Christine Eibner

@Chrissyeibner on Twitter

Paul O'Neill Alcoa Chair in Policy Analysis; Director, Payment, Cost, and Coverage Program; Director, RAND Compare; Senior Economist; Professor, Pardee RAND Graduate School

Washington Office

Education

Ph.D. in economics, University of Maryland, College Park

One Page Bio

Media Resources

This researcher is available for interviews.

To arrange an interview, contact the RAND Office of Media Relations at (310) 451-6913, or email media@rand.org.

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Overview

Christine Eibner is the Paul O'Neill Alcoa Chair in Policy Analysis; director, Payment, Cost, and Coverage Program; and a senior economist at the RAND Corporation.

Her research focuses on health insurance reforms, including modifications to the Affordable Care Act (ACA), changes to health insurance benefit design, and ACA replacement proposals. She currently leads an analysis of the effects of COVID-19 on insurance coverage in New York State, and policy options to address coverage loss. Additionally, she leads the evaluation of CMS's Medicare Advantage Value-Based Insurance Design Model Test, and oversees a large technical assistance contract for the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within the U.S. Department of Health and Human Services. Her work on health insurance reform includes topics such as 1332 waivers, cost containment strategies, and state single payer plans. In 2016, she was awarded the AcademyHealth HSR (Health Services Research) Impact Award for her work on the impact of modifications to the Affordable Care Act.

Eibner earned her Ph.D. in economics from the University of Maryland, College Park and her bachelor's degree in English and economics from the College of William and Mary.

Research Focus

Recent Projects

Socioeconomic disparities in health
Employer-sponsored insurance
Military medical policy
Modeling the effect of health care policy changes on costs, insurance coverage, and other outcomes
Analysis of health care reform options

Selected Publications

Miller, Amalia R., Christine Eibner, Carole Roan Gresenz, "Financing of Employer Sponsored Health Insurance Plans Before and After Health Reform: What Consumers Don’t Know Won’t Hurt Them?" International Review of Law and Economics, 36, 2013

Price, Carter C. and Christine Eibner, "For States that Opt Out of Medicaid Expansion: 3.6 Million Fewer Insured and $8.4 Billion Less in Federal Payments," Health Affairs, 32(6), 2013

Cordova, Amado, Christine Eibner, Raffaele Vardavas, James Broyles, Federico Girosi, "Modeling Employer Self-Insurance Decisions After the Affordable Care Act," Health Services Research, 48(2p2), 2013

Cordova, Amado, Frederico Girosi, Sarah Nowak, Christine Eibner, Kenneth Finegold, "The COMPARE Microsimulation Model and the U.S. Affordable Care Act," International Journal of Microsimulation, 6(3), 2013

Eibner, Christine, Dana P. Goldman, Jeffrey Sullivan, Alan M. Garber, "Three Large-Scale Changes to the Medicare Program Could Curb Its Costs but also Reduce Enrollment," Health Affairs, 32(5), 2013

Benjamin F. Mundell, Mark W. Friedberg, Christine Eibner and William C. Mundell, "US Military Primary Care: Problems, Solutions, And Implications For Civilian Medicine," Health Affairs, 32(11), 2013

Griffin, Beth Ann, Christine Eibner, Chloe E. Bird, Adria Jewell, Karen Margolis, Regina Shih, Mary Ellen Slaughter, Eric A. Whitsel, Matthew Allison, Jose J. Escarce, "The Relationship between Coronary Heart Disease and Urban Sprawl in Women," Health & Place, 20, 2013

Saltzman, Evan, Christine Eibner, Evaluating the "Keep Your Health Plan Fix": Implications for the Affordable Care Act Compared to Legislative Alternatives, RAND Corporation (RR-529), 2014

Recent Media Appearances

Interviews: CNBC; KJZZ-FM Online; PolitiFact; Tradeoffs

Commentary

Medicaid

Can the Health Insurance System Handle Massive Medicaid Reductions?
For many who have or will soon lose Medicaid as monthly redeterminations restart, and for millions more who could lose insurance due to other factors like job loss, three recent policy developments might increase the chances that they find new health care coverage.
May 12, 2023
The Hill
Health Insurance

Temporary Safety-Net Policies Prevented Mass Insurance Loss During the Pandemic
Although it provided a foundation, the ACA alone could not have absorbed the effects of the pandemic's sudden job losses on health care coverage. Temporary expansions to the safety net enacted by Congress also were necessary to stem coverage loss. As the pandemic continues, policymakers will want to keep safety-net provisions as available policy options.
Dec 13, 2021
The RAND Blog
Wages and Compensation

Is the Fight for $15 Going to Cost Low-Wage Workers Their Health Insurance?
Minimum wage increases can lead to reductions in employer-sponsored health insurance for some workers and their dependents. If policymakers want to raise the minimum wage, they should look beyond standard labor market outcomes and take into account other potential effects.
Oct 11, 2021
Newsweek
Affordable Care Act

ACA Subsidies for Higher-Income Families Are Key to Enrolling More Americans
The House Ways and Means Committee has proposed several insurance reforms in its emergency COVID-19 relief package, including increasing subsidizes and extending subsidies to people with higher incomes. The proposed combined approach is a far more efficient means of covering uninsured Americans than enhancing subsidies only for those who are currently eligible.
Mar 1, 2021
Health Affairs
Health Care Reform

Options for Designing a Public Option
State and federal policymakers are considering adding state-backed public options to the individual market in an effort to expand health coverage and improve affordability. We analyzed what would happen if public options became available in U.S. health insurance exchanges.
May 28, 2020
The RAND Blog
Affordable Care Act

What If the Supreme Court Strikes Down the ACA During the COVID-19 Pandemic?
With COVID-19 spreading across the United States, the fate of the Affordable Care Act is once again up in the air, hanging on the outcome of a Supreme Court case. Should the law be overturned, upwards of 20 million people could lose their health insurance during one of the deadliest pandemics in modern history.
Apr 3, 2020
The Hill
Affordable Care Act

All Health Policy Is Local: The Case of the Individual Mandate Penalty in New York
As with many Affordable Care Act policies, how New York is dealing with the absence of the individual mandate penalty is a potent reminder that all health policy is local.
Oct 30, 2018
The Health Care Blog
Health Care Payment Approaches

