R-3 Repository :: Browsing by Author "Marks, Elena M."

Browsing by Author "Marks, Elena M."

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Can a multibillion dollar investment in information technology improve the quality of health care or drive down its escalating costs?
(James A. Baker III Institute for Public Policy;Baylor College of Medicine, 2011) Marks, Elena M.; Pugh, Noel; James A. Baker III Institute for Public Policy
Health Reform Monitoring Survey – Texas, Issue Brief #1
(James A. Baker III Institute for Public Policy;Episcopal Health Foundation, 2014) Ho, Vivian; Marks, Elena M.; Bray, Patricia Gail; James A. Baker III Institute for Public Policy
In September 2013, as the nation prepared for the launch of the Affordable Care Act’s Health Insurance Marketplace, Texans were surveyed to learn about their recent experiences with health care and health insurance and their expectations going forward. This Issue Brief describes Texans’ experiences obtaining and paying for a variety of health services during the preceding year and the satisfaction levels of insured Texans with the quality and cost of their health plans. These data show that, on the eve of the launch of healthcare.gov, many Texans were struggling to pay for basic health services. Even those with health insurance reported dissatisfaction with the cost and availability of services. And most Texans expected 2014 to be more of the same.
Health Reform Monitoring Survey – Texas, Issue Brief #11: Effects of the Affordable Care Act on health insurance coverage in Texas as of March 2015
(James A. Baker III Institute for Public Policy;Episcopal Health Foundation, 2015) Ho, Vivian; Marks, Elena M.; James A. Baker III Institute for Public Policy
The major insurance coverage expansion provisions of the Affordable Care Act—the Health Insurance Marketplace and Medicaid expansion—went into effect in January 2014. At that time, individuals in all 50 states were able to purchase health plans during two open enrollment periods, with subsidies for those with incomes between 100% and 400% of the federal poverty level. Individuals with incomes below 139% of the federal poverty level were able to enroll in Medicaid in the 31 states that opted to expand Medicaid. This issue brief focuses on the changes in health insurance coverage among Texans ages 18-64 as of March 2015, following the ACA’s second open enrollment period. Because Texas has had the highest percentage of uninsured residents among the 50 states for many years, the coverage provisions of the ACA were expected to play a significant role in providing coverage to the more than 4 million adults ages 18-64 who previously lacked health insurance. Based on the HRMS-Texas March 2015 survey, we find that the ACA has had a substantial positive impact on the rate of health insurance coverage among Texans. The rate of uninsured Texans ages 18-64 dropped by nearly one-third, from 24.6% in September 2013 to 16.9% in March 2015. The drop is almost entirely attributable to newly insured individuals who purchased their own plans. The reduction in the rate of uninsured individuals occurred across all age groups, including younger adults. Despite this progress, Texas remains the state with the highest percentage of uninsured residents and, for the first time, Texas now has the largest number of uninsured residents. The percent of uninsured Texans with incomes above 138% of the federal poverty level dropped by 44.5% while those with the lowest income only dropped by 19.7%. As of March 2015, the lowest income Texans are almost four times more likely to be uninsured than higher income individuals. This coverage gap has grown since 2013 because the Marketplace enabled the higher income group to purchase health insurance with subsidies not available to lower income Texans. Unless Texas participates in an expanded Medicaid program or develops some other mechanism for covering the lowest income Texans, this is not likely to change.
Health Reform Monitoring Survey – Texas, Issue Brief #12: Change in Insurance Status of Adult Texans by Demographic Group as of March 2015.
(2015) Marks, Elena M.; Ho, Vivian; Balihe, Philomene; James A. Baker III Institute for Public Policy
In March 2015, as the second open enrollment period of the Affordable Care Act’s (ACA) Health Insurance Marketplace was drawing to a close, we surveyed adult Texans ages 18 to 64 to examine changes in insurance status since the opening of the Marketplace. As we reported in Issue Brief #11, the overall rate of uninsured adult Texans fell by more than 30%, from 24.6% to 16.9%. In this brief, we examine the change in uninsured rates based on eight demographic characteristics to understand the relative changes among groups. We also compare the Texas data to the national HRMS data and report on similarities and differences between Texas and the US.
