Category Archives: Health Care

COVID-19 Projected to Worsen Racial Disparities in Health Coverage

Source: Chris Sloan, Robin Duddy-Tenbrunsel, Samantha Ferguson, Angel Valladares, Thomas Kornfield, Avalere, September 16, 2020

From the summary:
The COVID-19 pandemic is exacerbating existing economic and healthcare inequalities between racial groups in the US. Nationally, employment decreased 13% from February to April 2020; this effect was disproportionately greater among Asian (-18%), Black (-15%), and Hispanic (-17%) workers compared to White (-11%) workers. Avalere analysis suggests that, because of these job losses, at least 1 million Asian, 2 million Black, and 3 million Hispanic people are likely to lose their employer-sponsored health insurance in 2020.

Mortality Rates From COVID-19 Are Lower In Unionized Nursing Homes

Source: Adam Dean, Atheendar Venkataramani, and Simeon Kimmel, Health Affairs, Ahead of Print, September 10, 2020
(subscription required)

From the abstract:
More than 40% of all reported coronavirus disease 2019 (COVID-19) deaths in the United States have occurred in nursing homes. As a result, health care worker access to personal protective equipment (PPE) and infection control policies in nursing homes have received increased attention. However, it is not known if the presence of health care worker unions in nursing homes is associated with COVID-19 mortality rates. Therefore, we used cross-sectional regression analysis to examine the association between the presence of health care worker unions and COVID-19 mortality rates in 355 nursing homes in New York State. Health care worker unions were associated with a 1.29 percentage point mortality reduction, which represents a 30% relative decrease in the COVID-19 mortality rate compared to facilities without health care worker unions. Unions were also associated with greater access to PPE, one mechanism that may link unions to lower COVID-19 mortality rates. [Editor’s Note: This Fast Track Ahead Of Print article is the accepted version of the peer-reviewed manuscript. The final edited version will appear in an upcoming issue of Health Affairs.]

US racial inequality may be as deadly as COVID-19

Source: Elizabeth Wrigley-Field, Proceedings of the National Academy of Sciences (PNAS), first published August 24, 2020

From the abstract:
The COVID-19 pandemic is causing a catastrophic increase in US mortality. How does the scale of this pandemic compare to another US catastrophe: racial inequality? Using demographic models, I estimate how many excess White deaths would raise US White mortality to the best-ever (lowest) US Black level under alternative, plausible assumptions about the age patterning of excess mortality in 2020. I find that 400,000 excess White deaths would be needed to equal the best mortality ever recorded among Blacks. For White mortality in 2020 to reach levels that Blacks experience outside of pandemics, current COVID-19 mortality levels would need to increase by a factor of nearly 6. Moreover, White life expectancy in 2020 will remain higher than Black life expectancy has ever been unless nearly 700,000 excess White deaths occur. Even amid COVID-19, US White mortality is likely to be less than what US Blacks have experienced every year. I argue that, if Black disadvantage operates every year on the scale of Whites’ experience of COVID-19, then so too should the tools we deploy to fight it. Our imagination should not be limited by how accustomed the United States is to profound racial inequality.

Transgender Status, Gender Identity, and Socioeconomic Outcomes in the United States

Source: Christopher S. Carpenter, Samuel T. Eppink, Gilbert Gonzales, Volume 73 Issue 3, May 2020
(subscription required)

From the abstract:
This article provides the first large-scale evidence on transgender status, gender identity, and socioeconomic outcomes in the United States, using representative data from 35 states in the Behavioral Risk Factor Surveillance System (BRFSS), which asked identical questions about transgender status and gender identity during at least one year from 2014 to 2017. More than 2,100 respondents, aged 18 to 64 years, identified as transgender. Individuals who identify as transgender are significantly less likely to be college educated and less likely to identify as heterosexual than are individuals who do not identify as transgender. Controlling for these and other observed characteristics, transgender individuals have significantly lower employment rates, lower household incomes, higher poverty rates, and worse self-rated health compared to otherwise similar men who are not transgender.