Misconceptions About 'Medicare for All'
Medicare for All is a talking point for both major U.S. political parties. Would it be free? Would people have to switch doctors? Would waits be long? Misconceptions abound about single-payer proposals and their likely effects. Here are the facts.
Oct 27, 2018
USA Today
Health Insurance Mandates

Understanding the Impact of the Elimination of the Individual Mandate Penalty
Starting in 2019, the Affordable Care Act's individual mandate penalty will be eliminated, effectively ending the law's requirement that most people have health insurance. While declines in coverage and increases in premiums are likely, the magnitudes of these effects are highly uncertain.
Aug 10, 2018
The Commonwealth Fund Blog
Health Care Reform

Do Americans Expect Too Much from Health Insurance?
Americans expect affordable coverage for pre-existing conditions, access to routine services, and protection from unpredictable and significant financial risk from accidents or illness. As a product designed primarily for risk protection, insurance may not be the most efficient or affordable approach to achieving all of these objectives.
Sep 23, 2017
U.S. News & World Report
Health Insurance Cost Sharing

Four Steps That Could Stabilize the Health Insurance Market
Congress will soon discuss options to stabilize the individual market and ensure that all Americans have access to affordable coverage. Policymakers could encourage enrollment, make targeted investments to lower premiums, fund cost-sharing reductions, and enforce the individual mandate.
Aug 25, 2017
The Hill
Extending Marketplace Tax Credits Would Make Coverage More Affordable for Middle-Income Adults
Paying for health care coverage is a challenge for Americans facing rising premiums, deductibles, and copayments. The ACA's tax credits that make marketplace insurance more affordable for lower-income individuals should be extended to middle-income adults aged 50–64.
Jul 27, 2017
The Commonwealth Fund Blog
Health Care Reform

Ingredients for Health Care Reform
Despite their differences, the Affordable Care Act and the current proposals to replace it take a similar approach to providing health insurance. What might some alternatives look like? And how could they provide coverage to more Americans?
Jul 10, 2017
Fortune
Health Insurance Benefit Design

How Would the House Health Care Plan Affect People with Pre-Existing Conditions?
The American Health Care Act would guarantee that individuals with pre-existing conditions could enroll in insurance even if they had a coverage lapse. But there is no guarantee that this coverage would be affordable, and coverage of some essential health benefits could be excluded.
May 28, 2017
U.S. News & World Report
Health Legislation

Removing Maternity Care and Mental Health Treatment from Coverage Requirements Would Reduce Premiums, but Lead to Significant Spending Increases for Some Consumers
The American Health Care Act passed by the U.S. House of Representatives to repeal and replace the Affordable Care Act allows states to waive benefits that the ACA deemed “essential.” Dropping maternity care coverage, for example, would reduce premiums by 5 percent but increase out-of-pocket spending for new mothers.
May 18, 2017
The Commonwealth Fund Blog
Affordable Care Act

Repeal-and-Delay Would Make Budget Neutrality for ACA Replacement Difficult
As Congress considers repealing and replacing the Affordable Care Act, it will need to consider how federal budget scoring can affect the fate of legislation. Depending on the ultimate cost of a replacement, finding enough savings to offset costs while maintaining budget neutrality could make it hard to pass a replacement.
Jan 11, 2017
The Commonwealth Fund Blog
Health Insurance Cost Sharing

Insuring Younger Adults Through the ACA's Marketplaces: Options to Expand Enrollment
Whether or not the Affordable Care Act is repealed, having young adults participate in the individual health insurance market remains critical to achieving affordable premiums for everyone.
Dec 16, 2016
The Commonwealth Fund Blog
Health Insurance Cost Sharing

Estimating the Impacts of the Trump and Clinton Health Plans
Donald Trump wants to repeal and replace the Affordable Care Act. Hillary Clinton wants to maintain and modify it. How could each proposal impact coverage, out-of-pocket costs, and the deficit?
Sep 23, 2016
Health Insurance Cost Sharing

What Happens If the ACA's Tax Credits Are Replaced with Premium Support?
As policymakers consider alternatives to reduce the federal government's financial burden from providing subsidies under the ACA, they should consider the consequences for enrollees. Existing premium-support models yield considerable savings for the federal government but could create age and income disparities in coverage.
Nov 24, 2015
The Commonwealth Fund Blog
Affordable Care Act

Insurance Enrollment Holds Steady in Advance of the 2016 Open Enrollment Period
Since September 2013, the number of people with health insurance coverage has increased by 16.6 million. But since the second ACA open enrollment period in February 2015, the number of people with coverage has remained relatively flat. The third open enrollment period began on November 1. Whether the number of uninsured will continue to decline remains an open question.
Nov 12, 2015
The RAND Blog
Affordable Care Act

Charging Older Adults Higher Premiums Could Cost Taxpayers
Under the Affordable Care Act, older adults cannot be charged more than three times as much as 21- to 24-year-olds for the same plan. Changing this rule to 5-to-1 may not be a cost-effective way to encourage enrollment among the young and healthy.
Sep 15, 2015
The Commonwealth Fund Blog
Health Insurance Mandates

The Ramifications of Repealing the Individual Mandate
As part of its goal of near-universal coverage, the Affordable Care Act requires most Americans to obtain insurance or pay a penalty. Repealing that requirement would significantly reduce health insurance enrollment and cause individual market premiums to rise.
Aug 13, 2015
The Commonwealth Fund Blog
Affordable Care Act

Why Obamacare Lives
Economic reasoning took center stage in the Supreme Court's decision on Thursday to uphold the legality of the Affordable Care Act's subsidies in all states.
Jun 26, 2015
U.S. News & World Report
Affordable Care Act

What Americans Know About King v. Burwell
An upcoming Supreme Court ruling regarding the Affordable Care Act could impact millions of Americans. Are Americans aware of the court case? And if so, what do they know about it?
Jun 12, 2015
The RAND Blog
Employer Sponsored Health Insurance

Exchange Tax Credits or Employer Coverage: What's Better for Low-Income Americans?
As the King v. Burwell case approaches, there's likely to be more discussion about potential modifications to the ACA's tax credit structure. Policymakers might consider whether there are opportunities to level the playing field for low-income workers, regardless of whether their employers offer insurance.
Feb 12, 2015
The Morning Consult
Health Care Costs

