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  • The Affordable Care Act and Insurance Coverage in Rural Areas

    Issue Brief

    Rural populations face disparities compared to metropolitan populations in health care. While rural individuals were not more likely to be uninsured than metropolitan counterparts pre-Affordable Care Act, they were poorer and less likely to have private insurance. With coverage changes in the ACA involving an expansion of Medicaid for poor and near-poor populations, decisions by states with large rural populations may cause rural residents to have disparate access to coverage, which may exacerbate cost and access barriers to health care.

  • The Latest on Geographic Variation in Medicare Spending: A Demographic Divide Persists But Variation Has Narrowed

    Report

    This report uses the most current data available to analyze Medicare per beneficiary spending, by county, in 2013; the growth in Medicare per beneficiary spending between 2007 and 2013, by county; and the extent to which geographic variation in Medicare per beneficiary spending has increased or decreased over time. The analysis finds that beneficiaries living in counties with relatively high Medicare per beneficiary spending tend to be sicker and poorer than beneficiaries living in lower-spending counties and that the gap between high and low-spending counties narrows but does not close after adjustments are made for differences in prices and beneficiaries’ health status. The analysis also shows that the amount of variation between the highest- and lowest-spending counties appears to have narrowed in recent years, raising questions as to whether these changes are due to specific shifts in payment policy. An interactive U.S. map showing county-level Medicare spending is also available.

  • Economic and Fiscal Trends in Expansion and Non-Expansion States: What We Know Leading Up to 2014

    Issue Brief

    This brief was prepared with the Rockefeller Institute of Government, the public policy research arm of the State University of New York. It is designed to provide some insight into the underlying economic and fiscal conditions in expansion and non-expansion states leading up to 2014 by looking at the typical (i.e. median) state for each group. This analysis will provide a framework against which to measure the impact of expansion decisions going forward. The sections focus on: demographics, tax capacity and revenue, state budgets and employment.