Health Reform Monitoring Survey – Texas, Issue Brief #13: Characteristics of Uninsured Texans as of March 2015
(2015) Marks, Elena M.; Ho, Vivian; Balihe, Philomene; James A. Baker III Institute for Public Policy
In March 2015, near the close of the Health Insurance Marketplace’s second open enrollment period, we surveyed adult Texans ages 18 to 64 to understand who remained uninsured and why, and to identify the differences, if any, in the characteristics of the uninsured population before the opening of the Marketplace in September 2013, and March 2015. Our survey indicates that the 16.9% of adult Texans who remain uninsured are more likely to be Hispanic, middle aged, low income and without a college degree. This corresponds with the pre-Marketplace data which indicated that these same groups were more likely to uninsured in 2013. The majority (57.1%) of the remaining uninsured cited costs as the biggest factor in their lack of insurance, and also reported that the prospect of a fine was not an important consideration to them.
Health Reform Monitoring Survey – Texas, Issue Brief #14: Comparison of Affordability and Utilization of Health Care Services by Insured and Uninsured Adult Texans
(2015) Marks, Elena M.; Ho, Vivian; Balihe, Philomene; James A. Baker III Institute for Public Policy
In March 2015, we surveyed adult Texans ages 18 to 64 to assess affordability and utilization of health care services by insured and uninsured Texans. Texas has made strong gains in coverage since the opening of the Marketplace in January 2014, and research by the Urban Institute suggests that coverage gains will increase access to and reduce the costs of health care for those who have gained coverage. We also examined self-reported health status for insured and uninsured Texans. Our results showed that those without coverage had more trouble paying medical bills than those with insurance and that they also skipped care due to costs more so than those with insurance. Self-reported health status was similar for the two groups regarding physical health, but uninsured respondents reported more days of poor mental health than the insured respondents.
Health Reform Monitoring Survey – Texas, Issue Brief #15: The Impact of the Affordable Care Act on Texas Workers
(James A. Baker III Institute for Public Policy;Episcopal Health Foundation, 2015) Ho, Vivian; Marks, Elena M.; Balihe, Philomene; James A. Baker III Institute for Public Policy
In March 2015, near the close of the Affordable Care Act’s (ACA) Health Insurance Marketplace’s second open enrollment period, we surveyed adult Texans ages 18 to 64 to understand the changes in insurance status, if any, for Texas workers since the January 2014 effective date of many provisions of the ACA. Despite predictions that the ACA would erode Employer Sponsored Insurance (ESI), the data show that Texas workers experienced gains in ESI. In particular, lower income workers saw significant gains in ESI and in individually purchased plans. Lower income workers remain the largest group of uninsured working Texans and, despite the available subsidies in the Marketplace, the majority reported that they remain uninsured because the costs of coverage are too high.
Health Reform Monitoring Survey – Texas, Issue Brief #16: Characteristics and Changes in Rates of the Uninsured in Texas and the United States as of September 2015
(2016) Marks, Elena M.; Ho, Vivian; Balihe, Philomene; James A. Baker III Institute for Public Policy
In September 2015, just before the third open enrollment period of the Affordable Care Act’s (ACA) Health Insurance Marketplace was about to open, we surveyed adult Texans ages 18 to 64 to examine changes in insurance status since the opening of the Marketplace. We then compared their responses to those of the United States population as a whole, as reported by the Urban Institute. We also looked at the changes for various demographic groups based on age, gender, race/ethnicity and income. The data show that Texans, like all Americans, experienced meaningful drops in the rates of the uninsured. As of September 2015, the uninsured rate among adults ages 18 to 64 in Texas and the U.S. was 18.5% (a 21.4% drop) and 10.4% (a 40.9% drop), respectively.
Health Reform Monitoring Survey – Texas, Issue Brief #17: Affordability of Health Services among Non-Elderly Texas Adults
(2016) Sim, Shao-Chee; Marks, Elena M.; Ho, Vivian; Balihe, Philomene; James A. Baker III Institute for Public Policy
In September 2015, just before the third open enrollment period of the Affordable Care Act’s (ACA) Health Insurance Marketplace was about to open, we surveyed Texans ages 18 to 64 to see whether they had trouble paying health care bills or skipped various types of care due to cost. We compared their responses to data from September 2013 to learn whether affordability had changed based on insurance status or income level. We also compared the Texas data to similar national data regarding affordability.