How Much Are You Paying for Health Care?
Americans devote about 17 percent of GDP to health care consumption. In 2013, U.S. GDP was $16.8 trillion, and the population was 316 million. Together, these numbers imply that Americans spent about $9,200 per person on health care. Who's paying for this?
Jan 15, 2015
The Morning Consult
Affordable Care Act

The ACA's Tax Credits Keep Premiums Low for Everyone
The ACA's tax credits currently contain several properties that stabilize premiums while providing assistance to low- and moderate-income people. As policymakers contemplate modifications to the ACA that would affect the tax credits, it will be important to consider not only how they affect those who are eligible, but also how they affect premiums for everyone else.
Nov 10, 2014
The Morning Consult
Affordable Care Act

Happy Birthday Healthcare.Gov
This month marks the one-year anniversary of the health insurance Marketplaces -- the online exchanges for buying and selling insurance created by the Affordable Care Act. Last year, after a near-disastrous start that included massive website failures, the Marketplaces rebounded to a surprising success.
Oct 16, 2014
The Morning Consult
Affordable Care Act

Survey Estimates Net Gain of 9.3 Million American Adults with Health Insurance
Early survey evidence indicates that the Affordable Care Act has already led to a substantial increase in insurance coverage. Consistent with the ACA's design, this gain in insurance has come not only from new enrollment in the marketplaces, but also from new enrollment in employer coverage and Medicaid.
Apr 8, 2014
The RAND Blog
Affordable Care Act

Who Does the Affordable Care Act Leave Behind?
Although one of the primary objectives of the Affordable Care Act is to achieve near-universal health insurance coverage, the Congressional Budget Office projects that 30 million residents, more than 10 percent of the nonelderly population, will remain uninsured after the major provisions of the ACA take full effect.
Mar 7, 2014
The RAND Blog
Affordable Care Act

First Steps on a Long Road: Three Key Findings from ACA's Early Enrollment Numbers
The vision of the ACA was “no wrong door” and an affordable option for everyone, but it appears based on the data available so far that, in the non-Medicaid expansion states, there is a closed door.
Feb 10, 2014
Health Affairs Blog
Employer Sponsored Health Insurance

Employer-Provided Health Insurance: Why Does It Persist, and Will It Continue after 2014?
As the ACA is implemented, policy makers should be attuned to potential inefficiencies and inequities created by a system with different regulatory and tax rules for small employers, large employers, and individual health plans. Attempts to equalize the playing field may be difficult.
Dec 2, 2013
New England Journal of Medicine
Affordable Care Act

Four Questions on Canceled Insurance Policy Fix
David Mastio, Forum editor at USA TODAY, asked RAND's Christine Eibner four questions about President Obama's plan to fix the problem with people getting their insurance canceled.
Nov 15, 2013
USA Today
Will the Affordable Care Act Make Health Care More Affordable?
Out-of-pocket spending on health care will decrease for both the newly insured as well as for those changing their source of insurance. These decreases will be largest for those who would otherwise be uninsured.
Oct 1, 2013
The Health Care Blog
Affordable Care Act

Will Small Firms Self-Insure After Jan. 1, 2014?
Because of the ACA's regulations, some smaller employers with young and healthy workers are considering avoiding the purchase of health care coverage in the regulated market, opting instead to self-insure their employees.
Jun 17, 2013
The RAND Blog
Health Care Costs

What Happens Without Individual Mandate?
If the individual mandate were ruled unconstitutional, subsidies and the age structure of premiums should keep enough healthy people in the insurance exchanges to prevent huge spikes in premiums, write Carter C. Price and Christine Eibner.
Mar 21, 2012
USA Today

