The Economic and Social Research
Institute (ESRI) ceased operations as of August 31, 2006. Most of the
former ESRI staff are now employees
Management Associates, which is a national research and consulting firm
specializing in complex health care program and policy issues,
with offices in eight cities across the United States. The Washington
office of HMA is
located at the former offices of ESRI, at 2100 M Street, N.W, Suite
605, Washington DC 20037. The telephone number is (202) 785-3669.
Recent ESRI Publications
Patient-Centered Care for Underserved Populations: Definition and Best Practices, by
Sharon Silow-Carroll, Tanya Alteras, and Larry Stepnick, January 2006,
March, 2006. Prepared by the Economic and Social Research Institute
for the W.K.
Kellogg Foundation. A groundbreaking report defines the
key components of patient-centered care for diverse, vulnerable populations,
and describes how such care is being put into practice across the
country. There is a particular focus on serving individuals who typically
face obstacles to appropriate health care related to language, culture,
education, age, and/or economic status. By improving the patient and
clinician experience, and enhancing the patient's understanding of
and role in his/her care, these practices can improve the effectiveness
of health care delivery and reduce disparities.
In addition to the overview, five case studies highlight successful
and innovative strategies at select hospital systems and
community health centers:
Massachusetts General Hospital
Cambridge Health Alliance in Massachusetts
G.A. Carmichael Family Health Center in Mississippi
Senior Health and Wellness Center in Oregon
Health Choice Network in Florida
The case studies describe the institutional supports
and structures necessary to provide patient-centered care and present
practices that could be replicated in a wide range of health
care and social
service settings. The report also presents policy recommendations
that could promote the development, adoption, and expansion of
such effective strategies.
Responsiveness, Health Coverage, and Economic Resilience:
A Preliminary Analysis, by
Stan Dorn (Economic
and Social Research Institute),
Barbara Markham Smith (Health Policy Innovation, Inc.),
and Bowen Garrett (Urban Institute), September 27, 2005. Prepared
for The Health Policy Institute of the Joint Center for
Political and Economic Studies, this report examines Medicaid's
responsiveness to changes in the economy, identifying possible
dangers that could result from caps on Medicaid spending
Take-Up of Health Coverage Tax Credits and the Design of
Future Tax Credits for the Uninsured,
Stan Dorn (Economic and Social Research Institute), Janet
Varon (Northwest Health Law Advocates), and Fouad Pervez
(Economic and Social Research
Institute), October 2005. Prepared
for the Commonwealth Fund, this report analyzes the federal tax credits
that were created as part of the Trade Act of 2002 to subsidize health
coverage for certain early retirees and workers displaced by international
trade. Though small, this relatively new program offers the opportunity
to learn how to design future tax credits for larger groups of uninsured.The
report is available in two forms—an issue
brief and a longer research report. For the
issue brief, click here. For the research
report, click here.
Oral Health Programs: Lessons Learned from Three Innovative Models, by
Silow-Carroll and Tanya Alteras, July 2005. Prepared for the W.K.
Kellogg Foundation. A case study report examining community-based
initiatives intended to improve the oral health of vulnerable populations.
This report highlights three successful and innovative initiatives:
The Washington State ABCD and ABCD”E” program, The
Apple Tree Dental program in Minneapolis-St. Paul, and Community
DentCare in Northern Manhattan. In addition, it describes the lessons
learned and the challenges these communities faced in developing
pathways for underserved populations to access oral health care.
in Action: A Quarterly Look at Innovations in Health Policy,
by Sharon Silow-Carroll and Tanya Alteras. A newsletter recently inaugurated
by the Commonwealth Fund to identify and describe innovative state programs
across the country. The first issue (May 2005) highlights strategies for
purchasing care, building on employer-based coverage, and expanding county-based
coverage. Future issues will examine efforts to improve the quality and
efficiency of care and continue to spotlight strategies to expand coverage.
Implementation of the Health Coverage Tax Credit in Maryland, Michigan,
and North Carolina: A Case Study Summary, by Stan Dorn,
Tanya Alteras, and Jack A. Meyer, April 2005. Prepared for The Commonwealth
Fund. A summary report of studies in three states that achieved above-average
results enrolling potentially eligible individuals into Health Coverage
Tax Credits (HCTCs) available for certain displaced workers and early
retirees. This overview report finds both significant accomplishments
and serious problems, recommending a number of program reforms. The
state reports are also available as follows:
Features of California Health Coverage: A California Perspective on National
Reforms—A Chart Book, prepared for the California
Health Care Foundation by Stan Dorn, February 2005. As national health
reform proposals are unveiled in the new Congress and by the Bush Administration,
this chart book identifies California’s unique stake in these proposals.
For Covering the Uninsured: How California Policymakers Could
Build on Lessons Learned at the Federal Level, prepared
for the California Health Care
Foundation by Jack A. Meyer and Stan Dorn, February 2005.