Health Reform Monitoring Survey – Texas, Issue Brief #18: Why were 20% of Adult Texans Uninsured in 2015?
(2016) Marks, Elena M.; Sim, Shao-Chee; Ho, Vivian; Balihe, Philomene; James A. Baker III Institute for Public Policy
In September 2015, just before the third open enrollment period of the Affordable Care Act’s (ACA) Health Insurance Marketplace was about to open, we surveyed Texans ages 18 to 64 to understand the reasons why the uninsured population remained uninsured two years after the implementation of the ACA’s , major insurance coverage provisions. We looked at the group of uninsured as a whole and by demographic subgroups including race/ethnicity and age. Our analysis shows that for the full group of uninsured adults, the overwhelming reason cited for remaining uninsured because they did not want health insurance, and even fewer cited lack of information as a reason.
Health Reform Monitoring Survey – Texas, Issue Brief #19: Health Insurance Literacy among Adult Texans
(2016) Marks, Elena M.; Sim, Shao-Chee; Ho, Vivian; Balihe, Philomene; James A. Baker III Institute for Public Policy
In September 2015, just before the third open enrollment period of the Affordable Care Act’s (ACA) Health Insurance Marketplace was about to open, we surveyed Texans ages 18 to 64 to assess their confidence level in understanding the basic terminology about health insurance plans. Our data show that approximately one-quarter of adult Texans lacked confidence in their understanding of some of the most basic health plan terms, including premium and co-payment. Uninsured Texans were significantly more likely to report a lack of confidence in understanding health plan terminology than their insured counterparts. White Texans generally reported greater confidence than Black respondents. Hispanic respondents reported the least confidence in their understanding of health plan terminology.
Health Reform Monitoring Survey – Texas, Issue Brief #23: The Experience of Texas Young Invincibles 2013-2016
(2016) Marks, Elena M.; Ho, Vivian; Sim, Shao-Chee; James A. Baker III Institute for Public Policy
A central goal of the Affordable Care Act (ACA) is to provide access to affordable health insurance coverage for millions of Americans. The inclusion in the insurance markets of young adults, who are generally healthier than older adults, helps the system as a whole by offsetting the costs of health services used by the older and less healthy populations. In this brief, we examine the health insurance experiences of Texans ages 18 to 34, the so-called “Young Invincibles,” between 2013 and 2016. The Young Invincibles term was coined by the health insurance industry to describe young people who were expected to forego health insurance based on the belief they were too healthy to warrant the cost. Prior to the implementation of the ACA, the Young Invincibles were less likely to be insured than their older counterparts. Our data show that the uptake of health insurance by Young Invincibles has increased significantly from 2013 to 2016. The uninsured rate for this group has fallen by more than one-third, from 32.7% to 21.3%. The increase is significantly attributable to the Young Invincibles' coverage through employer-sponsored insurance plans (21% increase). The largest sub-groups of Young Invincibles who remain uninsured are Hispanic and low income.
Health Reform Monitoring Survey – Texas, Issue Brief #24: Stability of Health Insurance Coverage among Texans ages 18-64
(James A. Baker III Institute for Public Policy;Rice University;The Episcopal Health Foundation, 2016) Sim, Shao-Chee; Marks, Elena M.; Ho, Vivian; James A. Baker III Institute for Public Policy
Health Reform Monitoring Survey – Texas, Issue Brief #2: The Affordable Care Act and Texas’ “Young Invincibles”
(James A. Baker III Institute for Public Policy;Episcopal Health Foundation, 2014) Marks, Elena M.; Bray, Patricia Gail; Ho, Vivian; James A. Baker III Institute for Public Policy
One of the goals of the Affordable Care Act (ACA) is to increase the number of young adults with health insurance coverage by offering comprehensive plans at affordable prices through the Health Insurance Marketplace. Participation in the Marketplace by young adults is important because it facilitates access to health care and protects against high, unexpected medical bills. The inclusion of younger, generally healthier people in the insurance risk pool helps the entire system by offsetting the costs of health services used by older and less healthy people. As the first enrollment period of the ACA’s Health Insurance Marketplace comes to a close, special attention is focused on extending health insurance coverage to people ages 18-34. This group is often referred to as the “Young Invincibles,” a term coined by the health insurance industry to describe young adults who forego health insurance believing that they are too healthy to justify the cost of coverage. This issue brief highlights HRMS-Texas’ findings about the Young Invincibles’ knowledge and perceptions of the ACA immediately prior to the opening of the Marketplace. We also report data regarding insurance status and affordability and accessibility of health services for young adults. The substantial number of uninsured Young Invincibles in Texas—2.3 million people—provides challenges and opportunities for the ACA.
