Category Archives: Health Care

Are Hospital Workers Healthy?: A Study of Cardiometabolic, Behavioral, and Psychosocial Factors Associated With Obesity Among Hospital Workers

Source: Shreela V. Sharma, Mudita Upadhyaya, Mandar Karhade, William Baun, William B. Perkison, Lisa A. Pompeii, Henry S. Brown, Deanna M. Hoelscher, Journal of Occupational & Environmental Medicine, Vol. 58 no. 12, December 2016
(subscription required)

From the abstract:
Objective: This study evaluated the cardiometabolic, behavioral, and psychosocial factors associated with weight status among hospital employees.

Methods: A total of n = 924 employees across the six hospitals in Texas participated in this cross-sectional study, 2012 to 2013. Association between weight status and waist circumference, blood pressure, biomarkers, diet, physical activity, sedentary behaviors, and psychosocial factors was assessed.

Results: About 78.1% of employees were overweight/obese. Obese participants (body mass index [BMI] ≥30.0 kg/m2) had higher consumption of potatoes, fats, sugary beverages, and spent more time watching television, playing computer games, and sitting than those having normal weight. Being obese was positively associated with blood pressure, blood glucose, low-density lipoprotein, and negatively associated with high-density lipoprotein. Finally, 78.8% of workers were dissatisfied with their worksite wellness with dissatisfaction being higher among obese employees. Being overweight (BMI 25.0 to 29.9 kg/m2) was positively associated with blood pressure, but not other variables.

Conclusion: Understanding the risk profile of hospital workers is critical to developing effective interventions.

State Budgets Aren’t Accounting for Obamacare Repeal

Source: Mattie Quinn, Governing, January 23, 2017

In planning their finances for the year, governors are counting on health care to remain the same. But if it doesn’t, states could suddenly be on the hook for billions of dollars.
State Budgets Will be Challenged Under House Republican ACA Plan
Source: Lynn Hume, Bond Buyer, February 17, 2017
(subscription required)
The finances of states and health care providers could be hurt by the House Republican plan for repealing and replacing the Affordable Care Act, Fitch Ratings and S&P Global Ratings said in recent reports.

Understanding the Intersection of Medicaid and Work

Source: Rachel Garfield, Robin Rudowitz and Anthony Damico, Kaiser Family Foundation, Issue Brief, February 2017

From the overview:
Medicaid is the nation’s public health insurance program for people with low incomes. Overall, the Medicaid program covers more than 70 million Americans, or 1 in 5, including many with complex and costly needs for care. Historically, nonelderly, non-disabled adults accounted for a small share (27%) of Medicaid enrollees; however, the enactment and implementation of the Affordable Care Act (ACA) has expanded coverage to nonelderly adults with income up to 138% FPL, or $16,394 for an individual in 2016. As of January 2017, 32 states have implemented the ACA Medicaid expansion. By design, the expansion extended coverage to the working poor (both parents and childless adults), most of whom do not otherwise have access to affordable coverage. With the expansion to more “able-bodied” adults, questions have arisen about tying work to eligibility.

President Trump may consider waiver proposals with a work requirement, and the Administration and leaders in Congress are considering proposals to repeal the ACA and to transform Medicaid from an entitlement program with guaranteed federal matching dollars for states to a block grant with no entitlement and capped funding. Such proposals would grant states additional flexibility to design and administer their programs and potentially include an option to allow states to impose a work requirement for Medicaid beneficiaries, which is not allowed under current law. This issue brief examines the work status of non-elderly, non-disabled adults with Medicaid coverage to understand the potential implications of work requirement proposals in Medicaid.

Pre-ACA Market Practices Provide Lessons for ACA Replacement Approaches

Source: Gary Claxton, Larry Levitt, and Karen Pollitz, Kaiser Family Foundation, Issue Brief, February 2017

From the overview:
Significant changes to the Affordable Care Act (ACA) are being considered by lawmakers who have been critical of its general approach to providing coverage and to some of its key provisions. An important area where changes will be considered has to do with how people with health problems would be able to gain and keep access to coverage and how much they may have to pay for it. People’s health is dynamic. At any given time, an estimated 27% of non-elderly adults have health conditions that would make them ineligible for coverage under traditional non-group underwriting standards that existed prior to the ACA. Over their lifetimes, everyone is at risk of having these periods, some short and some that last for the rest of their lives.