Publications

Journal Article
Evaluation of Phase II of the Medicare Advantage Value-Based Insurance Design Model Test: First Two Years of Implementation (2020–2021), and Appendixes
This report presents the RAND Corporation team's findings from its evaluation of Phase II of the Medicare Advantage Value-Based Insurance Design model test, for the years 2020 and 2021.
Oct 19, 2022
Report
Expanding Insurance Coverage to Undocumented Immigrants in Connecticut
Using the RAND Corporation's COMPARE microsimulation model, the authors estimate the impacts of expanding health insurance coverage for ineligible immigrants on enrollment, premiums, state spending, and hospital spending on uncompensated care.
Jun 7, 2022
Research Brief
Increasing Subsidies and Expanding Health Insurance Options in Connecticut: Findings Without the Build Back Better Act
The authors estimated the impacts of policy options to increase the affordability of insurance in Connecticut with the assumption that subsidy enhancements enacted under the American Rescue Plan Act of 2021 would not continue past 2022.
Mar 31, 2022
Report
Increasing Subsidies and Expanding Health Insurance Options in Connecticut
The authors estimated the impacts of policy options to increase the affordability of insurance in Connecticut. They calculated enrollment, premiums, and state spending and considered whether the results differed by race, ethnicity, or income group.
Mar 31, 2022
Journal Article
Projected Coverage and Subsidy Impacts If the American Rescue Plan's Marketplace Provisions Sunset in 2023
An estimated 3 million people currently insured in the individual market would lose coverage and become uninsured if the American Rescue Plan's premium tax credit provisions are not extended beyond 2022.
Mar 29, 2022
Journal Article
Do Financial Incentives Affect Utilization for Chronically Ill Medicare Beneficiaries?
We find that Medicare Advantage beneficiaries with chronic conditions respond to changes in copays, although these responses are small. Reductions in copays lead to reduced use of specialists, suggesting that lowering copays could be a way to reduce specialist care.
Mar 4, 2022
Report
Temporary Safety-Net Policies and Pandemic-Related Insurance Loss in New York State
Researchers assess the importance of temporary provisions relative to long-standing policies in stabilizing health insurance enrollment in New York state despite heavy job loss during the coronavirus disease 2019 pandemic.
Nov 12, 2021
Report
Summary of the Current Status of Health Insurance Enrollment in Connecticut
To help the state of Connecticut better understand current health insurance enrollment to support improvements to affordability, access, and equity, the authors estimate the distributions of health insurance enrollment by age, gender, race, and ethnicity in detailed insurance categories.
Aug 13, 2021
Journal Article
The Effect of the Minimum Wage on Employer-Sponsored Insurance for Low-Income Workers and Dependents
Minimum wage increases lead to reductions in employer-sponsored insurance coverage in families with incomes below 300% of the federal poverty level.
Jul 28, 2021
Journal Article
Section 1332 Waiver Evaluation Report: Evaluating the Minnesota Reinsurance Program
This report documents findings from the evaluation of Minnesota's waiver, through which the state implemented the Minnesota Premium Security Plan.
2021
Journal Article
Section 1332 Waiver Evaluation Report: Evaluating the Oregon Reinsurance Program
This report documents findings from the evaluation of Oregon's waiver, through which the state implemented the Oregon Reinsurance Program (ORP).
2021
Journal Article
Section 1332 Waiver Evaluation Report: Evaluating the Alaska Reinsurance Program
This report documents findings from the evaluation of Alaska's waiver, through which the state implemented the Alaska Reinsurance Program (ARP).
2021
Journal Article
Evaluation Report of the First Three Years (2017-2019) of the Medicare Advantage Value-Based Insurance Design Model Test
CMMI contracted with the RAND Corporation to evaluate the first three years of the MA VBID model test. This report serves as our second and final evaluation of the first three years of the model test.
Oct 21, 2020
Research Brief
Effects of a Public Option on Health Insurance Costs and Coverage
This brief describes how a public option for health care—that is, a government-sponsored health insurance plan with publicly determined provider payment rates—would affect insurance costs and coverage.
May 28, 2020
Report
Public Options for Individual Health Insurance: Assessing the Effects of Four Public Option Alternatives
There is growing interest in a "public option" for individual market insurance to improve affordability and enrollment. The authors estimate how adding a federal public option could affect enrollment, premiums, and government spending.
May 28, 2020
Journal Article
Insurers' Perspectives on MA Value-Based Insurance Design Model
In this study, we explored insurers' perspectives on Medicare Advantage value-based insurance design, identified perceived barriers to joining the model test, and described ways to overcome them.
Nov 19, 2019
Report
Medicare for 50-to-64-Year-Olds: Assessing the Effects of Allowing Older Adults to Buy Into the Medicare Program
In this report, the authors analyze how allowing adults ages 50 and older to buy into the Medicare program could affect health insurance coverage, individual market premiums, and federal health care spending.
Nov 18, 2019
Report
National Health Spending Estimates Under Medicare for All
This report draws from previous RAND research on single-payer health care to estimate the 2019 spending effects of a Medicare for All plan similar to some proposals being discussed in Congress.
Apr 10, 2019
Journal Article
First Annual Evaluation Report of the Medicare Advantage Value-Based Insurance Design Model Test: 2017, Year 1 of the Intervention
RAND researchers are evaluating a five-year model test to assess whether value-based insurance design can increase use of high-value services, reduce use of avoidable services, improve quality of care, and improve health outcomes and reduce spending.
2019
Journal Article
Expanding Enrollment Without the Individual Mandate: Options to Bring More People Into the Individual Market
The options analyzed would increase individual market enrollment by 400,000 to 3.2 million in 2020. Net increases in total enrollment (300,000 to 2.4 million) are smaller because of offsetting decreases in employer-sponsored insurance.
Dec 27, 2018
Report
Impacts of the Elimination of the ACA's Individual Health Insurance Mandate Penalty on the Nongroup Market in New York State
How will elimination of the Affordable Care Act's individual mandate penalty affect the nongroup insurance market in the state of New York? Researchers used RAND's COMPARE microsimulation model to estimate the effects.
Sep 20, 2018
Journal Article
Extending Marketplace Tax Credits Would Make Coverage More Affordable for Middle-Income Adults
Middle-income adults ages 50-64 would have more affordable coverage if the ACA's tax credits were extended to all income groups; this would improve the individual market risk pool because premiums for this group would exceed the cost of their care.
Aug 24, 2018
Report
An Assessment of the New York Health Act: A Single-Payer Option for New York State
This report assesses how the state-sponsored single-payer health program New York Health would affect health care utilization and costs in New York, estimating its effects on key outcomes and comparing them with future outcomes under the status quo.
