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Journal of Health Politics, Policy and Law

Howard H Roby, Christopher J Louis, Mallory M Johnson Cole, Natalie Chau, Bridgette Wiefling, David C Salsberry, Evan King, Allen Miller
The New York Delivery System Reform Incentive Payment (DSRIP) waiver was viewed as a prototype for Medicaid and safety net redesign waivers in the Affordable Care Act (ACA) era. After the insurance expansions of the ACA were implemented, it was apparent that accountability, value, and quality improvement would be priorities in future waivers in many states. Despite New York's distinct provider relationships, previous coverage expansions, and local and state politics, it is important to understand the key characteristics of the waiver so that other states can learn how to better incorporate value-based arrangements into future waivers or attempts to limit spending under proposed Medicaid per-capita caps or block grants...
April 1, 2018: Journal of Health Politics, Policy and Law
Philip Rocco, Simon F Haeder
The implementation of the Affordable Care Act (ACA) has been a politically volatile process. The ACA's institutional design and delayed feedback effects created a window of opportunity for its partisan opponents to launch challenges at both the federal and state level. Yet as recent research suggests, postreform politics depends on more than policy feedback alone; rather, it is shaped by the partisan and interest-group environment. We argue that "intense policy demanders" played an important role in defining the policy alternatives that comprised congressional Republicans' efforts to repeal and replace the ACA...
April 1, 2018: Journal of Health Politics, Policy and Law
Simone R Singh, Gary J Young, Lacey Loomer, Kristin Madison
Do nonprofit hospitals provide enough community benefits to justify their tax exemptions? States have sought to enhance nonprofit hospitals' accountability and oversight through regulation, including requirements to report community benefits, conduct community health needs assessments, provide minimum levels of community benefits, and adhere to minimum income eligibility standards for charity care. However, little research has assessed these regulations' impact on community benefits. Using 2009-11 Internal Revenue Service data on community benefit spending for more than eighteen hundred hospitals and the Hilltop Institute's data on community benefit regulation, we investigated the relationship between these four types of regulation and the level and types of hospital-provided community benefits...
April 1, 2018: Journal of Health Politics, Policy and Law
Emma E McGinty, Howard H Goldman, Bernice A Pescosolido, Colleen L Barry
In the ongoing national policy debate about how to best address serious mental illness (SMI), a major controversy among mental health advocates is whether drawing public attention to an apparent link between SMI and violence, shown to elevate stigma, is the optimal strategy for increasing public support for investing in mental health services or whether nonstigmatizing messages can be equally effective. We conducted a randomized experiment to examine this question. Participants in a nationally representative online panel (Nā€‰=ā€‰1,326) were randomized to a control arm or to read one of three brief narratives about SMI emphasizing violence, systemic barriers to treatment, or successful treatment and recovery...
April 1, 2018: Journal of Health Politics, Policy and Law
Ashley Tallevi
Privatization has grown exponentially, both in salience and in form, over the past several decades. This shifting of administrative authority away from the state can make it difficult for program recipients to link their use of a federal program back to government, a disconnect known as "submerging" the state. However, privatization is a process that occurs in degrees, and not all privatization initiatives look alike. This study leverages variation in the implementation of Medicaid managed care, which is the most widespread form of Medicaid privatization, to examine how privatization maps onto state submersion and affects state visibility...
April 1, 2018: Journal of Health Politics, Policy and Law
Rachel Sachs, Nicholas Bagley, Darius N Lakdawalla
In recent years, drug manufacturers and private payers have expressed interest in novel pricing models that more closely link a drug's price to its value. Indication-based pricing, outcome-based pricing, drug licenses, and drug mortgages have all been discussed as alternatives to paying strictly for volume. Manufacturers and payers have complained, however, that Medicaid's "best-price rule" inhibits their ability to enter into these new pricing arrangements. This article examines the best-price rule and assesses to what extent, if any, it might frustrate the goal of paying for value...
