health Reform Monitoring Survey found that the uninsured rate among adults aged 18-64 fell from 17.9 percent to 13.9 percent between the third quarter of 2013 and the second quarter of 2014.

Later today, the Census Bureau may also release similar preliminary estimates for early 2014, but these estimates — unlike the CDC estimates discussed here — are the first in a new series and thus can’t be compared to estimates from earlier years.

Census Data Show Uninsured Rate Fell Slightly in 2013, Continuing Earlier Progress

September 16, 2014 at 12:55 pm

Some 14.5 percent of Americans were uninsured in 2013, Census figures released today based on the American Community Survey (ACS) show, a slight but statistically significant reduction from 2012’s 14.8 percent and well below the recent high of 15.5 percent in 2010 (see graph).

The most widely used source of health coverage information is the Current Population Survey (CPS), but, as Census officials explained this morning, changes instituted to it in 2013 don’t allow for a historical analysis using CPS data.

Much of the improvement in health coverage since 2010 reflects health reform provisions permitting young adults to stay on their parents’ health plans until age 26 and building upon previous coverage gains for children under Medicaid and the Children’s Health Insurance Program by requiring states to keep their existing eligibility rules and procedures.

The results are for 2013 and so do not reflect the coverage gains in 2014 resulting from the major ACA coverage provisions, which took effect on January 1 — namely, the Medicaid expansion and subsidized marketplace coverage.  But updated data from four independent surveys show substantial reductions in the number and percentage of uninsured in 2014, particularly among states taking up the Medicaid expansion.

Consistent with those independent surveys, the Centers for Disease Control and Prevention (CDC) today released preliminary survey results showing a 1.3 percentage-point decline in the uninsured rate between 2013 and the first quarter of 2014, reflecting a 3.8 million reduction in the number without health coverage.  CDC data that include the second quarter of 2014 (as some of the independent surveys cited above did) will likely show even larger coverage gains.

The CDC’s estimated 13.1 percent uninsured rate is the lowest since it began collecting these data in 1997.  (The CDC data are not directly comparable to the Census data cited above.)

What to Know About Next Week’s Health Coverage Data

September 11, 2014 at 4:25 pm

The Census Bureau will release estimates Tuesday of the number and share of Americans without health coverage in 2013, based on its annual Current Population Survey (CPS).  While the CPS is the most widely used source of health coverage information, significant changes in its health coverage questions instituted for 2013 — the result of a multi-year Census initiative to improve the reliability and accuracy of the survey’s health coverage estimates — mean that the 2013 results cannot be compared to those for prior years, as we explain in a new report.  Moreover, because the CPS estimates are for 2013, they will not show the effects of health reform’s major coverage expansions, implemented starting in January 2014.

Analysts and policymakers should therefore look to other available data sources as well, including other federal and private surveys.  For example, the Census Bureau also will issue Tuesday the health coverage results from its American Community Survey (ACS).  Unlike the CPS, the ACS health insurance data for 2013 will be a part of a consistent data series back to 2008 and hence will allow analysis of changes in health coverage over recent years.

Preliminary results from the Centers for Disease Control and Prevention’s (CDC) National Health Interview Survey provide important clues about the upcoming Census estimate (under the ACS) of the change in health coverage in 2013.  The CDC data show that the share of Americans without health coverage remained stable between 2012 and 2013, as did rates of private coverage, Medicaid coverage, and coverage for particular groups of Americans.  These data show the uninsured rate rose from 14.5 percent in 2007 to 16.0 percent in 2010, then fell to 14.7 percent by 2012, and remained essentially unchanged (in statistical terms) at 14.4 percent in 2013.

Click here to read the full report.

GAO Medicaid Data Show Per Capita Caps Would Lead to Disparate, Harmful Funding Cuts

July 30, 2014 at 10:04 am

We’ve previously warned that proposals to change the formula for federal Medicaid funding for states to a fixed dollar amount per Medicaid beneficiary — known as a “per capita cap” — would mean cuts in federal funding for all states.  The change would hit some states particularly hard due to substantial differences in per-beneficiary spending and how fast such costs grow over time.  A recent Government Accountability Office (GAO) analysis backs up our warning.

