Sharon Long: Building on Experience

Sharon Long, Ph.D., is a Principal Research Associate in the Health Policy Center at the Urban Institute. Sharon has more than twenty years of experience in both quantitative and qualitative public policy research. Most recently, Sharon has evaluated several state health policy initiatives. Building on those evaluations, Sharon’s SHARE project examines how health reform efforts affect health insurance status, access to health care, and costs of health care in three states: Illinois, Massachusetts, and New York.

We talked to Sharon about state laboratories, being an economist, and fantasizing about the mountains.

Why did you choose to look at health care reform efforts in Illinois, Massachusetts, and New York?

All three states have implemented innovative reform efforts and have taken the lead in health care reform. Massachusetts stands alone in the scope of its reform. Illinois got serious about expanding coverage first for low-income parents and then for all children and made significant changes over a short time period. Now, Illinois’ Cover All Kids program is a model for other states. New York implemented reform a few years ago and I assessed its early impact - this study gives me an opportunity to expand on my previous study.

You are using National Health Interview Survey (NHIS) data, which is often overlooked in favor of Current Population Survey (CPS) data. Why explore the reform efforts with NHIS data?

Although the NHIS provides data by state, it hasn’t traditionally been used for state health reform evaluations. However, it offers some advantages for state evaluation over the CPS. First, the NHIS has a better measure of health insurance coverage than the CPS. It has monthly data which allows for modeling the timing of reform initiatives. This feature has been important especially for New York, with their particular circumstances surrounding 9/11. Prior to 9/11, Medicaid reform was being implemented in the state, but then after 9/11, Disaster Relief Medicaid came to the forefront. Afterwards, there was another shift back to the state’s reform initiative. Unlike the NHIS, the CPS doesn’t let us track that very closely. The NHIS also supports analyses of issues beyond health insurance coverage, including changes in access to and use of health care and health care costs under health reform.

Why are you interested in examining health reforms at the state level?

With much of the impetus for reform happening at the state level under Medicaid and SCHIP waivers, we need to learn from these initiatives. It’s an opportunity to learn what works, what doesn’t work, and why. We all hope that our evaluation can inform reform efforts in other states and future discussions of federal health reforms.

Sounds like you buy the idea of “states as laboratories.”

Most definitely. It’s clear for the last ten to fifteen years that the most creative approaches to health reform have been at the state level. Evaluation of state health reform becomes a natural extension of those efforts.

As an economist, how did you find yourself in the world of health policy research?

I’m not sure I’m counted as a real economist anymore. I trained as an economist, but my research interest in the programs and policies that affect low-income populations has led me to draw from other disciplines. My early work focused on employment and welfare policy. I moved to studies of Medicaid and health reform as an extension of that work given the importance of health insurance and health care to both employment and family welfare. If I had to describe myself these days, I would say I’m a health services researcher.

As a health services researcher who considers public policy implications, is it critical for investigators to be policy-minded?

Sometimes we, the researchers, are not skilled in taking our technical writing and making it easy to read and useful for policy-makers. It’s important that the translation function be there, whether it’s the researcher themselves, another organization, or reporters taking that information and making it more user-friendly.

Washington D.C., where you’re located now, is ideal for informing and witnessing policymaking. What does the future hold for healthcare policy?

The optimistic view or the pessimistic view? Surely we can learn from states that are doing expansions and implement at least some of those changes at the national level. We would like to think that the national policy-makers will learn from the efforts of Illinois, Massachusetts, and New York. But I’m afraid that we’ll have what we’ve had in the past, which is a stalemate. With the recent economic downturn, health reform becomes much, much harder.

If you were to shift gears and leave the health services research world, where would you go?

I enjoy the mountains. I grew up on the ocean in Florida, but I’m definitely a mountain person. I love the west. I’ve done bike trips and hikes out in Colorado, Utah, and New Mexico. I fantasize about retiring out there on a lake. Of course, that will only be after my 401(k) account recovers.