Research roundup: Making sense (or not) of health insurance; what a full Medicaid expansion could look like; recession and coverage

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

Journal of Health Economics: Consumers' Misunderstanding Of Health Insurance
The authors write: "We report results from two surveys of representative samples of Americans with private health insurance. The first examines how well Americans understand, and believe they understand, traditional health insurance coverage. The second examines whether those insured under a simplified all-copay insurance plan will be more likely to engage in cost-reducing behaviors relative to those insured under a traditional plan with deductibles and coinsurance, and measures consumer preferences between the two plans. The surveys provide strong evidence that consumers do not understand traditional plans and would better understand a simplified plan, but weaker evidence that a simplified plan would have strong appeal to consumers or change their healthcare choices" (Lowenstein et al., Sept. 2013).

The Urban Institute/The Kaiser Family Foundation: State And Local Coverage Changes Under Full Implementation Of The Affordable Care Act – Since it was deemed optional by the 2012 Supreme Court decision on the Affordable Care Act, many states have opted not to expand their Medicaid programs or are undecided. In this report, researchers highlight how the number and composition of individuals enrolled in Medicaid or the Children's Health Insurance Program would change with full implementation of the ACA, and find that Medicaid enrollment increases would vary substantially. According to the authors, "A total of 14 states are projected to experience enrollment increases in excess of 50 percent, while seven states are projected to expand their Medicaid/CHIP enrollment by less than 20 percent under the ACA," and they add: "These estimates also provide guidance on the areas that are likely to experience the largest declines in the uninsured and where the residual uninsured are likely to be concentrated"  (Kenney et al., 7/31).

The Kaiser Family Foundation provides interactive maps to "zoom in on your area and see how the number and composition of individuals enrolled in Medicaid or without insurance coverage could change if your state expands Medicaid" (7/31).

UCLA Center For Health Policy Research: The Effects Of The Great Recession On Health Insurance: Changes In The Uninsured Population From 2007 To 2009 – The 2007 economic recession's impact was proportionally greater in California than other states. According to the authors, "Unemployment in the state has been at least two percentage points higher than in the rest of the country." It took a toll on California's medically uninsured population: "In conjunction with this increase in unemployment, the number of those who were uninsured for all or part of the past year also swelled, increasing from 6.4 million in 2007 to 7.1 million in 2009," they write. Using survey data to examine the differences between 2007 and 2009, they found that people who lacked coverage for all or part of 2009 were older, more likely to be U.S.-born citizens, had lower household incomes, and were more likely to be unemployed and looking for work. The counties with the highest impact from the recession, however, did not have the highest rate of growth in the uninsured population (Lavarreda,  Snyder and Brown, 7/30).

Kaiser Family Foundation: A Discussion With Leading Medicaid Directors: As FY 2013 Ends, Looking Toward Health Care Reform Implementation In 2014 – In this policy brief, the authors highlight the main findings of a May 2013 meeting involving "leading" state Medicaid directors. "The discussion clearly illustrated how widely divergent state decisions and approaches are on expanding Medicaid," the authors write. But, according to the directors, all states indicated they were actively working to have new streamlined eligibility and enrollment processes ready for 2014 and were continuing to improve their existing Medicaid programs. "Despite different degrees of readiness at the start, they will continue to improve processes over time after initial implementation. At the same time, states are also continuing to pursue payment and delivery system reforms to better coordinate care for complex populations that the program serves," the authors conclude (Gifford, Artiga et al, 7/31).

Here is a selection of news coverage of other recent research:

Reuters: Court-Ordered Mental Health Treatment May Save Money
State-run programs that compel people with serious mental illness to get treatment may reduce costs, according to a new analysis of New York State's system known as Kendra's Law. Addressing the concerns of some lawmakers, researchers found that treatment costs dropped by about half among those covered under the program in New York City and even more for those in other counties throughout the state, largely as a result of fewer hospital admissions. ... Four-fifths of the patients in New York City and three-quarters of those in the other counties had a diagnosis of a schizophrenia spectrum disorder, the team writes in the American Journal of Psychiatry (Seaman, 7/30).

Reuters: Cancer Trial Results Slow To See Light Of Day: Study
U.S. law requires certain research results to be posted online within a year of a study's end date, but a new analysis found that only about half of cancer drug research results are made public after three years. Researchers who looked at 646 studies examining the safety and effectiveness of cancer drugs found that 55 percent were published online or in a medical journal three years after the studies' end dates (Seaman, 7/25).

MedPage Today: Low Cost, Doc Relationship Key To BP Control
Minimizing out-of-pocket drug costs and having one provider are two factors that appear to improve blood pressure treatment, a systematic review found. When medication costs or copayments increase, adherence to antihypertensive medication and control of blood pressure decreases, according to Will Maimaris, BM, Bchir, from the London School of Hygiene & Tropical Medicine, and colleagues from McMaster University in Ontario. The group evaluated 14 quantitative studies, nine of which were done in the U.S. (Kaiser, 7/31).

Medscape: Clinical Decision Support Tool Reduces Tests, Antibiotic Use
Providers who used an integrated clinical decision support tool for the management of patients with respiratory tract infections were less likely to prescribe antibiotics or order point-of-care testing when compared with providers not using the tool. Results of the randomized controlled trial were published online July 29 in JAMA Internal Medicine (Garcia, 7/29).

MinnPost: Newly Established Medical Practices Often Prove To Be Ineffective, Study Finds
A study that analyzed articles published in just one prominent medical journal over a period of 10 years has found that newly established medical practices -; even ones in wide use -; are often reversed by subsequent evidence-based research. The finding, which was published online this month in the journal Mayo Clinic Proceedings, belies the common assumption that the very latest screening technology, medication or surgical technique is an improvement on care (Perry, 7/31).