Medicaid on the Eve of the Affordable Care Act: What are the Research Priorities?

Medicaid on the Eve of the Affordable Care Act: What are the Research Priorities? Summary of the November 6, 2013, conference held at the Urban Institute in Washington, D.C. (Released November 2014) Sponsored by the School of Public and Environmental Affairs (SPEA) at Indiana University and the Urban Institute 1 | Page Executive Summary The School of Public and Environmental Affairs (SPEA) at Indiana University and the Urban Institute cosponsored a conference to identify high-priority research questions and gaps in our research knowledge related to changes in the Medicaid program occurring under the Affordable Care Act (ACA). The conference took place in November of 2013, just as the first open enrollment period was getting underway and two months before 26 states were slated to expand Medicaid eligibility under the ACA. The conference began with a status report on the major policy changes occurring around the country in Medicaid under the ACA and an assessment of pressing research questions. The sessions that followed covered research needs and opportunities in specific Medicaid topic areas including enrollment and coverage; quality of care and outcomes; access to care; and cost impacts. The luncheon panel featured foundations that discussed their priorities and processes related to Medicaid research. The conference ended with reflections from the day. Two of these speaker summaries form the summary of the conference and appear on p.9, directly after the agenda on p.4. The speakers and participants represented a broad spectrum of perspectives and stakeholders, including those who conduct, consume, and fund research on the Medicaid program. Speaker biographies can be found on p.162 and the list of participants and their institutions on p.8. Following the synthesis comments, the chapters of this document are organized in the order of the conference. All chapters reflect comments made at the conference, with some small updates made in early to mid 2014. Synthesis Comments • Setting Research Priorities for Medicaid on Eve of ACA Health Insurance Expansions (Daniel Polsky) • Transforming Medicaid through Evidence (Andrew B. Bindman) Assessment of Where the Nation Stands Currently- ACA Medicaid Implementation • An ACA & Medicaid Research Agenda: What Can We Learn? (Alan Weil) • Reactions: Fractious Federalism and the Future of Medicaid (Frank J. Thompson) Research Needs and Opportunities in Specific Medicaid Topic Areas Enrollment and Coverage • Research Needs and Opportunities in the Area of Health Insurance Program Enrollment and Coverage Following ACA Implementation (Thomas DeLeire) • Research and Data Needs for Monitoring and Implementation of the ACA in 2014 and Beyond: Enrollment and Coverage (Julie J. Sonier) • Reactions (Sharon K. Long) Quality of Care and Outcomes • Improving the Quality of Care for Medicaid Beneficiaries (Sara Rosenbaum) 2 | Page • Does Medicaid Improve Health? Lessons from the Past and Recommendations for the Future (Robert Kaestner) • Reactions: Research on ACA’s Effect on Medicaid Quality and Outcomes (Marsha Gold) Luncheon Panel: Foundation Perspectives: Medicaid Research Priorities (Chris Perrone) • Access to C are The Affordable Care Act and Access to Care: Existing Research and Open Questions (Thomas C. Buchmueller) • Reactions: How Will the ACA Affect Access to Care for Medicaid Enrollees? (Stephen Zuckerman) • Cost Impacts The Financial Impacts of Health Reform (John Holahan) • Medicaid Expansion: State Approaches. Considerations and Questions (Deborah Bachrach) • Cost Impacts (Matt Salo) • Reactions: Cost Impacts (Judith Solomon) • Reactions: Medicaid Expansion under the ACA: Dollars and Sense? ( Joseph Antos) Andy Bindman, in summarizing the discussion of the day, noted that, “The lack of understanding about the Medicaid program undermines our ability to maximize the return on the public’s investment in this program,” while Dan Polsky commented that, “A theme that was consistent across all topics was the need for data and sufficient research infrastructure to study these questions.” To address that need, Polsky remarked that, “Cooperation and strategizing will be needed ...” and suggested ways to “... begin to create the type of advocacy needed to overcome political and organization hurdles to developing better data for researchers.” We appreciate the support of our institutions in helping to define a research agenda on this large and growing healthcare program that serves so many of the nation’s most vulnerable populations. SPEA and UI, together with AcademyHealth, are continuing efforts to advance the Medicaid research field by convening a one-day workshop in November 2014, bringing state-based and national evaluation teams together to discuss ongoing and proposed evaluations o