Assistant Professor (@HarvardHPM) studying strategies to improve take-up and retention of health insurance and politics of health reform. @adrianna.bsky.social
May 26, 2023 • 6 tweets • 1 min read
I'm as guilty of this as anyone, but I think we should be careful about how jargon-y the term "procedural reasons" is when talking about Medicaid unwinding.
nytimes.com/2023/05/26/us/…
When we say someone was removed from Medicaid for "procedural reasons," we're saying that that person had their benefits terminated because the state *did not know* whether they're eligible for the program or not.
-Some figures I'm pulling from Mark's AEA presentation, rather than the WP itself
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Feb 22, 2021 • 5 tweets • 2 min read
There's a specific quirk about how this plays out—which @dylanlscott references in his write-up—that is worth, I think, elaborating at more length. It helps explain why the "marginal" patients here are actually older-but-healthier, not those we'd conventionally label "high-risk"
Upon acquiring nursing homes, PE firms don't appear to universally scale back nursing staff. RN time actually increases. But so-called "frontline" nurses—CNAs and LPNs—their staff hours fall, more than offsetting the increase in RN effort.
Dec 14, 2020 • 7 tweets • 2 min read
Every policy person I know who thinks about health insurance is on board with "smart defaults."
I see the primary problems as political (concerning carriers more than individuals) and logistical (including legal questions), not broader public opinion.
Even with soft-defaults, like indicating that a certain plan is someone's probable "best" option, will get pushback from carriers.
That's because if these nudges worked well—and my prior is that they would—they'd have considerable influence over market share.
Feb 25, 2020 • 26 tweets • 8 min read
I hadn't read last week's Lancet paper on M4A, but thought I would today since Bernie cites it in his newish-mostly-old set of pay-fors. thelancet.com/journals/lance…
Now that I've read it, I wonder—quite sincerely—how this article got past peer review.
The thing that jumped out to me most glaringly was the stipulation that utilization will ONLY increase among the 24% of Americans who are currently uninsured or underinsured (the yellow box has the underinsurance criteria from the cited Commonwealth Fund)
Jul 7, 2018 • 4 tweets • 2 min read
What the actual hell. Risk adjustment was a permanent feature of the ACA because you can't have a functional regulated insurance market without it.
Risk adjustment is necessary in a market-based insurance system because some plans—maybe because of benefit design, maybe by chance—are going to attract sicker (more expensive) beneficiaries, and shouldn't be punished for that. Punishment encourages cream skimming.
"The Secretary never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid." ecf.dcd.uscourts.gov/cgi-bin/show_p…
"The Secretary never provided a bottom-line estimate of how many people would lose Medicaid with Kentucky HEALTH in place. This oversight is glaring, especially given that the risk of lost coverage was 'factually substantiated in the record.'"
