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Abstract
This cross-sectional study analyzes changes in Medicaid enrollment for all 50 US states and Washington, DC, during the first 9 months of 2020, at the beginning of the COVID-19 pandemic.
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Affiliation(s)
- Peggah Khorrami
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Benjamin D. Sommers
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Medicine, Brigham & Women’s Hospital, Boston, Massachusetts
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2
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Abstract
This cross-sectional study uses national claims data to assess trends in well-child care visits with out-of-pocket costs before and after passage of the Affordable Care Act.
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Affiliation(s)
- Paul R. Shafer
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts
| | - Alex Hoagland
- Department of Economics, College of Arts and Sciences, Boston University, Boston, Massachusetts
| | - Heather E. Hsu
- Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
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3
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Abstract
In the midst of the COVID-19 outbreak, health care reform has again taken a major role in the 2020 election, with Democrats weighing Medicare for All against extensions of the Affordable Care Act, while Republicans quietly seem to favor proposals that would eliminate much of the ACA and cut Medicaid. Although states play a major role in health care funding and administration, public and scholarly debates over these proposals have generally not addressed the potential disruption that reform proposals might create for the current state role in health care. We examine how potential reforms influence state-federal relations, and how outside factors like partisanship and exogenous shocks like the COVID-19 pandemic interact with underlying preferences of each level of government. All else equal, reforms that expand the ACA within its current framework would provide the least disruption for current arrangements and allow for smoother transitions for providers and patients, rather than the more radical restructuring proposed by Medicare for All or the cuts embodied in Republican plans.
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Affiliation(s)
- Patrick N O'Mahen
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, , Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, , Houston, TX, USA
| | - Laura A Petersen
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, , Houston, TX, USA.
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, , Houston, TX, USA.
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4
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Myong C, Hull P, Price M, Hsu J, Newhouse JP, Fung V. The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts. PLoS One 2020; 15:e0243279. [PMID: 33270778 PMCID: PMC7714363 DOI: 10.1371/journal.pone.0243279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/18/2020] [Indexed: 11/24/2022] Open
Abstract
Importance Federally qualified health centers (FQHCs) receive federal funding to serve medically underserved areas and provide a range of services including comprehensive primary care, enabling services, and behavioral health care. Greater funding for FQHCs could increase the local availability of clinic-based care and help reduce more costly resource use, such as emergency department visits (ED). Objective To examine the impact of funding increases for FQHCs after the ACA on the use of FQHCs and EDs. Methods Retrospective study using the Massachusetts All Payer Claims Database (APCD) 2010–2013 that included APCD enrollees in 559 Massachusetts ZIP codes (N = 6,173,563 in 2010). We calculated shift-share predictions of changes in FQHC funding at the ZIP code-level for FQHCs that received Community Health Center funds in any year, 2010–13 (N = 31). Outcomes were the number of ZIP code enrollees with visits to FQHCs and EDs, overall and for emergent and non-emergent diagnoses. Results In 2010, 4% of study subjects visited a FQHC, and they were more likely to be younger, have Medicaid, and live in low-income areas. We found that a standard deviation increase in prior year FQHC funding (+31 percentage point (pp)) at the ZIP code level was associated with a 2.3pp (95% CI 0.7pp to 3.8pp) increase in enrollees with FQHC visits and a 1.3pp (95% CI -2.3pp to -0.3pp) decrease in enrollees with non-emergent ED visits, but no significant change in emergent ED visits (0.3pp, 95% CI -0.8pp to 1.4pp). Conclusions We found that areas exposed to greater FQHC funding increases had more growth in the number of enrollees seen by FQHCs and greater reductions in ED visits for non-emergent conditions. Investment in FQHCs could be a promising approach to increase access to care for underserved populations and reduce costly ED visits, especially for primary care treatable or non-emergent conditions.
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Affiliation(s)
- Catherine Myong
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Peter Hull
- The Becker Friedman Institute, University of Chicago, Chicago, Illinois, United States of America
| | - Mary Price
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - John Hsu
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Joseph P. Newhouse
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Harvard Kennedy School, Cambridge, Massachusetts, United States of America
| | - Vicki Fung
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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5
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Grossman D, Hamman M. Changes in Opioid Overdose Emergency Encounters Associated with Expansion of Wisconsin Medicaid to Childless Adults in Poverty. J Stud Alcohol Drugs 2020; 81:750-759. [PMID: 33308404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE The purpose of this study was to measure changes in the payer mix and incidence of emergency department (ED) opioid-related overdose encounters after an April 2014 expansion of Medicaid to childless adults led to a 43% increase in Medicaid coverage for men and 8% for women statewide. METHOD We explored two competing hypotheses using data visualization and comparative interrupted time-series analysis (CITS): (a) expanded eligibility for Medicaid is associated with a change in payer mix only and (b) sociodemographic groups that gained Medicaid eligibility were more likely to use ED services for opioid overdose. Data included encounters at all Wisconsin nonfederal hospitals over 23 quarters from 2010 to 2015 and American Community Survey estimates of pre- and post-policy Medicaid eligibility by sex and age. RESULTS We found an increase in the share of opioid-related ED visits covered by Medicaid for men and women ages 19-29 and for men ages 30-49 following the expansion. The number of visits increased substantially in April 2014 for men ages 30-49, with Medicaid-covered visits driving this result. We found little evidence of an increase in overall visits for other age groups for either men or women. CONCLUSIONS The relationship between Medicaid expansion and opioid ED use is complex. Changes in case mix and increased access to care likely both play a role in the overall increase in these ED visits. Being uninsured may be an important barrier to seeking emergency care for opioid-related overdoses.
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Affiliation(s)
- Daniel Grossman
- John Chambers College of Business and Economics, West Virginia University, Morgantown, West Virginia
| | - Mary Hamman
- College of Business Administration, University of Wisconsin-La Crosse, La Crosse, Wisconsin
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6
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Affiliation(s)
- Matthew Fiedler
- From the USC-Brookings Schaeffer Initiative for Health Policy, Brookings Institution, Washington, DC
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Pacheco J, Maltby E. Trends in State-Level Opinions toward the Affordable Care Act. J Health Polit Policy Law 2019; 44:737-764. [PMID: 31199871 DOI: 10.1215/03616878-7611635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CONTEXT This article argues that the devolution of the Affordable Care Act (ACA) to the states contributed to the slow progression of national public support for health care reform. METHODS Using small-area estimation techniques, the authors measured quarterly state ACA attitudes on five topics from 2009 to the start of the 2016 presidential election. FINDINGS Public support for the ACA increased after gubernatorial announcement of state-based exchanges. However, the adoption of federal or partnership marketplaces had virtually no effect on public opinion of the ACA and, in some cases, even decreased positive perceptions. CONCLUSIONS The authors' analyses point to the complexities in mass preferences toward the ACA and policy feedback more generally. The slow movement of national ACA support was due partly to state-level variations in policy making. The findings suggest that, as time progresses, attitudes in Republican-leaning states with state-based marketplaces will become more positive toward the ACA, presumably as residents begin to experience the positive effects of the law. More broadly, this work highlights the importance of looking at state-level variations in opinions and policies.