GAO’s analysis shows that states vary widely in how much they spend per beneficiary, consistent with our own analysis and that of the Kaiser Family Foundation.  GAO estimated average spending in 2008 for each state for different groups of beneficiaries — a child, a person with a disability, a senior, and a non-disabled, non-elderly adult — using federal expenditure and enrollment data.  As one would expect, overall, on average, Medicaid spending on people with disabilities and on seniors was significantly greater than spending on other adults and on children.

But spending on these enrollment groups varied considerably among states.  For example, Medicaid spending per child beneficiary was $5,877 in Vermont and $1,702 in California.  And average Medicaid spending per senior beneficiary was $28,564 in Montana and $9,882 in Alabama.

House Energy and Commerce Committee Chairman Fred Upton (R-MI) and Senate Finance Committee Ranking Member Orrin Hatch (R-UT), who requested the GAO analysis, responded to the findings by reiterating their proposal to establish a per capita cap, under which the federal government would no longer cover a fixed share of each state’s overall Medicaid costs but instead would limit each state to a fixed dollar amount per beneficiary.

Rep. Upton and Sen. Hatch previously argued that a per capita cap would “normalize” Medicaid spending across states, implying that states with higher-than-average spending per beneficiary have inflated costs.  In reality, states with relatively low Medicaid spending per beneficiary would likely fare disproportionately worse than higher-spending states under such a cap, because they would receive relatively less funding due to federal funding formulas that are typically based on current spending per beneficiary.

GAO tried to identify the factors driving this spending variation.  It concluded that while some factors were within the states’ control, such as optional benefits offered and optional eligibility levels, many significant factors were clearly not, including geographic variation in health care wages, differing enrollee service needs, and demographic differences among states such as the percentage of enrollees who are seniors.  In other words, just as overall health care spending and utilization among the states vary, so does Medicaid spending per beneficiary.  As a result, nothing in GAO’s report indicates that states with higher spending per beneficiary were somehow “overspending” relative to those with lower spending per beneficiary.

GAO’s findings don’t justify proposals to alter Medicaid’s financing structure.  They do, however, emphasize that while all states would face cuts in federal funding under proposals like a per capita cap, some states would disproportionately face larger ones.

Expanding Health Coverage Provides Financial Protection Too, Study Shows

February 25, 2014 at 1:39 pm

The comprehensive health reform that Massachusetts enacted in 2006 improved residents’ financial well-being, likely by protecting them from high out-of-pocket medical costs (among other things), according to recent research from the Federal Reserve Bank of Chicago.  Combined with previous research, these findings suggest that the federal Affordable Care Act (ACA) will not only give people better access to quality health care but also help them avoid financial hardship.

As the share of Massachusetts residents with health coverage rose by about 7 percentage points, residents’ credit scores improved, personal debt fell 22 percent on average, and the likelihood of bankruptcy fell 18 percent, after controlling for other personal and macroeconomic factors.  The positive financial effects of health coverage were especially pronounced among residents who had lower credit scores prior to health reform, though residents across the income spectrum benefited.

Using a rich database of credit report information, the Federal Reserve analysts evaluated a wider array of direct financial outcomes than has previous research.  They evaluated the impact on financial outcomes of each percentage-point increase in the share of the population with health coverage.  Since Massachusetts had one of the country’s highest rates of health coverage before enacting health reform, the Federal Reserve analysis suggests that the ACA’s major coverage expansions would have even greater financial benefits in states with lower health coverage rates.

The Massachusetts results reinforce findings from the landmark Oregon health insurance experiment, which found that uninsured adults who gained Medicaid coverage not only had better access to health care than adults who remained on a waiting list for Medicaid but also were less likely to borrow money or leave other bills unpaid to cover medical expenses.