Health Reform Monitoring Survey – Texas, Issue Brief #3
(2014) Ho, Vivian; Marks, Elena M.; Bray, Patricia Gail; James A. Baker III Institute for Public Policy
The major provisions of the Affordable Care Act influencing health insurance coverage took effect this year. Residents of all 50 states who could not obtain affordable health insurance through their employer or in state insurance markets can now purchase coverage through the ACA’s Health Insurance Marketplace. Families earning between 100% and 400% of the federal poverty level are eligible for subsidies to purchase insurance in the Marketplaces. Individuals in families earning less than 138% of the federal poverty level are eligible for Medicaid if the state they live in elected the Medicaid expansion offered by the ACA. Under the law, almost all individuals are required to obtain health insurance coverage by March 31, 2014, or pay a penalty levied by the IRS in their tax return for 2014. Given that Texas has consistently had the highest percent of uninsured residents among the 50 states for several years, the insurance provisions of the ACA are expected to play a substantial role in providing coverage to the close to 5 million adults who reportedly lacked health insurance in the state in 2010-2011. However, technical problems plagued the electronic websites for the Health Insurance Marketplaces in each state when they opened in October 2013, and some of these problems still exist today. In addition, Texas declined the Medicaid expansion offered by the ACA, so that most adults in families earning less than 138% of the federal poverty level are ineligible for any public subsidies to purchase health insurance. In this brief, we track changes in health insurance status in Texas between September 2013 and March 2014. We find that the rate of uninsured adults ages 18 to 64 in Texas declined from 24.8% to 23.5%. The majority of this decline is attributable to an increase in the percent of adult Texans obtaining insurance through an employer. The proportions of adults with either Medicaid or individual private insurance both declined during this period. However, these percentages likely disguise significant changes in insurance coverage in Texas over the time period. By mid-March 2014, an estimated 746,000 Texans had obtained private insurance through the Marketplace. Of these, 225,000 (30.2%) were previously uninsured. Although a seemingly small proportion of Texans obtained insurance through the state’s Marketplace, the large absolute numbers had a substantial impact on increasing access to insurance coverage in the United States.
Health Reform Monitoring Survey – Texas, Issue Brief #4: The Affordable Care Act and Hispanics in Texas
(James A. Baker III Institute for Public Policy;Episcopal Health Foundation, 2014) Marks, Elena M.; Ho, Vivian; James A. Baker III Institute for Public Policy
A central goal of the Affordable Care Act (ACA) is to improve access to affordable health insurance coverage for millions of Americans. Hispanics make up 39% of the Texas population and account for a disproportionate share of the 6 million uninsured Texans. Census data from 2012 indicate that 39% of Texas Hispanics were uninsured, compared to 17% of Whites and 22% of Blacks. The ability of Hispanics to obtain affordable health insurance under the ACA is important if we are to reduce the overall rate of uninsured residents in Texas. In September 2013, we surveyed Hispanic and non-Hispanic White Texan adults to assess their needs for the kinds of improved access to health care and health insurance promised by the ACA, and we surveyed them again in March 2014 to see if improvement had been realized. We find that during both periods, Texas Hispanics had more trouble accessing and affording health services than White Texans. On the eve of the opening of the Health Insurance Marketplace, Hispanics were more optimistic than Whites that their ability to obtain affordable health services would improve in 2014. Toward the end of the first open enrollment period, our data indicate that a significantly larger percentage of Texas Hispanics had enrolled in health plans through the Marketplace than their White counterparts.
