The mission of the National Institute for Health Care Reform (NIHCR) is to conduct high-quality, objective research and policy analyses of the organization, financing and delivery of health care in the United States. The Institute works to identify key health policy issues, identify policy options, and assess the advantages and disadvantages of policy options to help inform policy makers and other decision makers about how to expand access to high-quality, affordable health care to all Americans.
Sine Qua Non: A Healthy Nation Requires Real Budget Constraints in All Government Health Programs
Every government health program should operate under the same budget constraint that applies to other government programs. Failure to do so represents bad budgeting and economic, social, and health policy; redistributes income in perverse ways; and makes health care allocation extremely inefficient. No excuses for this failure to act—largely centered…
Strategies to Advance Insulin Affordability in the United States
How did insulin become unaffordable for millions of Americans and what can policymakers do about it? Altarum's new report, Strategies to Advance Insulin Affordability in the United States, answers this question and provides a detailed set of policy proposals to make insulins affordable to patients and payers through federal regulation, market…
Private Health Plans Pay Hospitals Much Higher Prices in Indiana than in Michigan: Explanations and Implications
Premiums for employer-sponsored health insurance have been growing at a rate well above growth in wages or overall inflation. Excess premium growth, in turn, suppresses wage growth and creates financial hardship for the middle class while, at the same time, reducing government tax revenues and employment. Spending on hospital care…
Impacts of Prior Authorization on Health Care Costs and Quality
This brief summarizes the use of prior authorization policies for coverage of health care goods and services and reviews the evidence on cost and quality impacts of these policies. Click here to download this report.
Assessing Responses to Increased Provider Consolidation in Six Markets: Final Report
Few communities in the United States have been exempt from the recent wave of consolidation among health care providers, whether it is hospital-to-hospital mergers and acquisitions (horizontal consolidation) or hospital acquisitions of physician groups and other ambulatory service providers (vertical consolidation). Increased provider concentration has been demonstrated to lead to…
Did Medicare Advantage Payment Cuts Affect Beneficiaries Access and Affordability?
American Journal of Managed Care •
DISCUSSION The ACA’s cuts to MA payments were expected to reduce the attractiveness of MA to both plans and beneficiaries, primarily through reductions in rebates, thereby decreasing enrollment in the MA plan program.7-9 Instead, MA enrollment steadily increased as the ACA was implemented. Prior research indicates that MA plans…
Why Did Medicare Advantage Enrollment Grow as Payment Pressure Increased?
Urban Institute Research Report •
Medicare Advantage (MA), also known as Medicare Part C, gives Medicare beneficiaries an option to receive their Parts A and B benefits through private health insurance plans as an alternative to traditional Medicare. MA has been attractive to many Medicare beneficiaries in part because of several enhancements plans typically make…
Insuring Good Health: Outcomes and Acceptability of a Participatory Health Insurance Literacy Intervention in Diverse Urban Communities
Health Education & Behavior •
Background. The U.S. uninsured rate has dropped significantly since the passage of the Affordable Care Act (ACA), yet insurance coverage remains lower in historically marginalized communities than in the overall population. New consumer engagement approaches that involve these populations are needed. The purpose of this study was to evaluate…
Assessing Responses to Increased Provider Consolidation in Three Markets: Detroit, Syracuse and Northern Virginia
Center on Health Insurance Reforms •
Rising health care prices have increased concerns about hospital and health system consolidation among policymakers, regulators, employers, and other purchasers of health coverage. Although merging hospitals and health systems claim they can achieve greater efficiencies through their consolidation, the economic literature almost universally finds that hospitals that merge have prices…
Why Do Medicare Advantage Plans Have Narrow Networks?
Urban Institute Research Report •
In contrast to commercial markets, narrow networks in Medicare Advantage (MA) markets are not motivated by unit-price discounts for insurers in exchange for higher patient volume for health systems. Through 15 interviews with MA experts, MA insurers, and health systems, we confirmed that the Medicare fee schedule is the basis…