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8
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Likosky DS, Sukul D, Seth M, He C, Gurm HS, Prager RL. Association Between Medicaid Expansion and Cardiovascular Interventions in Michigan. J Am Coll Cardiol 2019; 71:1050-1051. [PMID: 29495986 DOI: 10.1016/j.jacc.2017.12.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 12/15/2017] [Accepted: 12/19/2017] [Indexed: 11/30/2022]
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9
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Glied S, Lee TH. Is CBO Forecasting Good Enough for Government Work? N Engl J Med 2019; 380:2187-2189. [PMID: 31167047 DOI: 10.1056/nejmp1817536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sherry Glied
- From New York University, New York (S.G.); and Harvard Medical School and Press Ganey - both in Boston (T.H.L.)
| | - Thomas H Lee
- From New York University, New York (S.G.); and Harvard Medical School and Press Ganey - both in Boston (T.H.L.)
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10
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Ramaswamy A, Marchese M, Cole AP, Harmouch S, Friedlander D, Weissman JS, Lipsitz SR, Haider AH, Kibel AS, Schoenfeld AJ, Trinh QD. Comparison of Hospital Readmission After Total Hip and Total Knee Arthroplasty vs Spinal Surgery After Implementation of the Hospital Readmissions Reduction Program. JAMA Netw Open 2019; 2:e194634. [PMID: 31150074 PMCID: PMC6547226 DOI: 10.1001/jamanetworkopen.2019.4634] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE The Hospital Readmissions Reduction Program (HRRP) was recently expanded to penalize excessive readmissions after total hip arthroplasty (THA) and total knee arthroplasty (TKA). These are the first surgical procedures to be included in the HRRP. OBJECTIVE To determine whether the HRRP was associated with a greater decrease in readmissions after targeted procedures (THA and TKA) compared with similar nontargeted procedures (lumbar spine fusion and laminectomy). DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted of patients 50 years or older among all payers in the Nationwide Readmissions Database who underwent THA, TKA, lumbar spine fusion, or laminectomy between January 1, 2010, and September 30, 2015. Multivariable logistic regression and interrupted time-series models were used to calculate and compare 30-day readmission trends in 3 periods associated with the HRRP: preimplementation (January 2010-September 2012), implementation (October 2012-September 2014), and penalty (October 2014-September 2015). Statistical analysis was performed from January 1, 2010, to September 30, 2015. EXPOSURES Announcement and implementation of the HRRP. MAIN OUTCOMES AND MEASURES Readmission within 30 days after hospitalization for THA, TKA, lumbar spine fusion, or laminectomy surgery. RESULTS The study included 6 687 077 (58.3% women and 41.7% men; mean age, 66.7 years; 95% CI, 66.7-66.8 years) weighted hospitalizations for THA, TKA, lumbar spine fusion, and laminectomy surgery: 4 765 466 hospitalizations for targeted conditions and 1 921 611 for nontargeted conditions. After passage of the Patient Protection and Affordable Care Act, the risk-adjusted rates of readmission after all procedures decreased in a similar fashion. Implementation of the HRRP was associated with a 0.018% per month decrease in the rate of readmission (95% CI, -0.025% to -0.010%) after targeted procedures, which was not observed after nontargeted procedures (slope per month, -0.003%; 95% CI, -0.016% to 0.010%). Penalties were not associated with a greater decrease in readmission for either targeted or nontargeted procedures. CONCLUSIONS AND RELEVANCE These results appear to be consistent with hospitals responding to the future possibility of penalties by reducing readmissions after surgical procedures targeted by the HRRP.
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Affiliation(s)
- Ashwin Ramaswamy
- Icahn School of Medicine at Mount Sinai, New York, New York
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maya Marchese
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander P. Cole
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sabrina Harmouch
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Friedlander
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joel S. Weissman
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stuart R. Lipsitz
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Adil H. Haider
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Adam S. Kibel
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew J. Schoenfeld
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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11
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Tipirneni R, Kullgren JT, Ayanian JZ, Kieffer EC, Rosland AM, Chang T, Haggins AN, Clark SJ, Lee S, Solway E, Kirch MA, Mrukowicz C, Beathard E, Sears E, Goold SD. Changes in Health and Ability to Work Among Medicaid Expansion Enrollees: a Mixed Methods Study. J Gen Intern Med 2019; 34:272-280. [PMID: 30519839 PMCID: PMC6374260 DOI: 10.1007/s11606-018-4736-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/04/2018] [Accepted: 11/02/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Michigan expanded Medicaid under the Affordable Care Act (Healthy Michigan Plan [HMP]) to improve the health of low-income residents and the state's economy. OBJECTIVE To understand HMP's impact on enrollees' health, ability to work, and ability to seek employment DESIGN: Mixed methods study, including 67 qualitative interviews and 4090 computer-assisted telephone surveys (response rate 53.7%) PARTICIPANTS: Non-elderly adult HMP enrollees MAIN MEASURES: Changes in health status, ability to work, and ability to seek employment KEY RESULTS: Half (47.8%) of respondents reported better physical health, 38.2% better mental health, and 39.5% better dental health since HMP enrollment. Among employed respondents, 69.4% reported HMP helped them do a better job at work. Among out-of-work respondents, 54.5% agreed HMP made them better able to look for a job. Among respondents who changed jobs, 36.9% agreed HMP helped them get a better job. In adjusted analyses, improved health was associated with the ability to do a better job at work (aOR 4.08, 95% CI 3.11-5.35, p < 0.001), seek a job (aOR 2.82, 95% CI 1.93-4.10, p < 0.001), and get a better job (aOR 3.20, 95% CI 1.69-6.09, p < 0.001), but not with employment status (aOR 1.08, 95% CI 0.89-1.30, p = 0.44). In interviews, several HMP enrollees attributed their ability to get or maintain employment to improved physical, mental, and dental health because of services covered by HMP. Remaining barriers to work cited by enrollees included older age, disability, illness, and caregiving responsibilities. CONCLUSIONS Many low-income HMP enrollees reported improved health, ability to work, and job seeking after obtaining health insurance through Medicaid expansion.
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Affiliation(s)
- Renuka Tipirneni
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
- Division of General Medicine, Department of Internal Medicine , University of Michigan, Ann Arbor, MI, USA.
| | - Jeffrey T Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Division of General Medicine, Department of Internal Medicine , University of Michigan, Ann Arbor, MI, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Center for Clinical Management Research, University of Michigan, Ann Arbor, MI, USA
| | - John Z Ayanian
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Division of General Medicine, Department of Internal Medicine , University of Michigan, Ann Arbor, MI, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, USA
| | - Edith C Kieffer
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Ann-Marie Rosland
- Department of Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- VA Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, PA, USA
| | - Tammy Chang
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Adrianne N Haggins
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sarah J Clark
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Sunghee Lee
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Matthias A Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Christina Mrukowicz
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Erin Beathard
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Erin Sears
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Susan D Goold
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Division of General Medicine, Department of Internal Medicine , University of Michigan, Ann Arbor, MI, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
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12
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Abstract
In this month's Editorial, PLOS Medicine Academic Editor Zirui Song and his colleague Adrianna McIntyre discuss outcomes and possible futures for the United States Affordable Care Act as it nears the ten year mark.