CHIP’s Start: Lessons for Early Enrollment Under Health Reform

November 12, 2013 at 3:45 pm

The Administration is expected to issue estimates this week of enrollment since October 1 in health reform’s Medicaid expansion and its new health insurance marketplaces — and some media have already reported that the numbers did not meet Administration expectations.  But, as we’ve learned by examining the early experience with the Children’s Health Insurance Program (CHIP), early enrollment numbers aren’t a reliable indicator of health reform’s long-term performance.

CHIP — now recognized as an undeniable success — started slowly, too.  When the program started in fiscal year 1998, only eight states began enrolling low-income children in the first quarter.  By the end of that year, only 29 states operated CHIP programs and more than half of the 665,000 children enrolled came from just three states where most of the enrollment involved children transferred to CHIP from their pre-CHIP, state-funded children’s health programs.

But, by the end of fiscal year 2000, all 50 states and the District of Columbia had used CHIP to expand health insurance coverage to more low-income children, and enrollment had reached 3.3 million children.  Growing steadily ever since, CHIP now provides health insurance coverage to 8.1 million children.

The Congressional Budget Office (CBO) has estimated that health reform’s coverage expansions will eventually lead to 12 million to 13 million more people enrolled in Medicaid (and CHIP) and to about 20 million people enrolled in subsidized marketplace coverage.  But, these results will be achieved over time.  For example, steady-state enrollment won’t come in Medicaid until 2015 and in the marketplaces until 2017, CBO estimates (see chart).  (The coverage gains will be larger than this if most or all states ultimately adopt health reform’s Medicaid expansion for low-income non-elderly adults.)

Similar to states’ experiences with CHIP, it will likely take several years — as well as sustained, cooperative efforts by states, the federal government, and stakeholders — to maximize that enrollment.  (An analysis from First Focus similarly concludes that CHIP’s early years show that it likely will take considerable time for health reform to achieve major coverage gains.)

We can’t measure health reform’s success solely on the first month or first few months of enrollment numbers — or even on all of 2014 — just as CHIP couldn’t be judged based on its first year’s modest enrollment.  Rather, as with CHIP, it will take several years of experience to accurately evaluate health reform’s coverage expansions.

Click here to read the full paper.

Medicaid Coverage Doesn’t Discourage Employment, New Study Shows

October 28, 2013 at 12:05 pm

A new National Bureau of Economic Research (NBER) report refutes the claim by some opponents of health reform’s Medicaid expansion that enrolling in Medicaid discourages people from working.

The report strengthens the case for states to adopt the Medicaid expansion, a choice that more states are making.  It also corrects one of the many myths surrounding Medicaid; our recent short paper corrects five others.

The report uses data from the Oregon Health Study, a landmark, ongoing study of the state’s Medicaid program that allows researchers to compare low-income adults selected in a lottery to enroll in a Medicaid expansion to those who remained on a waiting list.

Researchers found no statistically significant difference between the two groups either in the share that had earnings (slightly more than half for both groups) or in the amount of earnings.

The researchers also found that Medicaid enrollment boosted participation in SNAP (formerly food stamps) among eligible people.

The increased SNAP participation reflected helpful state practices to coordinate program enrollment as well as enrollees’ greater awareness of SNAP because of their experience with Medicaid.

The report’s findings add to the other positive outcomes associated with Medicaid enrollment that previous research using the Oregon Health Study has identified.  Low-income adults enrolled in Oregon’s Medicaid expansion are more likely than the uninsured to receive preventive care, and they experience far less financial hardship from out-of-pocket health costs.

New Census Bureau Data Show More Young Adults Have Health Insurance Coverage Due to Health Reform

September 20, 2013 at 3:07 pm

The Census Bureau released its annual American Community Survey (ACS) this week, confirming that more young adults were insured in 2012.  (Earlier in the week, Census released its more well-known Current Population Survey (CPS), which found that the uninsured rate among young adults fell again in 2012, but not on a statistically significant basis.  The ACS’ larger sample size makes its health insurance data more robust than what’s reported through the CPS.)