This paper describes “lessons learned” from recent
national efforts to cover the uninsured and outlines possible
coverage expansions in California that build on those national
Safety Net Hospitals: A
Vital Resource for the U.S., by Jack A Meyer, November 2004.
The purpose of this paper is to explain and illustrate the vital role
played by safety net hospitals in serving a diverse group of vulnerable
populations and providing critically important community-wide health and
social services. Prepared for the National
Association of Public Hospitals and Health Systems.
Incremental Progress: Key Facts About Groups of Uninsured,
by Stan Dorn, September 2004, prepared for the California
Health Care Foundation. A fact sheet book providing key statistics
and identifying crucial policy design questions for eight groups
of uninsured who could potentially become the subject of incremental
health reform: employees of small business; workers who lose their
jobs; workers who are offered but decline employer coverage; low-income
parents; low-income, childless adults; the near-elderly; young adults;
children; and immigrants. Each fact sheet includes full citations
and internet links
to diverse sources.
Coverage for Poor Adults: A Potential Building Block for Bipartisan Health Reform,
by Stan Dorn, November 2004, prepared for the California
and Other Public Programs for Low-Income Childless Adults: An Overview
of Coverage in Eight States, August
2004, by Stan Dorn, Sharon Silow-Carroll, Tanya Alteras, Heather
Sacks, and Jack A. Meyer. Prepared for the Kaiser
Commission on Medicaid and the Uninsured. A summary report of
studies of eight states that implemented either Medicaid waivers
or state-only funding to provide health coverage to adults who were
neither elderly, disabled, pregnant, or currently parenting dependent
children. Without a waiver, Medicaid programs are forbidden from
covering such childless adults, no matter how poor they are.The individual
state reports are also available as follows:
Adult Coverage in the District of Columbia,” Heather Sacks
and Jack A. Meyer, August 2004.
Adult Coverage in Maine,” Tanya Alteras and Sharon Silow-Carroll,
A Case Study in Childless Adult Coverage,” Tanya Alteras and Sharon
Silow-Carroll, August 2004.
A Case Study in Childless Adult Coverage,” Heather Sacks and Stan
Dorn, August 2004.
York: A Case Study in Childless Adult Coverage,” Sharon Silow-Carroll,
Adult Coverage in Oregon,” Tanya Alteras, August 2004.
A Case Study in Childless Adult Coverage,” Stan Dorn and Jack Meyer,
State: Pioneer and Innovator in Covering Low-Income Workers,” Stan
Dorn and Tanya Alteras, August 2004.
Coverage Tax Credits Under the Trade Act of 2002, by
Stan Dorn and Todd Kutyla of ESRI, prepared for the Commonwealth
Fund and the
Nathan Cummings Foundation,
April 1, 2004. This
new report analyzes the initial effects of the Health Coverage
Trade Act. Just 3.6% of 235,000 potentially eligible
workers—a total of 8,400—were enrolled at the end
of 2003 in the program’s system for advancing tax credits
to insurers when monthly premiums are due. The authors say that
the precise causes of this low rate of uptake are unclear, as
is its future persistence. Barriers to enrollment that may need
to be addressed include premiums that appear to be too high for
many unemployed workers, even with a tax credit, and requirements
that laid-off workers “front” one or more months
of premiums in full before the advance tax credit kicks in.The
authors also praise federal
officials for establishing, more rapidly and broadly than many
thought would be possible, a novel and generally effective federal
infrastructure for administering this complex program. The full
brief version, as well as the press release, are available
in PDF format.
and Coverage Analysis of Ten Proposals to Expand Health Insurance Coverage,
by John Sheils and Randall
Haught, The Lewin Group, October 2003.
As part of the Covering America project, the Robert Wood Johnson
Foundation commissioned the Lewin Group to analyze the 10 coverage expansion
proposals published in Volume I (click here for the
proposals themselves) and to prepare estimates of the number of people
who would be covered by public and private health insurance and the costs
of extending coverage. The Summary
Report can be downloaded in PDF format.Appendices
of detailed cost and coverage estimates for each individual proposal are
also availableCopies of the summary report can ordered from the Economic
and Social Research Institute. Also available is a document
that summarizes in narrative and charts some of the lessons of this analysis,
prepared by the Economic and Social Research Institute.
for Financing Health Coverage Expansion
This fourth paper in the Issues in Coverage Expansion
Design Series discusses issues to be considered when
policymakers decide how to finance new coverage programs, including the
differences between budgetary and social costs, criteria for choosing
a financing source, and various sources for funding. The paper was written
by Jack A Meyer, President of ESRI, and Elliot K. Wicks, Senior Fellow
of ESRI. — To download the PDF file, click on the blue title above
Quality Improvement into Health Coverage Expansion Proposals.
