Urban Institute

The Urban Institute is a nonprofit, nonpartisan policy research and educational organization established in Washington, D.C., in 1968. Its multidisciplinary staff investigates the social, economic, and governance problems confronting the nation, evaluates the public and private means to alleviate them, and helps other countries build local government capacity, improve public service delivery, and nurture civil society.

Through work that ranges from broad conceptual studies to administrative and technical assistance, Institute researchers contribute to the knowledge available to guide decision making in the public interest and strive to deepen citizens' understanding of the issues and trade-offs policymakers face.

The Institute's genesis came in the mid-1960s, when many U.S. cities were in turmoil and tatters. President Lyndon B. Johnson, seeing the need for independent, unbiased analysis of the problems facing urban America, created a blue-ribbon commission of civic leaders who recommended chartering a center to do that work. The Urban Institute became that center.

Today, the Urban Institute is home to 10 policy centers and more than 230 economists, demographers, statisticians, sociologists, political scientists, educators, and other researchers and analysts. Its Health Policy Center, inaugurated in 1977 and now one of the Institute's largest research centers, uses rigorous methods to bring objective evidence to the panoply of health service concerns, including community-based care, disabilities, health insurance, hospital and physician payments, long-term care, Medicaid, Medicare, the State Children's Health Insurance Program (SCHIP), and uninsured and uncompensated care. Center scholars also address cost containment, managed care, liability and tort reform, the financing and delivery of health services, and their quality and appropriateness, among other issues.

Much of the Health Policy Center's work is on who gets needed health coverage, who doesn't, what the ramifications are of not having health insurance, and what can be done to secure access to care. A review of a quarter-century of studies found strong evidence that the uninsured receive fewer preventive and diagnostic services, tend to be more severely ill when diagnosed, and receive less therapeutic care, resulting in poorer health outcomes and higher mortality rates. Research on why 46 million people lack health insurance found that nearly all of them believe that they need coverage but more than half say that they can't afford it. Perceptions about cost matter, the study determined, whether the uninsured individual is old or young, healthy or disabled, with high income or income well below the poverty level.

Another analysis determined that the number of nonelderly people without health insurance climbed by 1.3 million between 2004 and 2005, bringing this group's uninsurance rate to nearly 18%. Eighty-five percent of this increase was among those with family incomes below 200% of the federal poverty level. The analysis showed that job-based insurance is dropping because of significant increases in premium costs; job shifts away from medium and large firms and those in the manufacturing, finance, and government sectors, employment environments that traditionally have high rates of employer-based insurance coverage; and [Page 1155]population movement toward the South and the West, regions with lower rates of employer-based health insurance coverage.

At the 10th anniversary of the SCHIP in 2007, the Institute estimated that the program had signed up close to 70% of its target population, but 1.8 million eligible children nationwide were yet to be enrolled. Federal funding for SCHIP, which was enacted in 1997 to expand health coverage to low-income uninsured children who do not qualify for Medicaid, will have to increase substantially, the study noted, if these children are to join the approximately 3.9 million children with SCHIP coverage.

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