Aug 1, 2018
Research Brief
Estimating the Effects of a Single-Payer Proposal in New York State
The New York Health Act could expand insurance coverage in New York without increasing overall health spending, if administrative costs are reduced and growth in provider payment rates is restrained. The program would be financed by new taxes.
Aug 1, 2018
Journal Article
The Effect of Eliminating the Individual Mandate Penalty and the Role of Behavioral Factors
Under alternative assumptions about consumer responses, we find that enrollment falls by 2.8 million to 13 million people nationwide and premiums for bronze plans increase by 3 percent to 13 percent when the mandate penalty is removed.
Jul 12, 2018
Journal Article
What Is the Impact on Enrollment and Premiums If the Duration of Short-Term Health Insurance Plans Is Increased?
Extending the duration of short-term individual health plans will have little effect on premiums or enrollment in the individual market.
Jun 14, 2018
Journal Article
Options to Expand Health Insurance Enrollment in the Individual Market
Policymakers have many options to expand coverage in the individual market. We considered federal investments that would enhance, extend, or increase the tax credits available to enrollees, as well as reinsurance approaches that would lower premiums.
Oct 31, 2017
Report
The Effects of Iowa's Proposed Stopgap Measure on Health Insurance Costs and Coverage
This report uses RAND's COMPARE microsimulation model to estimate the effects of a 1332 waiver application from the state of Iowa. The waiver is designed to stabilize Iowa's Affordable Care Act individual market through a series of modifications.
Oct 17, 2017
Report
The Benefits and Drawbacks of Alternative Tax Subsidization Approaches for Health Insurance
This report reviews the features of tax-based approaches to subsidizing health insurance, including tax credits and tax deductions, and summarizes their associated benefits and drawbacks.
Jul 13, 2017
Report
Financing Health Care in Oregon: Four Policy Options
This presentation describes four options for financing health care for residents of the state of Oregon and compares the projected impacts and feasibility of each option.
May 17, 2017
Journal Article
Association Between the Opening of Retail Clinics and Low-Acuity Emergency Department Visits
Retail clinics have not reduced ED visits for low-acuity conditions.
May 4, 2017
Report
The Effects of the American Health Care Act on Health Insurance Coverage and Federal Spending in 2020 and 2026
The authors used RAND's COMPARE microsimulation model to analyze the American Health Care Act, a bill proposed in the U.S. House of Representatives on March 6, 2017, that would have repealed and replaced many provisions of the Affordable Care Act.
May 3, 2017
Report
A Comprehensive Assessment of Four Options for Financing Health Care Delivery in Oregon
This report compares the impacts and feasibility of four options for financing health care in Oregon: two state-based plans that would ensure coverage for all residents, a state-sponsored plan offered in Oregon's nongroup market, and the status quo.
Jan 19, 2017
Research Brief
Oregon's Options to Overhaul Health Care Financing: Health Care Reform 2.0?
This analysis of three options to reform health care payment in Oregon (two state-based plans that would ensure coverage for all state residents and a state-sponsored plan offered in Oregon's nongroup market) found benefits and trade-offs for each.
Jan 19, 2017
Report
The Effect of the 2014 Medicaid Expansion on Insurance Coverage for Newly Eligible Childless Adults
The authors used the National Health Interview Survey to estimate how the Affordable Care Act Medicaid expansion affected health insurance enrollment, by source of coverage, among childless adults who became newly eligible for Medicaid in 2014.
Dec 29, 2016
Journal Article
Donald Trump's Health Care Reform Proposals: Anticipated Effects on Insurance Coverage, Out-of-Pocket Costs, and the Federal Deficit
The Trump health care proposal would decrease the number of insured and increase consumer health spending among those with marketplace insurance relative to current law. The policies would also increase the federal deficit by varying amounts.
Nov 4, 2016
Journal Article
Hillary Clinton's Health Care Reform Proposals: Anticipated Effects on Insurance Coverage, Out-of-Pocket Costs, and the Federal Deficit
The Clinton health care proposal would increase the number of insured individuals and decrease consumers' health spending relative to current law. However, the policies with the largest coverage gains also increase the federal deficit the most.
Nov 4, 2016
Journal Article
Gaining Coverage Through Medicaid or Private Insurance Increased Prescription Use and Lowered Out-of-Pocket Spending
A growing body of literature describes how the Affordable Care Act (ACA) has expanded health insurance coverage. What is less well known is how these coverage gains have affected populations that are at risk for high health spending.
Aug 19, 2016
Report
Consumer Decisionmaking in the Health Care Marketplace
To learn how health insurance information is conveyed to consumers, RAND researchers reviewed the literature on health insurance choice and best practices and examined choice tools used in 20 health insurance websites.
Jun 28, 2016
Report
Private Health Insurance Exchanges: Early Evidence and Implications for the Future
This report examines how private employer health exchanges function, how they may affect employers and employees, and the possible implications for the Affordable Care Act's Small Business Health Options Program Marketplaces.
May 9, 2016
Research Brief
Assessing Policy Options for Subsidies to Improve the Affordable Care Act: One Approach Could Insure More People, Reduce Premiums, and Save $14 Billion per Year
Of three alternatives examined for expanding health insurance and lowering premiums with no additional federal spending, extending the Affordable Care Act's subsidies to all consumers and placing a floor on subsidies had the greatest benefit.
Feb 5, 2016
Journal Article
Evaluating the CARE Act: Implications of a Proposal to Repeal and Replace the Affordable Care Act
Policymakers seeking to adopt the CARE Act, or to pursue a similar repeal-and-replace policy, may need to maintain some of the ACA's revenue-generating provisions, adopt alternative revenue-generating provisions, or reduce the generosity of tax credits to achieve budget neutrality.
2016
Report
Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs
Veterans who rely on Department of Veterans Affairs (VA) health care are older and less healthy than other veterans. Analysis of a range of data sources showed how the veteran population and demand for VA health care could change in the next decade.
Dec 31, 2015
Journal Article
Improving the Affordable Care Act: An Assessment of Policy Options for Providing Subsidies
A key challenge of health reform efforts is to make health insurance affordable for individuals and families who lack coverage without harming those with coverage or increasing federal spending.
Dec 10, 2015
Report
Harnessing Private-Sector Innovation to Improve Health Insurance Exchanges
In this paper, analysts consider privately facilitated health insurance exchanges to address some challenges and deepen the impact of health care reform. In this model, the private sector assumes responsibility for peripheral exchange functions.
Nov 6, 2015
Report
Can the Cadillac Tax Be Made Less Regressive by Replacing It with an Exclusion Cap? Methods and Results