This third paper in the Issues in Coverage Expansion Design Series, by
Jack A Meyer, President of ESRI, and Sharon Silow-Carroll, Senior Vice
President of ESRI, presents a number of quality improvement tools and
strategies that could be built into the full range of proposals to expand
health coverage. The paper shows how health care purchasers—public
and private—could use better information systems, financial incentives,
and quality measurement against standards to improve health outcomes as
we expand health care coverage. March 2003.
Points and Trade-Offs in Developing Comprehensive Health Coverage Reforms.
This paper by Elliot K. Wicks, Ph.D., is the first in the new series Issues
in Coverage Expansion Design. The paper presents an overview of the range
of decisions that policy reformers must make as they develop new programs
to cover the uninsured. Many of the issues explored in this paper will
be addressed in greater detail in subsequent papers. February 2003.
with Risk Segmentation: Challenges and Policy Options.
In this second paper in the new Issues in Coverage Expansion Design
series, Elliot K. Wicks, Ph.D., discusses in detail the problem
that confronts anyone proposing to extend health insurance to various
populations—how to ensure that premium costs are fairly shared among
people of high and low risk and how to make certain that sicker people
are not priced out of the insurance market. The paper presents the range
of possible solutions to the issues raised. February 2003.
Insurance to Laid-Off Workers: A Time for Action. This report,
by Lynn Etheredge and Stan Dorn, analyzes the potential benefits of extending
health coverage to laid-off, uninsured workers. The authors explain how
policymakers could help unemployed workers obtain insurance, building
on policies already accepted by national leaders in both parties. February
Real Remedies for the Uninsured, Volume 2,
three proposals for expanding health coverage, by David B. Kendall, Jeff
Lemieux, and S. Robert Levine; Tom Miller; and James A. Morone. Commentaries
by Christine Ferguson, Patricia Riley, and Sara Rosenbaum; Edward F. Lawlor
and Ann Dude; and Bruce C. Vladeck. Economics and Social Research Institute,
Toward Comprehensive Health Coverage
for All: Summaries of 20 State Planning Grants from the U.S. Health Resources
and Services Administration. Prepared by Heather
Sacks, Todd Kutyla, and Sharon Silow-Carrol, November 2002. This report,
published by The Commonwealth Fund, details the efforts of the first 20
states that received planning grants from the federal government to collect
data on their uninsured populations and devise plans to provide them with
of Coverage: HIPAA and COBRA. Jack A. Meyer and Larry S.
Stepnick, for The Commonwealth Fund, November 2002.
Insurance Purchasing Cooperatives. Elliot K. Wicks, November
2002, for The Commonwealth Fund, November 2002.
Assessing State Strategies for Health Coverage Expansion: Case
Studies of Oregon, Rhode Island, New Jersey, and Georgia. Sharon
Silow-Carrol, Emily K. Waldman, Jack A. Meyer, Claudia Williams, Kimberley
Fox and Joel C. Cantor. For The Commonwealth Fund, November 2002. Click
the summary or the
Nine Billion Dollars a Year
to Cover the Uninsured: Possible Common Ground for Significant, Incremental
Progress, October 2002, by Stan Dorn and Jack A. Meyer.
OCCASIONAL PAPER: Tax Credits for Individual
Health Insurance--Effects on Employer Coverage and Refinements to Improve
Overall Coverage Rates, August 2002, by Rick Curtis and Ed Neuschler,
Institute for Health Policy Solutions.
Coverage for Laid-off Workers: Searching for Common Ground, Issue
Alert No. 3, May 2002, by Stan Dorn and Jack A. Meyer.
ISSUE ALERT: What health coverage
would laid-off workers obtain under recent tax credit proposals?
Issue Alert No. 2, March 2002, by Stan Dorn and Jack A. Meyer.
Roadmaps to Coverage: Exploring Options
for the Uninsured — A Luncheon Briefing Sponsored
by ESRI and the Alliance for Health Reform. (You can view a video of the
meeting along with supporting material by clicking
Three promising approaches emerging from the Covering America
project were described and discussed at a May 19, 2003, luncheon briefing
sponsored by the Alliance for Health Reform and ESRI. Panelists were Elliot
Wicks of ESRI, Len Nichols of the Center for Studying Health System Change,
and Tom Miller of the Cato Institute. Robert Helms of the American Enterprise
Institute commented on the proposals. Ed Howard of the Alliance moderated
8th ESRI hosted a meeting of key stakeholders and Congressional staff
to discuss incremental and comprehensive options for providing health
insurance to uninsured Americans. Presentations were made by Mark Pauly,
David Kendall, Linda Blumberg, Jacob Hacker, Stuart Butler, Jeanne Lambrew,
Lynn Etheredge and Stan Dorn. A webcast of presentations along with a
transcript, speaker presentation slides, and related resources is available
via kaisernetwork.org, as a service of the Kaiser Family Foundation.