Impacts of Public Health Insurance on Occupational Upgrading

Source: Ammar Farooq, Adriana Kugler, IRL Review, OnlineFirst, Published June 5, 2020
(subscription required)

From the abstract:
Using data from the Current Population Survey’s Merged Outgoing Rotation Groups, the authors examine whether greater Medicaid generosity encourages people to switch toward better quality occupations. Exploiting variation in Medicaid eligibility expansions for children across states during the 1990s and early 2000s, they find that a one standard deviation increase in Medicaid infant income thresholds increased the likelihood that working parents move to a new occupation by 1.6 percentage points or 3.3%. Findings show that these effects are larger for those below 150% of the poverty line and for married parents who were not benefiting from Medicaid prior to the expansions. In addition, findings indicate that Medicaid generosity also increased mobility toward occupations with higher average wages and higher educational requirements. This article contributes to the literature on job lock by showing that access to public health insurance not only increases employment and job switches but also encourages occupational upgrading.

Racial Economic Inequality Amid the COVID-19 Crisis

Source: Bradley L. Hardy, Trevon D. Logan, Hamilton Project, Brookings Institution, Essay 2020-17 August 2020

From the introduction:
COVID-19 confronts Americans with two crises: a public health crisis and an economic crisis. The two operate together, since the public health crisis has dramatically reduced economic activity and overall spending. Moreover, this crisis has broader distributional consequences than any economic event in recent memory, altering most aspects of how we live, work, and conduct business—and in truth, who will survive.

Across the economy and society, the distributional consequences of COVID-19 are uneven: the pandemic and its broader economic and health consequences are disproportionately impacting Black Americans.

The outsized challenges that Black Americans are facing are a reflection of the generally diminished economic position and health status that they faced prior to this crisis. Several pre–COVID-19 economic conditions—including lower levels of income and wealth, higher unemployment, and greater levels of food and housing insecurity—leave Black families with fewer buffers to absorb economic shocks and contribute to Black households’ vulnerability to the COVID-19 economic crisis.

The interaction of those pre–COVID-19 economic and health disparities—including a higher rate of preexisting health conditions such as hypertension and lung disease—has contributed to higher COVID-19 mortality rates for Black Americans (e.g. Benitez, Courtemanche, and Yelowitz 2020; Weimers et al. 2020). According to the APM Research Lab, Black Americans continue to experience the highest overall actual COVID-19 mortality rates (80.4 per 100,000)—more than twice the rate of white Americans (35.9 per 100,000) or Asian Americans (33.1 per 100,000), who have the lowest COVID-19 mortality rates. In 2020 more Black Americans will die of COVID-19 than will succumb to diabetes, strokes, accidents, or pneumonia. In fact, COVID-19 is currently the third leading cause of death for Black Americans (APM Research Lab 2020).

The COVID-19 public health and economic crises leave vulnerable populations exposed

Source: Jevay Grooms, Alberto Ortega, and Joaquin Alfredo-Angel Rubalcaba, Brookings Institution, August 13, 2020

The coronavirus (COVID-19) pandemic has created a new reality worldwide. In the United States it has exposed the fragility of some of the most marginalized groups, particularly the millions of Americans we rely on for some of our most basic necessities. The pandemic has arguably buttressed the racial and ethnic inequities that persist in our society. Black and Hispanic households face additional social and economic disparities which are deeply rooted in structural discrimination and systemic racism—both of which have tremendous implications for health and well-being.

We use a novel panel data set collected between March and July of 2020 to describe disparities in outcomes related to the COVID-19 pandemic across race/ethnicity and employment status. Essential workers are a new class of employee defined as those who work in industries that are considered essential for a society’s survival, including (among others) health care, food service, and public transportation. We find that unemployed and essential workers are the most vulnerable given their lower income, lack of health insurance, and differences across household structure. When evaluated across race/ethnicity, the results suggest that some of these disparities are intensified among Black and Hispanic Americans.