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Affiliation(s)
- Adrianna McIntyre
- PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts, United States of America
| | - Zirui Song
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- * E-mail:
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Dua A, Rothenberg K, Srivastava G, Brown K, Lewis B, Rossi P, Seabrook G, Malinowski M, Wohlauer M, Lee CJ. Evolving Trends in Insurance Coverage of Vascular Surgery Patients in Academic Practice. Ann Vasc Surg 2018; 57:170-173. [PMID: 30500649 DOI: 10.1016/j.avsg.2018.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/23/2018] [Accepted: 09/20/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Insurance coverage of vascular surgery patients may differ from patients with less chronic surgical pathologies. The goal of this study is to identify trends in insurance status of vascular surgery patients over the last 10 years at a busy academic center. METHODS All consecutive patient visits for a vascular procedure from 2006 to 2016 were retrospectively reviewed from a prospectively collected institutional database. Data points included insurance status, procedures performed, and date of admission. The insurance status was categorized as Medicare, Medicaid, and uninsured. Samples were divided between 2006-2009 and 2011-2016 for comparison. Unpaired t-test, chi-squared test, and regression analysis were used to determine significant trends over the study period. RESULTS From 2006 to 2016, 6,007 vascular surgery procedures were performed. Procedure volume increased significantly from 1,309 to 4,698 between the 2 timeframes (P < 0.05), whereas the percentage of Medicaid and Medicare patients trended upward but did not achieve significance. There was a significant decrease in the percentage of uninsured patients between the cohorts (5.65% vs. 2.96%, P < 0.05). In 2012, 10.14% of patients were uninsured compared with 2.56% in 2016 (P < 0.05). CONCLUSIONS Insurance status affects access to care and subsequent outcomes. In our busy academic center, insurance coverage for vascular surgery has significantly increased over the past decade. The number of Medicaid and Medicare patients has slowly increased, but a significant and continuing decline in uninsured patients was observed. Implementation of the Affordable Care Act during this time period may have played a role in providing coverage for patient needing vascular surgery.
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Affiliation(s)
- Anahita Dua
- Division of Vascular Surgery, Stanford Health Care, Stanford, CA; Medical College of Wisconsin, Brookfield, WI
| | - Kara Rothenberg
- Division of Vascular Surgery, Stanford Health Care, Stanford, CA
| | | | | | - Brian Lewis
- Medical College of Wisconsin, Brookfield, WI
| | - Peter Rossi
- Medical College of Wisconsin, Brookfield, WI
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14
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Tan ASL, Young-Wolff KC, Carter-Harris L, Salloum RG, Banerjee SC. Disparities in the Receipt of Tobacco Treatment Counseling within the US Context of the Affordable Care Act and Meaningful Use Implementation. Nicotine Tob Res 2018; 20:1474-1480. [PMID: 29059372 PMCID: PMC6454423 DOI: 10.1093/ntr/ntx233] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/12/2017] [Indexed: 11/13/2022]
Abstract
Introduction Disparities in receiving advice to quit smoking and other tobacco use from health professionals may contribute to the continuing gap in smoking prevalence among priority populations. Under the Affordable Care Act (ACA), beginning in 2010, tobacco cessation services are currently covered in private and public health insurance plans. Providers and hospitals are also incentivized through the Meaningful Use of Electronic Health Records (EHRs) to screen and document patients' tobacco use and deliver brief cessation counseling. This study analyzes trends and correlates of receiving health professionals' advice to quit and potential disparities among US adult smokers from 2010 to 2015. Methods Data were from the National Health Interview Survey in 2010 and 2015. We analyzed the weighted prevalence of smokers' receipt of advice to quit smoking and other tobacco use from a health professional in 2010 and 2015 and correlates of receiving advice to quit. Results Prevalence of receiving advice to quit from a health professional increased from 51.4% in 2010 to 60.6% in 2015. This positive trend was observed across tobacco disparity population groups. Survey year (2015), age (older), ethnicity (non-Hispanic), region (Northeast), poverty level (above 100% poverty level), past quit attempt, daily smoking, cigarettes per day (11+ per day), and psychological distress were associated with higher odds of receiving advice to quit. Conclusion Based on national level data, receipt of advice to quit from health professionals increased between 2010 and 2015. However, disparities in receiving advice to quit from health professionals persist in certain populations. Implications This study provides important data on the national trends in receipt of health professional advice to quit smoking and other tobacco use in the context of the ACA and Meaningful Use implementation and whether these policies helped to narrow the gaps in receipt of health professional advice among vulnerable populations.
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Affiliation(s)
- Andy S L Tan
- Population Sciences Division, Center for Community Based Research, Dana-Farber Cancer Institute, Boston, MA
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA
| | | | | | - Ramzi G Salloum
- Department of Health Outcomes and Policy, University of Florida College of Medicine, Gainesville, FL
- Institute for Child Health Policy, University of Florida College of Medicine, Gainesville, FL
| | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
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15
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Glied SA, Jackson A. Who Entered and Exited the Individual Health Insurance Market Before and After the Affordable Care Act? Evidence from the Medical Expenditure Panel Survey. Issue Brief (Commonw Fund) 2018; 2018:1-11. [PMID: 30497127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
ISSUE The Affordable Care Act (ACA) made it easier for older adults and those with medical conditions to enroll in individual-market coverage by eliminating risk rating and limiting age rating. While the ACA also encourages young and healthy people to enroll through subsidies and the individual mandate, it’s not clear whether these incentives have been sufficient to prevent the risk pool from becoming disproportionately old and sick. GOAL To assess whether patterns in individual-market participation changed following ACA implementation. METHODS Comparison of Medical Expenditure Panel Survey (MEPS) data for the periods 2003–09 and 2014–15. FINDINGS AND CONCLUSION The analysis found few differences in individual-insurance market participation before and after the ACA. Adverse selection occurred during both: people switching into individual insurance coverage after being uninsured were higher utilizers prior to the switch than were those who remained uninsured. Those who disenrolled from individual plans tended to be lower utilizers of care before switching compared with those who kept their coverage. The main difference was that more people--especially young adults--switched from Medicaid to individual insurance, and vice versa, after the ACA. Adverse enrollment or disenrollment in the individual market did not increase following ACA implementation. The combination of easing rating rules and encouraging participation appears to have maintained market stability.