February 1, 2018: Journal of Health Politics, Policy and Law
Martin Gorsky, Gareth Millward
Britain's National Health Service (NHS) is a universal, single-payer health system in which the central state has been instrumental in ensuring equity. This article investigates why from the 1970s a policy to achieve equal access for equal need was implemented. Despite the founding principle that the NHS should "universalize the best," this was a controversial policy goal, implying substantial redistribution from London and the South and threatening established medical, political, and bureaucratic interests...
February 1, 2018: Journal of Health Politics, Policy and Law
Jacqueline Chattopadhyay
Social Security and Medicare enjoy strong political coalitions within the mass public because middle-class Americans believe they derive benefits from these programs and stand alongside lower-income beneficiaries in defending them from erosion. By pooling data from nine nationally representative surveys, this article examines whether the Affordable Care Act (ACA) is cultivating a similar cross-class constituency. The results show that middle-income Americans are less likely than low-income Americans to say the ACA has helped them personally so far...
February 1, 2018: Journal of Health Politics, Policy and Law
Adam S Wilk, Leigh C Evans, David K Jones
Six states that have rejected the Patient Protection and Affordable Care Act's (ACA) Medicaid expansion nonetheless extended the primary care "fee bump," by which the federal government increased Medicaid fees for primary care services up to 100 percent of Medicare fees during 2013-14. We conducted semistructured interviews with leaders in five of these states, as well as in three comparison states, to examine why they would continue a provision of the ACA that moderately expands access at significant state expense while rejecting the expansion and its large federal match, focusing on relevant economic, political, and procedural factors...
February 1, 2018: Journal of Health Politics, Policy and Law
Kelsey N Berry, Haiden A Huskamp, Howard H Goldman, Lainie Rutkow, Colleen L Barry
Over the past twenty-five years, thirty-seven states and the US Congress have passed mental health and substance use disorder (MH/SUD) parity laws to secure nondiscriminatory insurance coverage for MH/SUD services in the private health insurance market and through certain public insurance programs. However, in the intervening years, litigation has been brought by numerous parties alleging violations of insurance parity. We examine the critical issues underlying these legal challenges as a framework for understanding the areas in which parity enforcement is lacking, as well as ongoing areas of ambiguity in the interpretation of these laws...
December 2017: Journal of Health Politics, Policy and Law
Lynn A Blewett, Donna Spencer, Peter Huckfeldt
In recent years, accountable care organizations (ACOs) have become more prevalent in the United States. This study describes the origins, implementation, and early results of Minnesota's Medicaid ACO payment model, the Integrated Health Partnership (IHP) demonstration project. We describe the structure of the program and present preliminary evaluation results to document the state's important work and to provide lessons for other states interested in implementing Medicaid ACOs. The IHP program has expanded in size over time, the state has reported significant savings, and evidence exists of capacity building among participating providers...
December 2017: Journal of Health Politics, Policy and Law
Lynn T Kozlowski
Harm reduction debates are important in health policy. Although it has been established that morality affects policy, this article proposes that perspectives from moral psychology help to explain the challenges of developing evidence-based policy on prohibition-only versus tobacco/nicotine harm reduction for minors. Protecting youth from tobacco is critical, especially since tobacco/nicotine products are legal for adults, who usually begin using when young. Although cigarettes and other combustibles are the deadliest tobacco products, other products such as smokeless tobacco and electronic cigarettes, though unsafe, are upward of 90 percent less harmful than cigarettes...
December 2017: Journal of Health Politics, Policy and Law
Judy Feder, Alan R Weil, Robert Berenson, Rachel Dolan, Nicole Lallemand, Emily Hayes
States' role in payment as well as coverage will be subject to debate as the administration and the Congress decide how to address the Affordable Care Act (ACA) and otherwise reshape the nation's health policies. Acting as stewards of health care for the entire state population and stimulated by concern about rising costs and federal support under the ACA, the elected and administrative leaders of some states have been using their political influence and authority to improve their state's overall systems of care regardless of who pays the bill...