This timely evidence suggests a need for a more robust safety net, such as an expanded unemployment benefits program and more-accessible public health insurance during the COVID-19 pandemic, as well as more-deliberate targeting of federal support to Black and Hispanic households.

FAQs Clarify COVID-19 Testing and Diagnosis Requirements for Employer Health Plans

Source: Timothy J. Stanton and Kristine M. Bingman, Employee Relations Law Journal, Vol. 46, No. 2, Autumn 2020
(subscription required)

From the abstract:
This article reviews the key subjects covered by a federal guidance exploring requirements under the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act.

Macroeconomic Feedback Effects of Medicaid Expansion: Evidence from Michigan

Source: Helen Levy, John Z. Ayanian, Thomas C. Buchmueller, Donald R. Grimes, Gabriel Ehrlich, Journal of Health Politics, Policy and Law, Vol. 45 no. 1, February 2020
(subscription required)

From the abstract:

Context: Medicaid expansion has costs and benefits for states. The net impact on a state’s budget is a central concern for policy makers debating implementing this provision of the Affordable Care Act. How large is the state-level fiscal impact of expanding Medicaid, and how should it be estimated?

Methods: We use Michigan as a case study for evaluating the state-level fiscal impact of Medicaid expansion, with particular attention to the importance of macroeconomic feedback effects relative to the more straightforward fiscal effects typically estimated by state budget agencies. We combine projections from the state of Michigan’s House Fiscal Agency with estimates from a proprietary macroeconomic model to project the state fiscal impact of Michigan’s Medicaid expansion through 2021.

Findings: We find that Medicaid expansion in Michigan yields clear fiscal benefits for the state, in the form of savings on other non-Medicaid health programs and increases in revenue from provider taxes and broad-based sales and income taxes through at least 2021. These benefits exceed the state’s costs in every year.

Conclusions: While these results are specific to Michigan’s budget and economy, our methods could in principle be applied in any state where policy makers seek rigorous evidence on the fiscal impact of Medicaid expansion.

Administrative Easing: Rule Reduction and Medicaid Enrollment

Source: Ashley M. Fox, Edmund C. Stazyk, Wenhui Feng, Public Administration Review, Volume 80 Issue 1, January/February 2020
(subscription required)

From the abstract:
Administrative burden is widely recognized as a barrier to program enrollment, denying legal entitlements to many potentially eligible individuals. Building on recent research in behavioral public administration, this article examines the effect of voluntary state reductions in administrative burden (administrative easing) on Medicaid enrollment rates using differential implementation of the Affordable Care Act. Using a novel data set that includes state‐level data on simplified enrollment and renewal procedures for Medicaid from 2008 to 2017, the authors examine how change in Medicaid enrollment is conditioned by the adoption of rule‐reduction procedures. Findings show that reductions in the administrative burden required to sign up for Medicaid were associated with increased enrollments. Real‐time eligibility and reductions in enrollment burden were particularly impactful at increasing enrollment for both children and adults separate from increases in Medicaid income eligibility thresholds. The results suggest that efforts to ease the cognitive burden of enrolling in entitlement programs can improve take‐up.

Evidence for Practice
– The administrative burden associated with enrolling in social safety net programs in the United States imposes high costs on applicants. As a consequence, many eligible individuals do not receive the benefits that they are lawfully entitled to.
– Insights from behavioral economics, including streamlining of the enrollment process and automated benefit determinations, can be effectively employed—in some cases—to reduce the cognitive burden associated with program enrollment processes and increase take‐up of benefits.
– States that have implemented simple changes to enrollment processes, including administrative verification of income and real‐time decision‐making, have seen greater increases in Medicaid enrollments than those that did not implement such changes.