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Affiliation(s)
- Sherry A Glied
- Robert F. Wagner Graduate School of Public Service,vNew York University, New York
| | - Adlan Jackson
- Robert F. Wagner Graduate School of Public Service,vNew York University, New York
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16
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Baldwin P. How Are We Doing? Mid-Year Checkup. Consult Pharm 2018; 33:468. [PMID: 30068440 DOI: 10.4140/tcp.n.2018.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Eslami MH, Reitz KM, Rybin DV, Doros G, Farber A. Improved access to health care in Massachusetts after 2006 Massachusetts Healthcare Reform Law is associated with a significant decrease in mortality among vascular surgery patients. J Vasc Surg 2018; 68:1193-1202.e1. [PMID: 29615354 DOI: 10.1016/j.jvs.2017.12.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/18/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Access to medical care, by adequate insurance coverage, has a direct impact on outcomes for patients undergoing vascular procedures. We evaluated in-hospital mortality for patients undergoing index vascular procedures before and after the Massachusetts Healthcare Reform Law (MHRL) in 2006, which mandated insurance for all Massachusetts residents, both in Massachusetts and throughout the United States. METHODS The National Inpatient Sample was queried to identify patients undergoing interventions for peripheral arterial disease, carotid artery stenosis, and abdominal aortic aneurysms based on International Classification of Diseases, Ninth Revision, Clinical Modification procedural and diagnostic codes. The cohort was then divided into patients treated within Massachusetts (MA) and non-Massachusetts (NMA) hospitals. Two time intervals were examined: before (2003-2006, P1) and after the MHRL (2007-2011, P2). The primary outcome of interest included in-hospital mortality. Patients in MA and NMA hospitals were described in terms of demographics and presentation by time interval (P2 vs P1) compared using χ2 and t-tests. Weighted logistic regression with term modeling change in the odds ratio (OR) for P2 was performed to test and to estimate trends in mortality. Time (year of procedure) and region interactions were investigated by inclusion of time-region interactions in our analyses. Subgroup analysis was performed for P2 vs P1 among nonwhite, nonelderly, and low-income patients. RESULTS We identified 306,438 patients who underwent repair of abdominal aortic aneurysm, lower extremity bypass, or carotid endarterectomy in MA and NMA hospitals. MA hospital patients had an increase in both Medicaid and private insurance status after the MHRL (P1 = 2.6% and 21% vs P2 = 3.3% and 21.7%, respectively; P = .034). In-hospital mortality trended down for all groups across the entire study. In comparing P2 vs P1 trends, MA hospital odds of mortality per year was lowered by 26% (OR, 0.74; 95% confidence interval [CI], 0.56-0.99; P = .042) not seen in NMA hospitals (OR, 1.03; 95% CI, 0.97-1.09; P = .405). Time and region interaction terms indicated significant time trend difference in both unadjusted (P = .031) and adjusted (P = .033) analysis in MA hospitals not observed in NMA hospitals. This pattern continued when the samples were stratified by procedure. Patients undergoing vascular procedures in MA hospitals had a significantly lowered OR of mortality, with fewer patients presenting at late disease stages in P2 vs P1. Nonelderly patients in Massachusetts, who benefit from the Medicaid expansion provided by the MHRL, had a profound 92% drop in odds of mortality in P2 vs P1 (OR, 0.08; 95% CI, 0.010-0.641; P = .017) compared with the 14% drop in NMA (OR, 0.86; 95% CI, 0.709-1.032; P = .103). CONCLUSIONS The 2006 MHRL is associated with a decrease in mortality for patients undergoing index vascular surgery procedures in MA compared with NMA hospitals. This study suggests that governmental policy may play a key role in positively affecting the outcomes for patients.
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Affiliation(s)
- Mohammad H Eslami
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
| | | | - Denis V Rybin
- Department of Biostatistics, Boston University School of Public Health, Boston, Mass
| | - Gheorghe Doros
- Department of Biostatistics, Boston University School of Public Health, Boston, Mass
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, Mass
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Gabel JR, Whitmore H, Green M, Stromber S. Competition and Premium Costs in Single-Insurer Marketplaces: A Study of Five Rural States. Issue Brief (Commonw Fund) 2018; 2018:1-9. [PMID: 29991104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
ISSUE In 2017, five states--Alabama, Alaska, Oklahoma, South Carolina, and Wyoming--had only one issuer participating in their health care marketplaces, limiting consumer choice and competition among insurers. GOAL Examine the history of participation in the individual market from 2010 (before the Affordable Care Act was enacted) to 2017, and analyze premium changes among marketplace plans. METHODS Robert Wood Johnson Foundation's HIX Compare, which provides national data on the marketplaces from 2014 to 2017. FINDINGS AND CONCLUSIONS In 2010, the individual insurance market was already concentrated in the five study states, with Blue Cross and Blue Shield (BCBS) plans covering the majority of enrollees. By 2015, with the marketplaces in full swing, more issuers were competing in the five states. But by 2016, co-ops were facing bankruptcy and left the marketplaces in these states; and in 2017, citing large financial losses, national issuers UnitedHealthcare, Aetna, and Humana also exited, leaving only a single BCBS plan in each state. Three of the five states experienced substantially higher annual premium increases than the national average. Policy options with bipartisan support, such as resuming cost-sharing reduction payments and reestablishing reinsurance and risk corridors, could help attract new or returning issuers to marketplaces in these states.
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Affiliation(s)
| | - Heidi Whitmore
- Health Care Evaluation Department, NORC, University of Chicago, Chicago, IL
| | - Matthew Green
- Health Care Department, NORC, University of Chicago, Chicago, IL
| | - Sam Stromber
- Health Care Evaluation Department, NORC, University of Chicago, Chicago, IL
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Winkelman TNA, Chang VW. Medicaid Expansion, Mental Health, and Access to Care among Childless Adults with and without Chronic Conditions. J Gen Intern Med 2018; 33:376-383. [PMID: 29181792 PMCID: PMC5834959 DOI: 10.1007/s11606-017-4217-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/07/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND While the Affordable Care Act's (ACA) Medicaid expansion has increased insurance coverage, its effects on health outcomes have been mixed. This may be because previous research did not disaggregate mental and physical health or target populations most likely to benefit. OBJECTIVE To examine the association between Medicaid expansion and changes in mental health, physical health, and access to care among low-income childless adults with and without chronic conditions. DESIGN We used a difference-in-differences analytical framework to assess differential changes in self-reported health outcomes and access to care. We stratified our analyses by chronic condition status. PARTICIPANTS Childless adults, aged 18-64, with incomes below 138% of the federal poverty level in expansion (n = 69,620) and non-expansion states (n = 57,628). INTERVENTION Active Medicaid expansion in state of residence. MAIN MEASURES Self-reported general health; total days in past month with poor health, poor mental health, poor physical health, or health-related activity restrictions; disability; depression; insurance coverage; cost-related barriers; annual check-up; and personal doctor. KEY RESULTS Medicaid expansion was associated with reductions in poor health days (-1.2 days [95% CI, -1.6,-0.7]) and days limited by poor health (-0.94 days [95% CI, -1.4,-0.43]), but only among adults with chronic conditions. Trends in general health measures appear to be driven by fewer poor mental health days (-1.1 days [95% CI, -1.6,-0.6]). Expansion was also associated with a reduction in depression diagnoses (-3.4 percentage points [95% CI, -6.1,-0.01]) among adults with chronic conditions. Expansion was associated with improvements in access to care for all adults. CONCLUSIONS Medicaid expansion was associated with substantial improvements in mental health and access to care among low-income adults with chronic conditions. These positive trends are likely to be reversed if Medicaid expansion is repealed.
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Affiliation(s)
- Tyler N A Winkelman
- Division of General Internal Medicine, Hennepin County Medical Center, Hennepin County Medical Center, S2.309, 701 Park Ave, Minneapolis, MN, 55415, USA.
- Center for Patient and Provider Experience, Minneapolis Medical Research Foundation, Minneapolis, MN, USA.
| | - Virginia W Chang
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, USA
- Department of Population Health, School of Medicine, New York University, New York, NY, USA
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20
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Oberlander J. Hard Promises: Has the ACA Made Health Care More Affordable? N C Med J 2018; 79:58-59. [PMID: 29439108 DOI: 10.18043/ncm.79.1.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Jonathan Oberlander
- professor and chair of social medicine, UNC School of Medicine; professor, Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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KONSTAM MARVINA. THE FUTURE OF CARDIOVASCULAR CARE: FROM AFFORDABLE CARE TO THE ACADEMIC MEDICAL CENTER. Trans Am Clin Climatol Assoc 2018; 129:301-311. [PMID: 30166724 PMCID: PMC6116584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We are presently seeing exponential advances in medical knowledge and development of therapeutic and diagnostic tools. We have also begun to experience an historic restructuring of our health care system. But health care costs continue to rise, disparities persist, and the chaotic, disjointed, and often thoughtless discourse in Washington threatens to roll back the prior advances. Improvement in patient care will be severely stymied if the threats to academic medical centers are not countered. This paper will explore our present state through the lens of cardiovascular care. It will 1) examine clinical trends; 2) dissect the value and challenges to the Patient Protection and Affordable Care Act; 3) highlight limitations and alternatives to relying on the federal government; and 4) present the Academic Medical System construct, as a structure designed to retain and advance the academic mission.
