Research roundup: Studying states' readiness for insurance exchanges

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: Unauthorized Immigrants Spend Less Than Other Immigrants And US Natives On Health Care – Unauthorized immigrants' options for health care generally consist of hospital emergency rooms and community health centers. Using nationally representative survey data from 2000 to 2009, researchers compared medical spending for unauthorized immigrants, legal residents, naturalized citizens, and natives of the United States and found that "unauthorized immigrants have lower health care spending overall but higher rates of receiving uncompensated care than legal immigrants and US natives."  They note: "Just 7.9 percent of unauthorized immigrants benefited from public-sector health care expenditures (receiving an average of $140 per person per year), compared to 30.1 percent of US natives (who received an average of $1,385). Policy solutions could include extending coverage to unauthorized immigrants for the prevention and treatment of infectious diseases or granting them access to the Affordable Care Act's insurance marketplaces, which start in 2014" (Stimpson, Wilson and Su, 6/12).

The Dartmouth Atlas Project: Tracking Improvement In The Care Of Chronically Ill Patients: A Dartmouth Atlas Brief On Medicare Beneficiaries Near The End Of Life – According to the authors, the quality and efficiency of care given to patients during the last six months of life improved from 2007 to 2010. "Overall, patients spent fewer days in the hospital and more received hospice services in 2010 compared to 2007," they report, adding the "changes reflect the preferences of most patients to spend their last weeks and months in a home-life environment whenever possible, avoiding procedures that have little chance of improving the quality or length of their lives. But the pace of change varied across hospitals, with some experiencing rapid change while other health systems showed little improvement." They conclude: "Less intensive and expensive care can both save money and improve quality, satisfaction, and outcomes for many Medicare beneficiaries" (Goodman et al., 6/12).

Centers For Studying Health System Change/California HealthCare Foundation: Ready Or Not: Are Health Care Safety-Net Systems Prepared For Reform? – When it comes to implementing the Affordable Care Act, safety-net providers – public hospitals and community health centers – are falling behind, according to the authors: "Almost all safety-net providers in the study reported concerns about sufficient funding and workforce to care for newly insured people and for those who remain uninsured." They add that "at the same time, these safety-net providers are bracing for potential competition for insured patients from other providers and a consequence reduction in revenue." They studied six California communities in 2011 and 2012. "The findings ... indicate that community activities to prepare for health care reform can help mitigate the stress on the health care system to enroll and care for people come 2014," they conclude (Felland and Cross, 6/12).

Centers For Studying Health System Change/Robert Wood Johnson Foundation: Denver: Competitive Insurance Market Awaits National Health Reform – The authors note that Colorado is a leader compared to other states in preparing for the health law's insurance marketplaces. Based on interviews, they write that "Denver-area health plan executives, benefits consultants, brokers and others expressed concerns about the market's readiness for open enrollment in the exchange on Oct. 1. Top concerns include the uncertainty about the impact of health reform on risk selection and premium costs." Respondents expected "most of the major Denver carriers –Anthem, United and Kaiser – to participate in the exchange," the authors write and also highlight other top concerns including uncertainties in setting premiums and possible rate shock (Felland, Carrier, Lechner and Gourevitch, 6/13).