Health Reform Monitoring Survey – Texas, Issue Brief #7: Insurance Status of Adult Texans and Characteristics of the Uninsured as of June 2014
(James A. Baker III Institute for Public Policy;Episcopal Health Foundation, 2014) Marks, Elena M.; Ho, Vivian; Mineo, Jennifer; James A. Baker III Institute for Public Policy
In June 2014, after the completion of Health Insurance Marketplace’s first open enrollment period, we surveyed adult Texans aged 18 to 64 to examine changes in insurance status since the opening of the Marketplace and to identify the characteristics of the uninsured population. Our survey indicates that there were small gains in coverage for adult Texans from September 2013 to June 2014 and that the types of coverage did not change much when compared with pre-Marketplace coverage. Low income and Hispanic populations still comprise the majority of the uninsured, and about half are employed. Comparisons to national data show many similarities in the characteristics of the uninsured although Texas’ uninsured population tends to be more Hispanic and female and less educated than the total US uninsured adult population.
Health Reform Monitoring Survey – Texas, Issue Brief #8: Affordability of Marketplace Plans in the Largest Metropolitan Areas of Texas
(James A. Baker III Institute for Public Policy;Episcopal Health Foundation, 2014) Ho, Vivian; Marks, Elena M.; James A. Baker III Institute for Public Policy
Lower income Texans are much more likely to be uninsured than higher income residents of the state. Data collected by the Urban Institute and the Kaiser Commission on Medicaid indicate that in 2011-2012, 26% of individuals in Texas households with incomes between 139% and 250% of the federal poverty level were uninsured. The percent uninsured declined to 13% for households earning between 251% and 399% of the FPL, and to 10% for households earning 400%+ of the FPL. One of the strategies for making health care more attainable under the Affordable Care Act is the provision of tax credits to purchase insurance in state-based marketplaces for persons earning between 139% and 399% of the federal poverty level. We refer to this group as the “Target Population.” In June 2014, 15% or 1.5 million individuals in the Target Population in Texas remained uninsured. In Issue Brief 6, we reported that almost half of the people in this income category did not buy a policy in 2014, because the costs were too high, or they did not have enough money. In this issue brief, we present and compare the premiums that were offered in the Texas marketplace for those who did and did not qualify for tax credits in the four largest cities in Texas.
Health Reform Monitoring Survey – Texas, Issue Brief #9: Preparing for the Second Marketplace Enrollment period in Texas
(2014) Marks, Elena M.; Ho, Vivian; Mineo, Jennifer; James A. Baker III Institute for Public Policy
This issue brief focuses on the lessons learned during the first Marketplace open enrollment period in order to prepare for the second enrollment period that begins next month. This second open enrollment period is shorter than the first- only 15, 2015. The health insurance Marketplace is the official source for people to get information about and enroll in health coverage under the Affordable Care Act (ACA). The mechanisms the ACA has put in place to connect people with the Marketplace are the ACA website, healthcare.gov; the toll free call center, 1-800-318-2596; and individual assisters such as navigators, non-navigator assistance personnel, and certified application counselors, who are trained and employed by local organizations. There are also various other informal ways a person can learn about the Marketplace, but ultimately enrollment is accomplished through healthcare.gov. Texas data from the June 2014 Health Reform Monitoring Survey (HRMS) tell us which Marketplace resources people utilized the most, which methods were easiest, and where improvements can be made. We provide this data to inform those engaged in enrollment activities so that they will understand what Texans found most helpful and where improvements are needed. As the data show, some enrollment methods were widely utilized and perceived as very helpful. As we move into the second open enrollment period, each available method will need to be at peak performance to facilitate the enrollment of the hundreds of thousands of Texans who are eligible for subsidized plans but remain uninsured.
Health Reform Monitoring Survey- Texas, Issue Brief #20: Insured Texans lack clear understanding of their health insurance plans
(James A. Baker III Institute for Public Policy;Episcopal Health Foundation, 2016-03) Sim, Shao-Chee; Marks, Elena M.; Ho, Vivian; Balihe, Philomene; James A. Baker III Institute for Public Policy
In September 2015, just before the third open enrollment period of the Affordable Care Act's (ACA) Health Insurance Marketplace was about to open, we surveyed insured Texans ages 18 to 64 to assess their confidence level in understanding the basic terminology about health insurance plans and in how they use their health insurance plans. Our data show that, as compared to Texans with employer-sponsored insurance (ESI) and those with public health insurance, Texans with individual plans were more likely to lack confidence in understanding health insurance terminology. Texans with individual plans also expressed more difficulty in understanding how to use their health insurance plans.