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Hayes SL, Collins SR, Radley DC, McCarthy D. What's at Stake: States' Progress on Health Coverage and Access to Care, 2013–2016. Issue Brief (Commonw Fund) 2017; 2017:1-20. [PMID: 29239575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
ISSUE Given uncertainty about the future of the Affordable Care Act, it is useful to examine the progress in coverage and access made under the law. GOAL Compare state trends in access to affordable health care between 2013 and 2016. METHODS Analysis of recent data from the U.S. Census Bureau and the Behavioral Risk Factor Surveillance System. FINDINGS AND CONCLUSIONS Between 2013 and 2016, the uninsured rate for adults ages 19 to 64 declined in all states and the District of Columbia, and fell by at least 5 percentage points in 47 states. Among children, uninsured rates declined by at least 2 percentage points in 33 states. There were reductions of at least 2 percentage points in the share of adults age 18 and older who reported skipping care because of costs in the past year in 36 states and D.C., with greater declines, on average, in Medicaid expansion states. The share of at-risk adults without a recent routine checkup, and of nonelderly individuals who spent a high portion of income on medical care, declined in at least of half of states and D.C. These findings offer evidence that the ACA has improved access to health care for millions of Americans. However, actions at the federal level — including a shortened open enrollment period for marketplace coverage, a failure to extend CHIP funding, and a potential repeal of the individual mandate’s penalties — could jeopardize the gains made to date.
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Hirsch MA, Nguyen VQC, Wieczorek NS, Rhoads CF, Weaver PR. Teaching Health Care Policy: Using Panel Debate to Teach Residents About the Patient Protection and Affordable Care Act. MedEdPORTAL 2017; 13:10655. [PMID: 30800856 PMCID: PMC6338139 DOI: 10.15766/mep_2374-8265.10655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/12/2017] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The debate format has been infrequently used in resident education. We used the panel debate format as a tool to improve health care professionals' knowledge of the Patient Protection and Affordable Care Act (PPACA). METHODS Six physical medicine and rehabilitation resident physician debaters led a 60-minute panel debate about the PPACA. Outcome measures included a survey of the spectators with validated questions on physician attitudes towards health care reform in the US and open-ended questions regarding Americans' views on the US health care system. RESULTS Twenty-nine physician and nonphysician faculty and staff participated as spectators. Responses to the questions on attitudes toward reform of the health care system indicated that zero spectators rated the current US health care system (i.e., the PPACA) as "Excellent," 25% rated it as "Good," 42% "Average," 25% "Poor," and 8% "Failing." Half of the respondents indicated they support a US president who advocates making the US health care system more like those of other countries. The majority of respondents (89%) expressed the idea that the US does not have the best health care system in the world. DISCUSSION Approaching a topic as broad as health care reform with the debate format promoted knowledge, reflection, and interaction with both the opposing debaters and audience.
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Affiliation(s)
- Mark A. Hirsch
- Senior Scientist, Department of Physical Medicine and Rehabilitation, Carolinas Department of Physical Medicine and Rehabilitation Core Laboratory
- Director, Carolinas Department of Physical Medicine and Rehabilitation Core Laboratory
- Director, Resident Research Education (Physical Medicine and Rehabilitation), Carolinas Medical Center
- Adjunct Associate Professor, University of North Carolina at Charlotte
- Associate Graduate Faculty, University of North Carolina at Charlotte
| | - Vu Q. C. Nguyen
- Director, Stroke Program, University of North Carolina
- Vice Chair of Academics, University of North Carolina
- Director, Physical Medicine and Rehabilitation Residency Program, University of North Carolina
- Professor, University of North Carolina
| | | | - Charles F. Rhoads
- Staff Physiatrist, Department of Physical Medicine and Rehabilitation, William Jennings Bryan Dorn Veterans Administration Medical Center
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Wewers ME, Shoben A, Conroy S, Curry E, Ferketich AK, Murray DM, Nemeth J, Wermert A. Effectiveness of Two Community Health Worker Models of Tobacco Dependence Treatment Among Community Residents of Ohio Appalachia. Nicotine Tob Res 2017; 19:1499-1507. [PMID: 27694436 PMCID: PMC5896470 DOI: 10.1093/ntr/ntw265] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 09/27/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Community health workers (CHW) may be effective in the delivery of tobacco dependence treatment with underserved groups. This study evaluated two evidence-based CHW models of treatment. It was hypothesized that smokers assigned to a CHW face-to-face condition would have higher abstinence at 12-month posttreatment than smokers enrolled in CHW referral to a state-sponsored quitline condition. Intrapersonal and treatment-related factors associated with abstinence at 12 months were determined. METHODS A group-randomized trial was conducted with residents of 12 Ohio Appalachian counties with counties (n = 6) randomized to either a CHW face-to-face (F2F) or CHW quitline (QL) condition. Both conditions included behavioral counseling and free nicotine replacement therapy for 8 weeks. Follow-up data were collected at 3-, 6-, and 12-month posttreatment. Biochemically validated abstinence at 12 months served as the primary outcome. RESULTS Seven hundred and seven participants were enrolled (n = 353 CHWF2F; n = 354 CHWQL). Baseline sample characteristics did not differ by condition. Using an intent-to-treat analysis (85.4% retention at 12 months), 13.3% of CHWF2F participants were abstinent at 12 months, compared to 10.7% of CHWQL members (OR = 1.28; 95% confidence interval [CI] = 0.810, 2.014; p = .292). No differences in abstinence were noted at 3 or 6 months by condition. Age, marital status, and baseline levels of cigarette consumption, depressive symptoms, and self-efficacy for quitting in positive settings were associated with abstinence, as was counseling dose during treatment. CONCLUSIONS This research adds to the body of science evaluating the effectiveness of CHW models of tobacco dependence treatment. Both approaches may offer promise in low-resource settings and underserved regions. IMPLICATIONS This 12-county community-based group-randomized trial in Ohio Appalachia adds to the body of science evaluating the effectiveness of CHW models of tobacco dependence treatment. Both CHW approaches may offer promise in low-resource settings and underserved regions. These findings are useful to national, state, and local tobacco control agencies, as they expand delivery of preventive health care services postadoption of the Affordable Care Act in the United States.
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Affiliation(s)
- Mary Ellen Wewers
- Division of Health Behavior and Health Promotion, College of Public Health, Ohio State University, Columbus, OH
| | - Abigail Shoben
- Division of Biostatistics, College of Public Health, Ohio State University, Columbus, OH
| | - Sara Conroy
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH
| | - Elana Curry
- Division of Health Behavior and Health Promotion, College of Public Health, Ohio State University, Columbus, OH
| | - Amy K Ferketich
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH
| | - David M Murray
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD
| | - Julianna Nemeth
- Division of Health Behavior and Health Promotion, College of Public Health, Ohio State University, Columbus, OH
| | - Amy Wermert
- Division of Health Behavior and Health Promotion, College of Public Health, Ohio State University, Columbus, OH
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25
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Polsky D, Weiner J, Zhang Y. Exploring the decline of narrow networks on the 2017 ACA marketplaces. LDI Issue Brief 2017; 21:1-6. [PMID: 29236404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The prevalence of narrow provider networks on the ACA Marketplace is trending down. In 2017, 21% of plans had narrow networks, down from 25% in 2016. The largest single factor was that 70% of plans from National carriers exited the market and these plans had narrower networks than returning plans. Exits account for more than half of the decline in the prevalence of narrow networks, with the rest attributed to broadening networks among stable plans, particularly among Blues carriers. The narrow network strategy is expanding among traditional Medicaid carriers and remains steady among provider-based carriers and regional/local carriers.