December 2017: Journal of Health Politics, Policy and Law
Sarah E Gollust, Colleen L Barry, Jeff Niederdeppe
This study examines the public's motivated reasoning of competitive messages about sugary drink taxes, a public health policy approach attempted with some recent success in the United States. In an experiment embedded in a nationally representative survey fielded in the fall of 2012, we randomized participants ( N ā€‰=ā€‰5,147) to receive one of four messages: control, a strong protax message, a two-sided message, or a message refuting arguments made in soda company antitax messages. The protax message showed no effects on tax support, while the two-sided message depressed Republicans' support...
December 2017: Journal of Health Politics, Policy and Law
Marian Jarlenski, Philip Rocco, Renuka Tipirneni, Amy Jo Kennedy, Nivedita Gunturi, Julie Donohue
Since the Supreme Court decided that the Affordable Care Act's (ACA) Medicaid expansion is optional for the states, several have obtained federal approval to use Section 1115 waivers to expand Medicaid while changing its coverage and benefits design. There has long been concern that policy making for Medicaid populations may lack meaningful engagement with low-income constituents, and therefore the ACA established a new process under which the public can submit comments on pending Medicaid waiver applications...
December 2017: Journal of Health Politics, Policy and Law
Mark A Hall
United States' courts have played a limited, yet key, role in shaping health equity in three areas of law: racial discrimination, disability discrimination, and constitutional rights. Executive and administrative action has been much more instrumental than judicial decisions in advancing racial equality in health care. Courts have been reluctant to intervene on racial justice because overt discrimination has largely disappeared, and the Supreme Court has interpreted civil rights laws in a fashion that restricts judicial authority to address more subtle or diffused forms of disparate impact...
October 2017: Journal of Health Politics, Policy and Law
Daniel Q Gillion
What are the different rhetorical approaches presidents used to address minority health inequality? More importantly, how have the efforts of presidents impacted minorities' perceptions of health? I offer a historical perspective that describes the three major periods of presidential engagement in discussions of minority health since the 1960s. I couple this historical overview with an empirical assessment that introduces a novel and extensive dataset of every presidential discussion of minority health spanning five decades (1960-2016)...
October 2017: Journal of Health Politics, Policy and Law
Colleen M Grogan
This commentary reviews the many different ways the Affordable Care Act (ACA) explicitly and implicitly attempted to improve health equity, and then assesses how the Republican proposal to repeal and replace the ACA (the proposed American Health Care Act) would impact efforts to improve health equity. Although the American health care system still had a long way to go to achieve health equity, it may be argued that the ACA was a major step forward in creating new programs and regulations that had the potential to improve health equity...
October 2017: Journal of Health Politics, Policy and Law
Deborah Stone
Donald Trump's rhetoric and leadership are destroying the "culture of community" necessary for progress on health equity. His one-line promises to provide "quality health care at a fraction of the cost" smack of neoliberal nostrums that shifted ever more costs onto patients, thereby preventing many people from getting care. The dangers of Trump go far beyond health policy, however; Trump's presidency threatens the political and cultural institutions that make any good policy possible.
October 2017: Journal of Health Politics, Policy and Law
Rashawn Ray, Abigail A Sewell, Keon L Gilbert, Jennifer D Roberts
Blacks and Latinos are less likely than whites to access health insurance and utilize health care. One way to overcome some of these racial barriers to health equity may be through advances in technology that allow people to access and utilize health care in innovative ways. Yet, little research has focused on whether the racial gap that exists for health care utilization also exists for accessing health information online and through mobile technologies. Using data from the Health Information National Trends Survey (HINTS), we examine racial differences in obtaining health information online via mobile devices...
October 2017: Journal of Health Politics, Policy and Law
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