The share of 18- to 24-year-olds without health insurance coverage declined from 25.8 percent in 2011 to 24.3 percent in 2012, according to the ACS data.  This marked the second consecutive year that the uninsured rate for this group has fallen, now down 5.2 percentage points since 2010 (see chart).

These coverage gains are due to growth in private coverage among young adults primarily resulting from a provision of health reform (the Affordable Care Act, or ACA) that allows adult children to stay on their parents’ private insurance plans until they turn 26.  The share of 18- to 24-year-olds with private coverage increased to 63.2 percent in 2012, up from 61.6 percent in 2011 and 58 percent in 2010.

These findings amplify a growing body of research on the positive coverage effects of the young-adult provision.  A Commonwealth Fund survey found that 6.6 million adults aged 19 through 25 who either joined or stayed on their parents’ insurance plans between November 2010 and November 2011 could not have done so without the health reform provision.  Similarly, analyses by the Centers for Disease Control and Prevention, the National Bureau of Economic Research, and the Kaiser Family Foundation show significant coverage gains among young adults since 2010.  Other studies from the Commonwealth Fund and the RAND Corporation have found that health insurance coverage protects young adults with health concerns against financial hardship.

The increase in coverage among 18- to-24-year-olds means that they’re no longer the age group most likely to be uninsured.  That dubious distinction now belongs to 25- to 34-year olds, 27.3 percent of whom were uninsured in 2012.  However, the uninsured rate for this group — as well as other non-elderly adults — should fall considerably in 2014, when health reform’s major coverage expansions take effect.

Where Is Health Reform in the New Census Bureau Health Data?

September 17, 2013 at 4:13 pm

Today’s Census Bureau health insurance coverage data do not reveal much about the impact of health reform.  That’s because the Census data reflect the number of people with and without health insurance coverage in 2012, but health reform’s major coverage expansion provisions will not take effect until 2014.  But, anyone examining the Census data should keep the following in mind:

  • Health reform has increased coverage among young adults. While the share of 19- to 25-year-olds without health insurance coverage remained unchanged between 2011 and 2012, it has fallen by 4.2 percentage points since 2009 (see chart).  Under health reform, adult children have been able to enroll in their parents’ health insurance plan up to their 26th birthday since September 2010.  This provision was likely the biggest reason for the drop in uninsured young adults.

  • Health reform required states to maintain their Medicaid and Children’s Health Insurance Program (CHIP) eligibility and enrollment procedures (through 2019 for children and until 2014 for adults). That allowed the overall share of people with Medicaid and CHIP to hold steady between 2011 and 2012.  Along with gains in private coverage in 2012, stable Medicaid and CHIP coverage helped cut the rate of children without health insurance coverage in 2012 to 8.9 percent, a historically low mark.  Medicaid and CHIP enrollment for adults has also increased, but not by enough to compensate for reductions in private coverage between 1999 and 2012; the uninsured rate rose more than 25 percent among non-elderly adults over that period.
  • Health reform can address regional inequities in health insurance coverage. The South remains the region with the greatest share of uninsured people, at 18.6 percent.  Most of the states in this region, however, don’t plan to take up health reform’s Medicaid expansion to low-income adults, even though the federal government will pick up the vast majority of the cost.  More Southern states opting for the expansion would produce large coverage gains.
  • Health reform can fill the coverage gaps that exist today for those without access to employer-based coverage or who are unemployed. Employer-based coverage remains the primary source of coverage in the United States.  Indeed, 54.9 percent of Americans had employer-based coverage in 2012.  But, the uninsured rates among those working only part-time (27.7 percent) and those without a job (25.8 percent) are much higher than the overall uninsured rate.  Health reform’s new health insurance exchanges (also known as marketplaces) and premium subsidies to purchase exchange plans will offer these individuals quality, affordable health insurance coverage irrespective of their employment circumstances.

We’ll take a closer look at the Census findings in a report tomorrow.