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Affiliation(s)
- Daniel Polsky
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Janet Weiner
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Yuehan Zhang
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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McCue MJ, Hall MA. How Have Health Insurers Performed Financially Under the ACA' Market Rules? Issue Brief (Commonw Fund) 2017; 2017:1-9. [PMID: 29020733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
ISSUE The Affordable Care Act (ACA) transformed the market for individual health insurance, so it is not surprising that insurers' transition was not entirely smooth. Insurers, with no previous experience under these market conditions, were uncertain how to price their products. As a result, they incurred significant losses. Based on this experience, some insurers have decided to leave the ACA’s subsidized market, although others appear to be thriving. GOALS Examine the financial performance of health insurers selling through the ACA's marketplace exchanges in 2015--the market’s most difficult year to date. METHOD Analysis of financial data for 2015 reported by insurers from 48 states and D.C. to the Centers for Medicare and Medicaid Services. FINDINGS AND CONCLUSIONS Although health insurers were profitable across all lines of business, they suffered a 10 percent loss in 2015 on their health plans sold through the ACA's exchanges. The top quarter of the ACA exchange market was comfortably profitable, while the bottom quarter did much worse than the ACA market average. This indicates that some insurers were able to adapt to the ACA's new market rules much better than others, suggesting the ACA's new market structure is sustainable, if supported properly by administrative policy.
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Affiliation(s)
- Michael J McCue
- School of Allied Health Professions, Virginia Commonwealth University
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Polite BN, Adams-Campbell LL, Brawley OW, Bickell N, Carethers JM, Flowers CR, Foti M, Gomez SL, Griggs JJ, Lathan CS, Li CI, Lichtenfeld JL, McCaskill-Stevens W, Paskett ED. Charting the future of cancer health disparities research: A position statement from the American Association for Cancer Research, the American Cancer Society, the American Society of Clinical Oncology, and the National Cancer Institute. CA Cancer J Clin 2017; 67:353-361. [PMID: 28738442 DOI: 10.3322/caac.21404] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 05/18/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Blase N Polite
- Associate Professor of Medicine, Department of Medicine, The University of Chicago, Chicago, IL
| | - Lucile L Adams-Campbell
- Associate Director, Minority Health and Health Disparities Research, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Otis W Brawley
- Chief Medical Officer, American Cancer Society, Atlanta, GA
| | - Nina Bickell
- Professor of Medicine and General Internal Medicine, Icahn Mount Sinai School of Medicine, New York, NY
| | - John M Carethers
- Professor and Chair, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Christopher R Flowers
- Associate Professor, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Margaret Foti
- Chief Executive Officer, American Association for Cancer Research, Philadelphia, PA
| | - Scarlett Lin Gomez
- Consulting Associate Professor, Department of Health Research and Policy, Cancer Prevention Institute of California, Fremont, CA
| | - Jennifer J Griggs
- Professor, Department of Health Management and Policy, University of Michigan, Ann Arbor, MI
| | - Christopher S Lathan
- Assistant Professor of Medicine, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
| | - Christopher I Li
- Research Associate Professor, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Worta McCaskill-Stevens
- Chief, Community Oncology and Prevention Trials Research Group, National Cancer Institute, Rockville, MD
| | - Electra D Paskett
- Professor of Cancer Research, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH
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Gunja MZ, Collins SR, Doty MM, Beautel S. How the Affordable Care Act Has Helped Women Gain Insurance and Improved Their Ability to Get Health Care: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016. Issue Brief (Commonw Fund) 2017; 2017:1-18. [PMID: 28805362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
ISSUE: Prior to the Affordable Care Act (ACA), one-third of women who tried to buy a health plan on their own were either turned down, charged a higher premium because of their health, or had specific health problems excluded from their plans. Beginning in 2010, ACA consumer protections, particularly coverage for preventive care screenings with no cost-sharing and a ban on plan benefit limits, improved the quality of health insurance for women. In 2014, the law’s major insurance reforms helped millions of women who did not have employer insurance to gain coverage through the ACA’s marketplaces or through Medicaid. GOALS: To examine the effects of ACA health reforms on women’s coverage and access to care. METHOD: Analysis of the Commonwealth Fund Biennial Health Insurance Surveys, 2001–2016. FINDINGS AND CONCLUSIONS: Women ages 19 to 64 who shopped for new coverage on their own found it significantly easier to find affordable plans in 2016 compared to 2010. The percentage of women who reported delaying or skipping needed care because of costs fell to an all-time low. Insured women were more likely than uninsured women to receive preventive screenings, including Pap tests and mammograms.
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Hayes SL, Riley P, Radley DC, McCarthy D. Reducing Racial and Ethnic Disparities in Access to Care: Has the Affordable Care Act Made a Difference? Issue Brief (Commonw Fund) 2017; 2017:1-14. [PMID: 28836751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
ISSUE: Prior to the Affordable Care Act (ACA), blacks and Hispanics were more likely than whites to face barriers in access to health care. GOAL: Assess the effect of the ACA’s major coverage expansions on disparities in access to care among adults. METHODS: Analysis of nationally representative data from the American Community Survey and the Behavioral Risk Factor Surveillance System. FINDINGS AND CONCLUSIONS: Between 2013 and 2015, disparities with whites narrowed for blacks and Hispanics on three key access indicators: the percentage of uninsured working-age adults, the percentage who skipped care because of costs, and the percentage who lacked a usual care provider. Disparities were narrower, and the average rate on each of the three indicators for whites, blacks, and Hispanics was lower in both 2013 and 2015 in states that expanded Medicaid under the ACA than in states that did not expand. Among Hispanics, disparities tended to narrow more between 2013 and 2015 in expansion states than nonexpansion states. The ACA’s coverage expansions were associated with increased access to care and reduced racial and ethnic disparities in access to care, with generally greater improvements in Medicaid expansion states.
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Funderburk JS, Polaha J. To clinician innovators: A special invitation. Fam Syst Health 2017; 35:105-109. [PMID: 28617012 DOI: 10.1037/fsh0000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Our vision for this special issue was simple: to inspire clinician innovators working in integrated care to not only consume the literature but also contribute to it. Growing the research capacity of clinician innovators in integrated care is vital for at least three reasons. First and foremost, real-world clinicians have an excellent vantage on the processes and outcomes that relate to the reach or the extent to which the given intervention or model of care engages its intended audience (Klesges, Estabrooks, Dzewaltowski, Bull, & Glasgow, 2005). Second, policy changes within the Affordable Care Act have facilitated the rapid uptake of integrated care in recent years (Beacham, Kinman, Harris, & Masters, 2012; Nash, Khatri, Cubic, & Baird, 2013), but the growth of the published evidence base has not kept pace. Third, clinician innovators in integrated care are well positioned to contribute to the evidence base because of the growing emphasis on demonstrating outcomes in health care. Many of the articles in this special issue highlight specific recommendations that clinician innovators can make to transform a local evaluation into one that produces generalizable findings worthy of publication. Our hope is that this special issue can help dismantle the "research" stereotype and inspire future clinician innovators to become more active participants. (PsycINFO Database Record
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Abstract
Inequalities in medical care are endemic in the USA. The Affordable Care Act (ACA), passed in 2010 and fully implemented in 2014, was intended to expand coverage and bring about a new era of health-care access. In this review, we evaluate the legislation's impact on health-care equity. We consider the law's coverage expansion, insurance market reforms, cost and affordability provisions, and delivery-system reforms. Although the ACA improved coverage and access-particularly for poorer Americans, women, and minorities-its overall impact was modest in comparison with the gaps present before the law's implementation. Today, 29 million people in the USA remain uninsured, and substantial inequalities in access along economic, gender, and racial lines persist. Although most Americans agree that further reform is needed, the proper direction for reform-especially following the 2016 presidential election-is highly contentious. We discuss proposals for change from opposite sides of the political spectrum, together with their potential impact on health equity.
