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Health Affairs

Timothy Stoltzfus Jost
The Trump administration proposed liberalizing rules governing non-ACA-compliant, short-term coverage; responding to state guidance, Blue Cross of Idaho filed health plans not meeting ACA requirements.
March 12, 2018: Health Affairs
Timothy Stoltzfus Jost
The Trump administration broke from its predecessors by authorizing Medicaid work requirements. It also proposed to dramatically broaden rights to refuse to provide treatments for religious and moral reasons.
February 12, 2018: Health Affairs
Fredric Blavin, Michael Karpman, Genevieve M Kenney, Benjamin D Sommers
In states that expanded Medicaid eligibility under the Affordable Care Act, nonelderly near-poor adults-those with family incomes of 100-138 percent of the federal poverty level-are generally eligible for Medicaid, with no premiums and minimal cost sharing. In states that did not expand eligibility, these adults may qualify for premium tax credits to purchase Marketplace plans that have out-of-pocket premiums and cost-sharing requirements. We used data for 2010-15 to estimate the effects of Medicaid expansion on coverage and out-of-pocket expenses, compared to the effects of Marketplace coverage...
January 24, 2018: Health Affairs
Timothy Stoltzfus Jost
The month brought the repeal of the individual mandate's penalties, but also 2018 enrollment numbers rivaling those of 2017.
January 16, 2018: Health Affairs
Richard L Hall, Peter D Jacobson
Scholars and public health advocates have expressed optimism about the potential for the health-in-all-policies approach to address social disparities in health, but little research has been done on whether it promotes health equity in practice. Based on sixty-five in-depth interviews with US officials in the public and private sectors conducted in five states in 2016-17, we found a relationship between the use of the approach and the prominence of health equity as a policy concern. In emphasizing the social determinants of health, the approach gives public officials and policy entrepreneurs a framework for promoting this goal...
March 2018: Health Affairs
Emilie Courtin, Peter Muennig, Nandita Verma, James A Riccio, Mylene Lagarde, Paolo Vineis, Ichiro Kawachi, Mauricio Avendano
Opportunity NYC-Family Rewards was the first conditional cash transfer, randomized controlled trial for low-income families in the United States. From 2007 to 2010, Family Rewards offered 2,377 New York City families cash transfers that were conditional upon their investments in education, preventive health care, and parental employment. Their health and other outcomes were compared to those of a control group of 2,372 families. The experiment led to a modest improvement in health insurance coverage and a large increase in the use of preventive dental care...
March 2018: Health Affairs
Laura Rosella, Kathy Kornas, Anjie Huang, Catherine Bornbaum, David Henry, Walter P Wodchis
With falling mortality rates for several diseases, patients are living longer with complex multimorbidities. We explored the burden of multimorbidity at the time of death, how it varies by socioeconomic status, and trends over time in Ontario, Canada. We calculated the proportions of decedents with varying degrees of multimorbidity and types of conditions at death, and we analyzed the trend from 1994 to 2013 in the number of conditions at the time of death. The prevalence of multimorbidity at death increased from 79...
March 2018: Health Affairs
Glenn Flores, Hua Lin, Candy Walker, Michael Lee, Janet Currie, Rick Allgeyer, Marco Fierro, Monica Henry, Alberto Portillo, Kenneth Massey
Latinos have the highest US childhood uninsurance rate of any race/ethnicity, but little is known about effective ways to eliminate this disparity. We evaluated the effects of parent mentors-Latino parents with children covered by Medicaid or the Children's Health Insurance Program-on insuring Latino children in a randomized, controlled, community-based trial of 155 uninsured children conducted in the period 2011-15. Parent mentors were trained to assist families in getting insurance coverage, accessing health care, and addressing social determinants of health...
March 2018: Health Affairs
Ana M Progovac, Benjamin Lê Cook, Brian O Mullin, Alex McDowell, Maria Jose Sanchez R, Ye Wang, Timothy B Creedon, Mark A Schuster
Health care utilization patterns for gender minority Medicare beneficiaries (those who are transgender or gender nonbinary people) are largely unknown. We identified gender minority beneficiaries using a diagnosis-code algorithm and compared them to a 5 percent random sample of non-gender minority beneficiaries from the period 2009-14 in terms of mental health and chronic diseases, use of preventive and mental health care, hospitalizations, and emergency department (ED) visits. Gender minority beneficiaries experienced more disability and mental illness...
March 2018: Health Affairs
James A Morone, David Blumenthal
There is a formidable historical arc to health care policy: Every modern US president has sought to expand coverage. Democrats eagerly placed the issue on the agenda. Republicans vociferously opposed Democratic proposals but countered with creative ways to expand coverage on their own terms. Democrats eventually absorbed elements of the latest Republican plan-which Republicans, in turn, attacked, and the cycle began anew. The dynamic interaction between the parties slowly, often haphazardly, expanded health insurance as each sought to extend coverage in its own way...