One of the biggest changes that the ACA made to the non-group insurance market was to eliminate consideration by insurers of a person’s health or health history in enrollment and rating decisions. This assured that people who had or who developed health problems would have the same plan choices and pay the same premiums as others, essentially pooling their expected costs together to determine the premiums that all would pay.

Proposals for replacing the ACA such as Rep. Tom Price’s Empowering Patients First Act and Speaker Paul Ryan’s “A Better Way” policy paper would repeal these insurance market rules, moving back towards pre-ACA standards where insurers generally had more leeway to use individual health in enrollment and rating for non-group coverage.1 Under these proposals, people without pre-existing conditions would generally be able to purchase coverage anytime from private insurers. For people with health problems, several approaches have been proposed: (1) requiring insurers to accept people transitioning from previous coverage without a gap (“continuously covered”); (2) allowing insurers to charge higher premiums (within limits) to people with pre-existing conditions who have had a gap in coverage; and (3) establishing high-risk pools, which are public programs that provide coverage to people declined by private insurers…..
Compare Key Elements of ACA Repeal and Replace Proposals with New Interactive Tool

How the Black Lives Matter Movement Is Mobilizing Against Trump

Source: Brandon Ellington Patterson, Mother Jones, February 7, 2017

Donald Trump repeatedly expressed hostility towards Black Lives Matter activists during his presidential campaign, particularly for their efforts to confront police brutality. Now, faced with a Trump agenda whose repercussions for African Americans could reach far beyond policing, BLM organizers say they are broadly expanding their mission. …. In the wake of Trump’s immigration order, BLM organizers mobilized their networks to turn out at airports to protest. The groups also fired up their social media networks to amplify calls for the release of detained travelers. BLM leaders say their strategy will evolve as more details become known about what Trump plans to do on matters ranging from policing and reproductive rights to climate change and LGBT issues. They will focus on combating what they see as Trump’s hostile, retrograde agenda—and that of right-wing politicians emboldened by Trump—primarily at the state and local levels. ….

Sicker-Than-Anticipated ACA Enrollees Caused Major Problems for State Individual Health Marketplaces over Past Four Years, New Brookings-Rockefeller Research Finds

Source: Nelson A. Rockefeller Institute of Government, Press Release, February 9, 2017

Due to the higher-than-expected costs of new Obamacare enrollees, many health insurers were unable to turn a profit and thus left the Affordable Care Act (ACA) marketplace exchanges —- further increasing premiums for remaining enrollees —- according to a new five-state study from the Center for Health Policy at Brookings Institution and the Rockefeller Institute of Government of the State University of New York (SUNY). The study highlights the difficulties of meeting the ACA’s goals of competition and consumer choice, especially in rural areas and urban places with high concentration of providers. …

… Several factors caused a substantial shift toward narrower insurer networks that offered more health maintenance organization (HMO) plans than broad preferred provider organization (PPO) plans, the authors found. Enrollees with pre-existing conditions disproportionately joined PPOs in order to maintain access to their current doctors and specialists, increasing the cost of offering these plans. Insurers also faced hurdles, negotiating lower prices within PPOs because they could not trade higher patient volumes for lower prices as they could when negotiating with HMOs. By the third year of the ACA, insurers reduced the number of PPO plans they offered and many switched to offering only HMOs. In Texas, no insurer currently offers a PPO product in the individual market. Although the authors caution against generalizations from their five-state sample, they conclude that if policymakers craft an ACA replacement that continues to rely on insurer markets, they should bear in mind the large local differences that exist; there is uncertainty about adverse selection and risk; market competition is dependent on the local provider base; there is a tendency toward narrowing networks; and insurers adjust rapidly to recent experiences.