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Affiliation(s)
- Adam Gaffney
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Danny McCormick
- Division of Social and Community Medicine, Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
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Runyan CN. The future of collaborative care without the Affordable Care Act: We did it before and will do it again. Fam Syst Health 2017; 35:100-101. [PMID: 28333523 DOI: 10.1037/fsh0000256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This article provides insight into the challenges we face in 2017 following the repeal of the Affordable Care Act by the newly elected Republican Congress and president. (PsycINFO Database Record
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Rubin RJ. Replace or...? The future awaits on Trumpcare '17. Nephrol News Issues 2017; 31:16-18. [PMID: 30399277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
To provide context to what follows, I wrote this review about a month after the election and after President-elect Trump announced that he will nominate Rep. Tom Price, MD, to be the Secretary of the Department of Health and Human Services (DHHS) and Seema Verma, a Medicaid expert, to be the Administrator of the Centers for Medicare and Medicaid Services (CMS). It will be published about a month after the Inauguration.
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Pant S, Burgan R, Battistini K, Cibotto C, Guemara R. Obamacare: A View From the Outside. Hawaii J Med Public Health 2017; 76:42-44. [PMID: 28435758 PMCID: PMC5375013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Samaksha Pant
- Faculty of Medicine, University of Geneva, Switzerland (SP, RB, KB, CC, RG)
| | - Ryan Burgan
- Faculty of Medicine, University of Geneva, Switzerland (SP, RB, KB, CC, RG)
| | - Kevin Battistini
- Faculty of Medicine, University of Geneva, Switzerland (SP, RB, KB, CC, RG)
| | - Cedric Cibotto
- Faculty of Medicine, University of Geneva, Switzerland (SP, RB, KB, CC, RG)
| | - Romain Guemara
- Faculty of Medicine, University of Geneva, Switzerland (SP, RB, KB, CC, RG)
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Wood D. Repeal without replacement is reckless. Minn Med 2017; 100:26. [PMID: 30428178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Affiliation(s)
- Lawrence O Gostin
- Lawrence O. Gostin, JD, is University Professor and Faculty Director, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, and Director of the World Health Organization Collaborating Center on Public Health Law and Human Rights. His most recent book is Global Health Law (Harvard University Press)
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Russell KS. ACOs continue to evolve. Health Manag Technol 2017; 38:14-17. [PMID: 29474024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Weiner J, Marks C, Pauly M. Effects of the ACA on Health Care Cost Containment. LDI Issue Brief 2017; 24:1-7. [PMID: 28378960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This brief reviews the evidence on how key ACA provisions have affected the growth of health care costs. Coverage expansions produced a predictable jump in health care spending, amidst a slowdown that began a decade ago. Although we have not returned to the double-digit increases of the past, the authors find little evidence that ACA cost containment provisions produced changes necessary to "bend the cost curve." Cost control will likely play a prominent role in the next round of health reform and will be critical to sustaining coverage gains in the long term.
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Affiliation(s)
- Janet Weiner
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Mark Pauly
- Wharton School, University of Pennsylvania, Philadelphia, PA, USA
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Affiliation(s)
- Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC
| | - David A Hyman
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC
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Ku L, Steinmetz E, Brantley E, Bruen B. Repealing Federal Health Reform: Economic and Employment Consequences for States. Issue Brief (Commonw Fund) 2017; 1:1-18. [PMID: 28072508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Issue: The incoming Trump administration and Republicans in Congress are seeking to repeal the Affordable Care Act (ACA), likely beginning with the law’s insurance premium tax credits and expansion of Medicaid eligibility. Research shows that the loss of these two provisions would lead to a doubling of the number of uninsured, higher uncompensated care costs for providers, and higher taxes for low-income Americans. Goal: To determine the state-by-state effect of repeal on employment and economic activity. Methods: A multistate economic forecasting model (PI+ from Regional Economic Models, Inc.) was used to quantify for each state the effects of the federal spending cuts. Findings and Conclusions: Repeal results in a $140 billion loss in federal funding for health care in 2019, leading to the loss of 2.6 million jobs (mostly in the private sector) that year across all states. A third of lost jobs are in health care, with the majority in other industries. If replacement policies are not in place, there will be a cumulative $1.5 trillion loss in gross state products and a $2.6 trillion reduction in business output from 2019 to 2023. States and health care providers will be particularly hard hit by the funding cuts.
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Affiliation(s)
- Leighton Ku
- Center for Health Policy Research, Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, USA.
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Barker AR, Huntzberry K, McBride TD, Mueller KJ. Changing Rural and Urban Enrollment in State Medicaid Programs. Rural Policy Brief 2017:1-4. [PMID: 28102652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose. From October 2013—before implementation of the Affordable Care Act (ACA)—to November 2016, Medicaid enrollment grew by 27 percent. However, very little attention has been paid to date to how changes in Medicaid enrollment vary within states across the rural-urban continuum. This brief reports and analyzes changes in enrollment in metropolitan, micropolitan, and rural (noncore) areas in both expansion states (those that used ACA funding to expand Medicaid coverage) and nonexpansion states (those that did not use ACA funding to expand Medicaid coverage). The findings suggest that growth has been uneven across rural-urban geography, and that Medicaid enrollment growth is lower in rural counties, particularly in nonexpansion states. Key Findings. (1) Medicaid growth rates in metropolitan counties in nonexpansion states from 2012 to 2015 were twice as large as in rural counties (14 percent compared to 7 percent). (2) In contrast, the differential in growth rates between metropolitan, micropolitan, and rural counties was much less dramatic in expansion states (growth rates of 43 percent, 38 percent, and 38 percent, respectively). (3) Analysis at the state level shows much variability across the states, even when controlling for expansion status. For example, some states with an above-average rural population, such as Tennessee and Idaho, had higher-than-average enrollment increases, with strong rural increases, while other states with similar proportions of rural residents, such as Nebraska, Oklahoma, Maine, and Wyoming, experienced enrollment decreases in micropolitan and/or rural counties. (4) States’ pre-ACA Medicaid eligibility levels for parents and children affected the potential for growth. For example, some states that had higher eligibility levels (e.g., Maryland and Illinois) experienced lower Medicaid growth rates from 2012 to 2015, in part because their baseline enrollment was higher. (5) In the expansion states of Colorado and Nevada, which both have State-Based Marketplaces (SBMs), enrollment increases were over four times the overall average.