March 2018: Health Affairs
Diana Hernández
Being unable to meet basic household energy needs can have dire health consequences and merits more attention and resources.
March 2018: Health Affairs
Marilyn Werber Serafini
The City of Los Angeles continues to struggle to make available housing that is both affordable and accessible.
March 2018: Health Affairs
Jerzy Eisenberg-Guyot, Caislin Firth, Marieka Klawitter, Anjum Hajat
The fringe banking industry, including payday lenders and check cashers, was nearly nonexistent three decades ago. Today it generates tens of billions of dollars in annual revenue. The industry's growth accelerated in the 1980s with financial deregulation and the working class's declining resources. With Current Population Survey data, we used propensity score matching to investigate the relationship between fringe loan use, unbanked status, and self-rated health, hypothesizing that the material and stress effects of exposure to these financial services would be harmful to health...
March 2018: Health Affairs
(no author information available yet)
Many factors that affect health can have disproportionate effects on vulnerable groups, such as those with low socioeconomic status, women, racial and ethnic minorities, people who are disabled, and those who are LGBTQ. Factors such as educational opportunity, geography, food and housing security, safety, and environmental conditions are often beyond a person's direct control. Exploring these determinants of health, the disparities that arise from them, and policies that attempt to improve equity by addressing them are active areas of research...
March 2018: Health Affairs
K John McConnell, Christina J Charlesworth, Thomas H A Meath, Rani M George, Hyunjee Kim
In 2012 Oregon transformed its Medicaid program, providing coverage through sixteen coordinated care organizations (CCOs). The state identified the elimination of health disparities as a priority for the CCOs, implementing a multipronged approach that included strategic planning, community health workers, and Regional Health Equity Coalitions. We used claims-based measures of utilization, access, and quality to assess baseline disparities and test for changes over time. Prior to the CCO intervention there were significant white-black and white-American Indian/Alaska Native disparities in utilization measures and white-black disparities in quality measures...
March 2018: Health Affairs
Michael F Pesko, Jaskaran Bains, Johanna Catherine Maclean, Benjamin Lê Cook
The Affordable Care Act (ACA) allowed employer plans in the small-group marketplace to charge tobacco users up to 50 percent more for premiums-known as tobacco surcharges-but only if the employer offered a tobacco cessation program and the employee in question failed to participate in it. Using 2016 survey data collected by the Henry J. Kaiser Family Foundation and Health Research and Educational Trust on 278 employers eligible for Small Business Health Options Program, we examined the prevalence of tobacco surcharges and tobacco cessation programs in the small-group market under this policy and found that 16...
March 2018: Health Affairs
Andrea Dunne-Sosa, John Wilhelm, Tom Kenyon
No abstract text is available yet for this article.
March 2018: Health Affairs
Philipp Hessel, Mauricio Avendano, Carlos Rodríguez-Castelán, Tobias Pfutze
The countries of Latin American are aging rapidly. Because most countries in the region lack adequate social protection systems, many Latin American governments have introduced noncontributory pension programs to reduce poverty and food shortages. This study assessed the effects of a large national noncontributory pension program on the health and health care use of older people in Colombia. Using an instrumental variables approach that exploited differential rollout of the program across municipalities, we found evidence that the program led to significant but small improvements in self-reported health and reductions in hospitalizations among men...
March 2018: Health Affairs
Manuel Pastor, Veronica Terriquez, May Lin
Public health scholarship increasingly recognizes community organizing as a vehicle for unleashing the collective power necessary to uproot socioeconomic inequities at the core of health disparities. In this article we reverse the analytical focus from how organizing can affect health equity, and we consider how the frame of health equity has shaped grassroots organizing. Using evidence from a range of cases in California, we suggest that the health equity frame can guide and justify grassroots groups' efforts to improve the health outcomes of marginalized populations; connect issues such as housing and school discipline to health; and provide a rationale for community organizing groups to directly address the trauma experienced by their own members and staff, who often come from communities at risk for poor health outcomes...
March 2018: Health Affairs
Marsha Regenstein, Jennifer Trott, Alanna Williamson, Joanna Theiss
The US health care system needs effective tools to address complex social and environmental issues that perpetuate health inequities, such as food insecurity, education and employment barriers, and substandard housing conditions. The medical-legal partnership is a collaborative intervention that embeds civil legal aid professionals in health care settings to address seemingly intractable social problems that contribute to poor health outcomes and health disparities. More than three hundred health care organizations are home to medical-legal partnerships...
March 2018: Health Affairs
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