Read the five-state summary
Read the California study
Read the Florida study
Read the Michigan study
Read the North Carolina study
Read the Texas study

How has Obamacare impacted state health care marketplaces?
Source: Michael Morrisey, Richard P. Nathan, Alice M. Rivlin, and Mark Hall, Brookings Institution, February 9, 2017

Report to the New Leadership and the American People on Social Insurance and Inequality

Source: Benjamin W. Veghte, Elliot Schreur, and Alexandra L. Bradley (eds.), National Academy of Social Insurance, January 2017

From the abstract:
Our nation’s social insurance infrastructure forms the foundation of economic and health security for American workers and their families. Like all infrastructure, it must be periodically strengthened and modernized if it is to continue to meet the needs of a changing economy and society. This Report presents the new Administration and Congress with a range of evidence-based policy options, developed by the nation’s top social insurance experts, for doing so.

The first part of the Report takes stock of the policy challenges facing existing social insurance programs: Social Security, the major health insurance programs, and Unemployment Insurance. The second part discusses potential new directions for social insurance in coping with emerging needs in the areas of long-term services and supports, caregiving supports, and nonstandard work.

Children’s health insurance, family income, and welfare enrollment

Source: Martin Saavedra, Children and Youth Services Review, Volume 73, February 2017
(subscription required)

From the abstract:
Children from wealthier families are more likely to have health insurance than children from poorer families on average. However, the relationship between family income and health insurance is non-linear, as children near the Federal Poverty Line (FPL) are less likely to be insured than children from both wealthier families (who obtain health insurance from the private market) and poorer families (who obtain government-funded health insurance). This health insurance dip has persisted even as Medicaid has been expanded to cover those above the FPL. One explanation for this is that families who are far below the poverty line are better connected to the welfare system, and consequently, are more likely to enroll in Medicaid. This study uses data from the 2001–2013 Current Population Surveys and finds that (1) controlling for many of the determinants of eligibility, those on other forms of government assistance are more likely to have health insurance, and (2) the relationship between family income and children’s health insurance status is strictly increasing after controlling for enrollment in other welfare programs


• Children near the poverty line are some of the least likely to have health insurance.
• Children on public assistance are more likely to have insurance.
• The insurance-income relationship is increasing after controlling for welfare enrollment.

Affordable Care Act Executive Order: Legal Considerations

Source: Congressional Research Service, CRS Reports & Analysis Legal Sidebar, January 24, 2016

On January 20, 2017, President Donald J. Trump issued an executive order (EO) declaring his intention to “seek the prompt repeal of the Patient Protection and Affordable Care Act [ACA]” while minimizing “economic and regulatory burdens of the Act,” ensuring that the ACA is “efficiently implemented,” and preparing to allow states “more flexibility and control.” Broadly, the EO issues the following three directives to executive branch agencies:

– First, it directs agencies with authorities or responsibilities under the ACA to “waive, defer, grant exemptions from, or delay the implementation of” any ACA provision that would impose a fiscal or regulatory burden on states or a host of private entities (including individuals, health care providers, health insurers, and medical device manufacturers).
– Second, the EO directs those same agencies to provide greater flexibility and cooperation to states in implementing healthcare programs.
– Third, the EO directs all agencies with responsibilities relating to healthcare or health insurance to encourage the development of a free and open interstate market for health services and health insurance…

Repealing the Affordable Care Act would cost jobs in every state

Source: Josh Bivens, Economic Policy Institute, January 31, 2017

From the press release:
A new report by EPI Research Director Josh Bivens finds that repealing the Affordable Care Act (ACA) will cost the economy 1.2 million jobs in 2019, with jobs lost in every state. The report looks at the effects of cuts to both spending and taxes that would occur under a full repeal.

The $109 billion in spending cuts would have a disproportionally negative effect on states with the highest share of low and middle-income families and those states that took up the ACA Medicaid expansion, while the $70 billion tax cuts would disproportionately benefit those states with the largest share of households in the top 1 percent. Because low- and moderate-income households tend to spend a much higher share of marginal increases in disposable income, the overall effect of ACA repeal would be less spending and slower demand growth across all states…..