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Taylor DA, Broyhill BS, Burris AM, Wilcox MA. A Strategic Approach for Developing an Advanced Practice Workforce: From Postgraduate Transition-to-Practice Fellowship Programs and Beyond. Nurs Adm Q 2017; 41:11-19. [PMID: 27918400 DOI: 10.1097/naq.0000000000000198] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The healthcare provider landscape is rapidly changing. Given the imminent retirement of baby boomer physicians, implementation of the Affordable Care Act, and the increased utilization of health care services by an ever-aging population, the supply of providers cannot keep pace with the demand for services. This has led to an increased utilization of advanced clinical practitioners (ACPs). This article shows how one large highly-matrixed health care system approached identifying this workforce, and how thought leaders worked collaboratively with physicians, administrators, and ACPs to meet a growing demand for providers. Carolinas HealthCare System developed a 3-pronged approach to this opportunity. The development of a Center for Advanced Practice was explored and implemented. This Center serves as a 2-way conduit of information and ideas between system administrators and providers. It also serves as a central source of regulatory and practice information for administrators and providers. The growing number of open ACP positions, along with the reluctance to employ novice and new graduate ACPs, led to the development of a postgraduate transition to practice fellowship program. This program's clinical tracks and curriculum are described. Finally, a collaborative effort between the health care system and a local university resulted in the local offering of an acute care nurse practitioner program, which allowed system nurses to continue their education without the need for relocation. Higher satisfaction and engagement, lower turnover, better career opportunities, more satisfied administrators, and physicians all contributed to the overwhelming success of this initiative.
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Affiliation(s)
- Dennis A Taylor
- Center for Advanced Practice, Carolinas HealthCare System, Charlotte, North Carolina
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Collins SR, Gunja MZ, Doty MM, Beutel S. How the Affordable Care Act Has Improved Americans’ Ability to Buy Health Insurance on Their Own: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016. Issue Brief (Commonw Fund) 2017; 5:1-20. [PMID: 28150921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Issue: Since 2001, long before the passage of the Affordable Care Act (ACA), the Commonwealth Fund Biennial Health Insurance Survey has examined health coverage and consumers’ experiences buying insurance and using health care. Goals: To examine long-term trends and to make comparisons before and after passage of health reform. Methods: Analysis of the Commonwealth Fund Biennial Health Insurance Survey, 2016. Findings and Conclusions: There have been dramatic improvements in people’s ability to buy health plans on their own following the passage of the ACA. For adults with family incomes less than $48,500, uninsured rates dropped about 17 percentage points below their 2010 peak. Lower-income whites, blacks, and Latinos have experienced drops this large, though Latinos are uninsured at higher rates. Among working-age adults who had shopped for plans in the individual market and ACA marketplaces over the prior three years, the percentage who reported it was very difficult to find affordable plans fell by nearly half from 2010, prior to the ACA reforms, to 2016. Coverage gains are helping working-age Americans get the care they need: the number of adults who reported problems getting needed health care and filling prescriptions because of costs fell from a high of 80 million in 2012 to an estimated 63 million in 2016.
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Morrisey MA. Turmoil in the Health Insurance Marketplaces. LDI Issue Brief 2016; 21:1-5. [PMID: 28080010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The first three years of the Affordable Care Act’s Health Insurance Marketplaces have been tumultuous ones, with rapid entry and exit of insurers and recent spikes in premiums. As concerns mount about the stability and viability of the Marketplaces, this brief provides some insight into the forces behind the headlines and presents six options for policymakers to consider.
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Glied S, Solís-Román C, Parikh S. How the ACA's Health Insurance Expansions Have Affected Out-of-Pocket Cost-Sharing and Spending on Premiums. Issue Brief (Commonw Fund) 2016; 28:1-16. [PMID: 27632806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
One important benefit gained by the millions of Americans with health insurance through the Affordable Care Act (ACA) is protection from high out-of-pocket health spending. While Medicaid unambiguously reduces out-of-pocket premium and medical costs for low-income people, it is less certain that marketplace coverage and other types of insurance purchased to comply with the law's individual mandate also protect from high health spending. Goal: To compare out-of-pocket spending in 2014 to spending in 2013; assess how this spending changed in states where many people enrolled in the marketplaces relative to states where few people enrolled; and project the decline in the percentage of people paying high amounts out-of-pocket. Methods: Linear regression models were used to estimate whether people under age 65 spent above certain thresholds. Key findings and conclusions: The probability of incurring high out-of-pocket costs and premium expenses declined as marketplace enrollment increased. The percentage reductions were greatest among those with incomes between 250 percent and 399 percent of poverty, those who were eligible for premium subsidies, and those who previously were uninsured or had very limited nongroup coverage. These effects appear largely attributable to marketplace enrollment rather than to other ACA provisions or to economic trends.
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Affiliation(s)
- Sherry Glied
- Robert Wagner Graduate School of Public Service, New York University
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Abstract
The US healthcare system is rapidly moving toward rewarding value. Recent legislation, such as the Affordable Care Act and the Medicare Access and CHIP Reauthorization Act, solidified the role of value-based payment in Medicare. Many private insurers are following Medicare's lead. Much of the policy attention has been on programs such as accountable care organizations and bundled payments; yet, value-based purchasing (VBP) or pay-for-performance, defined as providers being paid fee-for-service with payment adjustments up or down based on value metrics, remains a core element of value payment in Medicare Access and CHIP Reauthorization Act and will likely remain so for the foreseeable future. This review article summarizes the current state of VBP programs and provides analysis of the strengths, weaknesses, and opportunities for the future. Multiple inpatient and outpatient VBP programs have been implemented and evaluated; the impact of those programs has been marginal. Opportunities to enhance the performance of VBP programs include improving the quality measurement science, strengthening both the size and design of incentives, reducing health disparities, establishing broad outcome measurement, choosing appropriate comparison targets, and determining the optimal role of VBP relative to alternative payment models. VBP programs will play a significant role in healthcare delivery for years to come, and they serve as an opportunity for providers to build the infrastructure needed for value-oriented care.
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Affiliation(s)
- Tingyin T Chee
- From Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC (T.T.C., W.B.B.); Department of Health Policy, University of Michigan, Ann Arbor (A.M.R.); and Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.H.W.)
| | - Andrew M Ryan
- From Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC (T.T.C., W.B.B.); Department of Health Policy, University of Michigan, Ann Arbor (A.M.R.); and Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.H.W.)
| | - Jason H Wasfy
- From Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC (T.T.C., W.B.B.); Department of Health Policy, University of Michigan, Ann Arbor (A.M.R.); and Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.H.W.)
| | - William B Borden
- From Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC (T.T.C., W.B.B.); Department of Health Policy, University of Michigan, Ann Arbor (A.M.R.); and Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.H.W.)
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Collins SR, Gunja M, Doty MM, Beutel S. Americans' Experiences with ACA Marketplace and Medicaid Coverage: Access to Care and Satisfaction: Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, February–April 2016. Issue Brief (Commonw Fund) 2016; 14:1-18. [PMID: 27224966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The fourth wave of the Commonwealth Fund Affordable Care Act Tracking Survey, February--April 2016, finds at the close of the third open enrollment period that the working-age adult uninsured rate stands at 12.7 percent, statistically unchanged from 2015 but significantly lower than 2014 and 2013. Uninsured rates in the past three years have fallen most steeply for low-income adults though remain higher compared to wealthier adults. ACA marketplace and Medicaid coverage is helping to end long bouts without insurance, bridge gaps when employer insurance is lost, and improve access to health care. Sixty-one percent of enrollees who had used their insurance to get care said they would not have been able to afford or access it prior to enrolling. Doctor availability and appointment wait times are similar to those reported by insured Americans overall. Majorities with marketplace or Medicaid coverage continue to be satisfied with their insurance.
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