Examines the effects of the Affordable Care Act's Cadillac tax versus an alternative tax, based on an exclusion gap, on families in different income ranges.
Oct 8, 2015
Research Brief
How Does the ACA Individual Mandate Affect Enrollment and Premiums in the Individual Insurance Market?
Describes how removing the Affordable Care Act's individual mandate would affect health insurance premiums and the overall numbered of insured.
Jun 4, 2015
Journal Article
Early Marketplace Enrollees Were Older and Used More Medication Than Later Enrollees: Marketplaces Pooled Risk
Little is known about the health status of the 7.3 million Americans who enrolled in insurance plans through the Marketplaces established by the Affordable Care Act in 2014.
May 29, 2015
Journal Article
Trends in Health Insurance Enrollment, 2013-15
This analysis examined insurance transitions between September 2013 and February 2015, before and after the Affordable Care Act's coverage-related provisions took effect in 2014.
May 8, 2015
Report
Insurance Transitions Following the First ACA Open Enrollment Period
This report examines health insurance transitions between September 2013 and November 2014 using longitudinal data from the RAND Health Reform Opinion Study.
May 6, 2015
Report
Methodology of the RAND Health Reform Opinion Study
This report describes a methodology to track transitions in health insurance enrollment between November 2014 and December 2015.
May 6, 2015
Research Brief
How Would Alternative Subsidy Structures Affect Stability in the ACA Individual Market?
Describes the extent to which changing the subsidy structure of the Affordable Care Act would make the individual health insurance market more sensitive to the rate of young adult enrollment.
Apr 6, 2015
Research Brief
How Does Enrollment of Young Invincibles Affect Premiums in the ACA Individual Market?
Describes the extent to which reduced enrollment of 18-to-34-year-olds in the U.S individual health insurance market would lead to increased premiums.
Feb 5, 2015
Research Brief
How Do ACA Tax Subsidies Affect Premiums and Enrollment?
Describes the extent to which eliminating the subsidies offered by the Affordable Care Act would disrupt the U.S. individual health insurance market.
Jan 16, 2015
Journal Article
More Choice in Health Insurance Marketplaces May Reduce the Value of the Subsidies Available to Low-Income Enrollees
More plans to choose from in health insurance Marketplaces does not translate into lower premiums.
Jan 9, 2015
Report
The Effect of Eliminating the Affordable Care Act's Tax Credits in Federally Facilitated Marketplaces
In this research report, RAND Corporation researchers assess the expected change in health insurance enrollment and premiums if the U.S. Supreme Court rules to eliminate subsidies in states with federally facilitated marketplaces.
Jan 8, 2015
Report
The Economic Incidence of Health Care Spending in Vermont
Estimates the economic incidence of health spending in the state of Vermont for 2012 and as projected for 2017.
Jan 8, 2015
Report
Assessing Alternative Modifications to the Affordable Care Act: Impact on Individual Market Premiums and Insurance Coverage
Estimates, using the COMPARE microsimulation model, the sensitivity of health insurance premiums to the Affordable Care Act's tax credits, to the presence of law's individual mandate, and to the share of young adult enrollees in the market.
Oct 21, 2014
Research Brief
Premiums and Stability in the Individual Health Insurance Market: The Effects of Young Adult Enrollment and Subsidies
Reduced young-adult enrollment in the individual health insurance market created under the Affordable Care Act would lead to modest premium increases; however, eliminating tax credits would substantially increase premiums and reduce enrollment.
Oct 21, 2014
Infographic
How the Commonwealth of Pennsylvania May Fare Under the Affordable Care Act
This infographic presents findings from a RAND analysis of the economic and other effects of Medicaid expansion on the Commonwealth of Pennsylvania.
May 21, 2014
Report
Changes in Health Insurance Enrollment Since 2013: Evidence from the RAND Health Reform Opinion Study
This paper examines changes in enrollment in health care coverage in the wake of the implementation of the Affordable Care Act using results from the RAND's Health Reform Opinion Study.
Apr 8, 2014
Report
Evaluating the "Keep Your Health Plan Fix": Implications for the Affordable Care Act Compared to Legislative Alternatives
Evaluates and compares three proposals to address the recent cancellation of millions of Americans' health plans under the minimum coverage requirements of the Affordable Care Act.
Jan 21, 2014
Research Brief
Will the Affordable Care Act Make Health Care More Affordable?
For most lower-income people who obtain coverage as a result of the Affordable Care Act, health care spending will fall. But spending by some newly insured higher-income people will increase because they will be now paying insurance premiums.
Dec 11, 2013
Journal Article
US Military Primary Care: Problems, Solutions, and Implications for Civilian Medicine
The US Military Health System (MHS) faces challenges in delivering cost-effective, high-quality primary care while maintaining a provider workforce capable of meeting both peacetime and wartime needs.
Nov 1, 2013
Report
Effects of the Affordable Care Act on Consumer Health Care Spending and Risk of Catastrophic Health Costs
This study examines likely effects of the Affordable Care Act on average annual consumer health care spending and risk of catastrophic medical costs and considers how these outcomes are affected by state decisions to expand Medicaid.
Oct 1, 2013
Report
The Affordable Care Act and Health Insurance Markets: Simulating the Effects of Regulation
The authors estimate the effects of the Affordable Care Act on health insurance enrollment and premiums for ten states and for the nation overall, with a focus on outcomes in the nongroup and small group markets.
Aug 29, 2013
Research Brief
Major Changes to Medicare Would Cut Costs but Also Squeeze Enrollment and Raise Spending for Seniors
Potential policy changes, such as raising the eligibility age of Medicare from 65 to 67, would save Medicare from $400 billion to $1.2 trillion between 2012 and 2036 but would also reduce the number of seniors enrolled.
Aug 26, 2013
Report
The Budgetary Effects of Medicaid Expansion on Pennsylvania: An Expansion on Previous Work
This addendum to a spring 2013 analysis assessing the budget effects of the expansion of Medicaid on the Commonwealth of Pennsylvania examines the sensitivity of that report's findings to alternative assumptions about the state budgetary effects.
Jun 24, 2013
Research Brief
The Math of State Medicaid Expansion
Summarizes a RAND analysis of how opting out of Medicaid expansion would affect insurance coverage and spending and whether alternative policy options -- such as partial Medicaid expansion -- could cover as many people at lower costs to states.
Jun 7, 2013
Journal Article
For States That Opt Out of Medicaid Expansion: 3.6 Million Fewer Insured and $8.4 Billion Less in Federal Payments
The authors conclude that in terms of coverage, cost, and federal payments, states would do best to expand Medicaid.
Jun 1, 2013
Journal Article
Three Large-Scale Changes to the Medicare Program Could Curb Its Costs but Also Reduce Enrollment
With Medicare spending projected to increase to 24 percent of all federal spending and to equal 6 percent of the gross domestic product by 2037, policy makers are again considering ways to curb the program's spending growth.
May 1, 2013
Report
The Economic Impact of Medicaid Expansion on Pennsylvania
The Affordable Care Act is a substantial reform of the U.S. health care insurance system. RAND researchers assessed the act’s potential economic effects on Pennsylvania, factoring in whether the state includes an expansion of Medicaid.
Mar 28, 2013
Journal Article
The Relationship Between Urban Sprawl and Coronary Heart Disease in Women
Studies have reported relationships between urban sprawl, physical activity, and obesity, but – to date – no studies have considered the relationship between sprawl and coronary heart disease (CHD) endpoints.
Mar 1, 2013
Journal Article
The COMPARE Microsimulation Model and the U.S. Affordable Care Act
In anticipation of upcoming health care legislation, the RAND Corporation developed a microsimulation model to forecast the responses of individuals, families and firms to such legislation.
2013
Journal Article
Modeling Employer Self-Insurance Decisions After the Affordable Care Act
Self-insurance rates will increase among small firms only under the hypothetical situation that generous stop-loss policies are available to them after implementation of the ACA. Even if many small firms choose to self insure under this situation, it will not increase the premiums charged in the insurance exchanges by more than a few tenths of a percent.
2013
Journal Article
The Women's Health Initiative: The Food Environment, Neighborhood Socioeconomic Status, BMI, and Blood Pressure
Post menopausal women living in neighborhoods with higher socioeconomic status and more supermarkets have lower body mass and lower blood pressure.
Apr 1, 2012
Report
The Effect of the Affordable Care Act on Enrollment and Premiums, With and Without the Individual Mandate
This analysis used a RAND microsimulation model to predict the effects of a possible Supreme Court decision invalidating the individual mandate provision in the Patient Protection and Affordable Care Act and keeping the rest of the law intact.
Feb 16, 2012
Research Brief
How Would Eliminating the Individual Mandate Affect Health Coverage and Premium Costs?
An analysis of the effects of implementing the Affordable Care Act without an individual mandate found that over 12 million people who would have otherwise signed up for coverage will be uninsured and premium prices will increase by 2.4 percent.
Feb 16, 2012
Journal Article
Systematic Review of the Impact of Worksite Wellness Programs
Analyzes the impact of worksite wellness programs on health and financial outcomes, and the effect of incentives on participation.
Feb 1, 2012
Journal Article
Small Firms' Actions in Two Areas, and Exchange Premium and Enrollment Impact
An analysis of two rules that allow small businesses to avoid participating in health reform concludes they will have only a minor impact because relatively few businesses are likely to take advantage of the options.
2012
Research Brief
What Is the Impact of Using Evidence-Based Treatments for Posttraumatic Stress Disorder and Depression in Veterans?
If all veterans suffering from major depression and posttraumatic stress disorder were to receive evidence-based treatments, policy simulations suggest that cost savings generated would be $138 million (15 percent) over two years.
Jul 6, 2011
Report
Employer Self-Insurance Decisions and the Implications of the Patient Protection and Affordable Care Act as Modified by the Health Care and Education Reconciliation Act of 2010 (ACA)
Implications of the Patient Protection and Affordable Care Act of 2010 (as Modified by the Health Care and Education Reconciliation Act) for small firms' decisions to offer self-insured health plans and consequences of self-insurance for enrollees.
May 25, 2011
Research Brief
How Will Health Care Reform Affect Costs and Coverage? Examples from Five States
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in five states.
Apr 1, 2011
Report
The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in Illinois: An Analysis from RAND COMPARE
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Illinois through 2020.
Apr 1, 2011
Report
The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in Texas: An Analysis from RAND COMPARE
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Texas through 2020.
Apr 1, 2011
Report
The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in California: An Analysis from RAND COMPARE
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in California through 2020.
Apr 1, 2011
Report
The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in Montana: An Analysis from RAND COMPARE
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Montana through 2020.
Apr 1, 2011
Report
The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in Connecticut: An Analysis from RAND COMPARE
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Connecticut through 2020.
Apr 1, 2011
Journal Article
Ambient Particulate Matter Air Pollution and Venous Thromboembolism in the Women's Health Initiative Hormone Therapy Trials
There is little evidence of an association between short- or long-term exposure to particulate matter air pollution and venous thromboembolism; and no evidence that hormone therapy is modifing such a link.
Mar 2, 2011
Journal Article
Invisible Wounds, Visible Savings? Using Microsimulation to Estimate the Costs and Savings Associated with Providing Evidence-Based Treatment for PTSD and Depression to Veterans of Operation Enduring Freedom and Operation Iraqi Freedom
This study simulated the social costs and savings of providing universal access to care for depression and PTSD to troops returning from Operations Enduring Freedom and Iraqi Freedom.
2011
Journal Article
Neighborhood Socioeconomic Status and Cognitive Function in Women
Neighborhood socioeconomic status (NSES) is associated with cognitive functioning in older US women. Future research is needed on the longitudinal relationships between NSES, cognitive impairment, and cognitive decline.
2011
Research Brief
How Will the Affordable Care Act Affect Employee Health Coverage at Small Businesses?
Finds that the Affordable Care Act will increase the percentage of employers that offer health coverage to workers: from 57 percent to 80 percent for firms with 50 or fewer workers, and from 90 percent to 98 percent for firms with 51 to 100 workers.
Sep 8, 2010
Journal Article
The Effects of the Affordable Care Act on Workers' Health Insurance Coverage
The nature of employer-sponsored coverage may change substantially after implementation of the Patient Protection and Affordable Care Act, with an increase in the number of workers offered coverage through the health insurance exchanges.
Sep 1, 2010
Report
Establishing State Health Insurance Exchanges: Implications for Health Insurance Enrollment, Spending, and Small Businesses
The Patient Protection and Affordable Care Act will increase insurance offer rates at small businesses. By 2016, rates would increase from 53 to 77 percent at firms with ten or fewer workers and from 71 to 90 percent at firms with 11 to 25 workers.
Aug 11, 2010
Report
Grandfathering in the Small Group Market Under the Patient Protection and Affordable Care Act: Effects on Offer Rates, Premiums, and Coverage
To avoid changes in current health coverage, the Patient Protection and Affordable Care Act exempts existing plans from some regulations. These exemptions may lead to higher employer-sponsored insurance enrollment and lower government spending.
Jun 2, 2010
Research Brief
RAND COMPARE Analysis of President Obama's Proposal for Health Reform
Compares President Obama's Proposal for Health Reform, the U.S. House and Senate health care reform bills, and the status quo on changes in number of uninsured and government and national costs, as estimated by the RAND COMPARE microsimulation model.
Mar 3, 2010
Journal Article
Modeling Health Care Policy Alternatives
Current modeling approaches could be improved by enhancing longitudinal data, improving access to linked data, and developing data focused on providers.
2010
Draft
Overview of the COMPARE Microsimulation Model
To enhance the assessment of proposals to reform U.S. health policy, RAND researchers created the COMPARE microsimulation model, which develops a synthetic U.S. population and projects how it would respond to a variety of coverage-oriented options.
Dec 30, 2009
Periodical
RAND Review: Vol. 33, No. 3, Winter 2009-2010
Features focus on stabilization missions, grade retention, health financing, and RAND's president; other items discuss the European Union, sodium, health insurance, retail medical clinics, energy efficiency, disaster recovery, and alcohol pricing.
Dec 23, 2009
Research Brief
Controlling Health Care Spending in Massachusetts
In 2006, Massachusetts passed landmark legislation ensuring near-universal health insurance coverage to its residents, but rising costs threaten the initiative; this policy brief assesses 21 options for controlling health care spending in the state.
Sep 10, 2009
Report
RAND COMPARE: Understanding the Effects of Health Care Reform from a National Perspective
Provides an overview of COMPARE and shows the estimated effect of four policies: employer mandates, Medicaid and SCHIP expansions, individual mandates, and refundable tax credits.
Aug 28, 2009
Research Brief
Using Civilian Facilities to Maintain Military Medical Skills
To maintain relevant medical skills, some military medical personnel stationed at military treatment facilities could be stationed in civilian emergency rooms and trauma centers, where cases more closely resemble those found during deployment.
Aug 25, 2009
Report
Controlling Health Care Spending in Massachusetts: An Analysis of Options
Presents a comprehensive menu of cost containment strategies and options and determines their potential effect on Massachusetts' health care system.
Aug 17, 2009
Journal Article
Controlling U.S. Health Care Spending--Separating Promising from Unpromising Approaches
The reform legislation moving through Congress includes both promising and unpromising approaches to limiting health care spending.
2009
Research Brief
Gauging Future Demand for Veterans' Health Care: Does the VA Have the Forecasting Tools It Needs?
This research highlight summarizes an evaluation of the Enrollee Health Care Projection Model's accuracy and validity; identifies potential model enhancements; and assesses the risks posed by the VA's reliance on the model for budgeting and planning.
Oct 21, 2008
Report
Review and Evaluation of the VA Enrollee Health Care Projection Model
This evaluation of the Enrollee Health Care Projection Model examines its accuracy and validity, identifies potential model enhancements, and assesses the risks and benefits posed by the VA's reliance on the model for budgeting and planning.
Oct 20, 2008
Testimony
Invisible Wounds of War: Quantifying the Societal Costs of Psychological and Cognitive Injuries
Testimony presented before the Joint Economic Committee on June 12, 2008.
Jun 12, 2008
Research Brief
Invisible Wounds: Mental Health and Cognitive Care Needs of America's Returning Veterans
This research brief summarizes a comprehensive RAND study of the mental health and cognitive needs of returning servicemembers and veterans of Operations Enduring Freedom and Iraqi Freedom.
Apr 8, 2008
Research Brief
Is the Economic Burden of Providing Health Insurance Greater for Small Firms Than for Large Firms?
This research brief reports that, from 2000 to 2005, the economic burden of providing health insurance increased for employers, especially for the smallest firms, and that small firms offered plans of slightly lower quality than did large firms.
Mar 31, 2008
Report
Invisible Wounds of War: Summary and Recommendations for Addressing Psychological and Cognitive Injuries
Summarizes key findings and recommendations from Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery (Tanielian and Jaycox [Eds.], MG-720-CCF, 2008).
Mar 30, 2008
Report
Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery
A comprehensive study of the post-deployment health-related needs associated with post-traumatic stress disorder, major depression, and traumatic brain injury among servicemembers returning from Operations Enduring Freedom and Iraqi Freedom.
Mar 26, 2008
Report
The Economic Burden of Providing Health Insurance: How Much Worse Off Are Small Firms?
This report explores trends in the economic burden faced by small and large businesses that provide health insurance, as well as the quality of plans that small and large firms offer.
Mar 17, 2008
Report
Maintaining Military Medical Skills During Peacetime: Outlining and Assessing a New Approach
The skills required of military medical personnel differ during deployment and peacetime. This study explored the possibility of stationing personnel in nonmilitary settings where the case mix might more closely resemble that under deployment.
2008
Journal Article
Employers' Health Insurance Cost Burden, 1996-2005
Data from the Employment Cost Index show that health insurance costs relative to payroll increased 34 percent between 1996 and 2005 and that the increase was largest for businesses paying low wages; simultaneously, data from the Employee Benefits Survey show that benefit packages became less generous, yet cost growth was not paralleled by a commensurate decrease in employer offers.
2008
Research Brief
Health Coverage Options for Military Retirees
This research brief summarizes the results of a 2006 pilot survey of military retirees, providing information on retirees' enrollment in civilian health care plans and reliance on TRICARE, the Department of Defense-sponsored health insurance.
Jul 4, 2007
Report
Civilian Health Insurance Options of Military Retirees: Findings from a Pilot Survey
Results of a pilot survey (in early 2006) of military retirees offer useful information on retirees' health care status, enrollment in civilian health care plans, and reliance on TRICARE, the Department of Defense-sponsored health insurance.
Jun 26, 2007
Journal Article
The Efficacy of the Rio Hondo DUI Court: A 2-Year Field Experiment
This study reports results from an evaluation of the experimental Rio Hondo driving under the influence (DUI) court of Los Angeles County, California.
2007
Report
Civilian Workforce Planning in the Department of Defense: Different Levels, Different Roles
Explores workforce planning and requirements determination at Department of Defense (DoD) installations, and identifies potential planning-process roles for the Office of the Secretary of Defense and data sources for DoD-wide workforce planning.
May 1, 2006
Journal Article
Is the Drug Court Model Exportable? The Cost-Effectiveness of a Driving-Under-The-Influence Court
The authors assessed the cost-effectiveness of the Rio Hondo driving-under-the-influence (DUI) court.
2006
Journal Article
US-based Indices of Area-Level Deprivation: Results from HealthCare for Communities
The authors find that area-level deprivation predicts poor mental and physical health outcomes, but different components of deprivation have different effects.
2006
Journal Article
Does Relative Deprivation Predict the Need for Mental Health Services?
Investigates whether low income relative to a reference group is associated with a higher probability of depressive disorders or anxiety disorders.
2004