Category Archives: Health Care

Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance

Source: Benjamin D. Sommers, Robert J. Blendon, E. John Orav, Arnold M. Epstein, JAMA Intern Mededicine, Online First, Published online August 8, 2016
(subscription required)

From the abstract:
Importance: Under the Affordable Care Act (ACA), more than 30 states have expanded Medicaid, with some states choosing to expand private insurance instead (the “private option”). In addition, while coverage gains from the ACA’s Medicaid expansion are well documented, impacts on utilization and health are unclear.

Objective: To assess changes in access to care, utilization, and self-reported health among low-income adults in 3 states taking alternative approaches to the ACA.

Design, Setting, and Participants: Differences-in-differences analysis of survey data from November 2013 through December 2015 of US citizens ages 19 to 64 years with incomes below 138% of the federal poverty level in Kentucky, Arkansas, and Texas (n = 8676). Data analysis was conducted between January and May 2016.

Exposures: Medicaid expansion in Kentucky and use of Medicaid funds to purchase private insurance for low-income adults in Arkansas (private option), compared with no expansion in Texas.

Main Outcomes and Measures: Self-reported access to primary care, specialty care, and medications; affordability of care; outpatient, inpatient, and emergency utilization; receiving glucose and cholesterol testing, annual check-up, and care for chronic conditions; quality of care, depression score, and overall health.

Results: Among the 3 states included in the study, Arkansas, Kentucky, there were no differences in sex, income, or marital status. Respondents from Texas were younger, more urban, and disproportionately Latino compared with those in Arkansas and Kentucky. Significant changes in coverage and access were more apparent in 2015 than in 2014. By 2015, expansion was associated with a 22.7 percentage-point reduction in the uninsured rate compared with nonexpansion. Expansion was associated with significantly increased access to primary care, fewer skipped medications due to cost, reduced out-of-pocket spending, reduced likelihood of emergency department visits, and increased outpatient visits. Screening for diabetes, glucose testing among patients with diabetes, and regular care for chronic conditions all increased significantly after expansion. Quality of care ratings improved significantly, as did the share of adults reporting excellent health. Comparisons of Arkansas vs Kentucky showed increased private coverage in the former, increased Medicaid in the latter, and higher diabetic glucose testing rates in Kentucky, but no other statistically significant differences.

Conclusions and Relevance: In the second year of expansion, Kentucky’s Medicaid program and Arkansas’s private option were associated with significant increases in outpatient utilization, preventive care, and improved health care quality; reductions in emergency department use; and improved self-reported health. Aside from the type of coverage obtained, outcomes were similar for nearly all other outcomes between the 2 states using alternative approaches to expansion.

Related:
Press release

Overview of Health Insurance Exchanges

Source: Namrata K. Uberoi, Annie L. Mach, Bernadette Fernandez, Congressional Research Service, CRS Report, R44065, July 1, 2016

….This report provides an overview of the various components of the health insurance exchanges. The report includes summary information about how exchanges are structured, the intended consumers for health insurance exchange plans, and consumer assistance available in the exchanges, as specified in the ACA. The report also describes the availability of financial assistance for certain exchange consumers and small businesses and outlines the range of plans offered through exchanges. Moreover, the report provides a brief summary of the implementation and operation of exchanges since 2014….

Gender-Based Discrimination in the Workplace: Why Courts Tell Employers That Breastfeeding Discrimination Is Legal

Source: Ashley M. Alteri, Review of Public Personnel Administration, Vol. 36 no. 3, September 2016
(subscription required)

From the abstract:
In March 2010, the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act were signed into law. These Acts include a provision governing “reasonable break time for nursing mothers” for those employers and employees covered under the Fair Labor Standards Act. However, neither these Acts, nor the Pregnancy Discrimination Act, nor Title VII, nor the Americans with Disabilities Act expressly protect women from discrimination resulting from her choice to lactate at work (to include either feeding a child directly from the breast or by expressing milk to be used at a later time). Accordingly, this article examines how federal courts have treated claims of breastfeeding discrimination at work. Although courts have generally been unsympathetic to these claims, employers should consider proactive accommodation measures because recent cases indicate that courts may be willing to entertain these claims.

The High Health Costs of TPP’s “Free Trade”

Source: Joseph Stiglitz, Public Citizen, Global Trade Watch, 2016

Despite protests from industry lobbyists who are upset that they did not get everything they wanted, big pharmaceutical companies are some of the biggest winners in the Trans-Pacific Partnership (TPP). This supposed “free trade” agreement between the United States and 11 countries in the Americas and Asia would enshrine expansive monopoly protections for intellectual properties that shield drug makers from competition and provide them with new powers to challenge government decisions aimed at managing health care costs. A win for Big Pharma here will leave virtually everyone else worse off, with their higher profits coming at the expense of higher health care costs for consumers and taxpayers, avoidable deaths and suffering, and health innovations being brought to market at a slower pace….

The Interconnected Relationships of Health Insurance, Health, and Labor Market Outcomes

Source: Matthew S. Rutledge, Center for Retirement Research at Boston College, WP#2016-2, July 2016

From the abstract:
The Affordable Care Act (ACA) has greatly increased the proportion of non-elderly Americans with health insurance. One justification for the ACA is that improving individuals’ access to health insurance would improve their health outcomes, mostly by increasing the probability that they have a regular source of care. Another is that increasing the availability of health insurance outside of employment reduces the “job lock” that ties poorly matched workers to their jobs only because they want to maintain coverage. This study reviews the literature on the relationships between health insurance and health, between health and work, and between health insurance and labor market outcomes directly. The review uses evidence from recent policy expansions in Oregon and Massachusetts, and among Social Security disability beneficiaries and Medicare enrollees, to evaluate the extent to which expansions have the expected effects on labor market outcomes, indirectly and directly.

This paper found that:
• Health insurance generally improves health. The gains in mental health are the most consistent across studies, though most studies also find notable improves in physical health measures, including mortality.
• Greater health generally allows for increased labor supply, though the strength of this relationship depends crucially on whether the health measure is objective or subjective, the group under consideration, and the study’s strategy for accounting for the endogeneity of the relationship.
• Expanded access to health insurance increases transitions into self-employment and allows older workers to retire earlier, but the effect on labor force participation, employment, and job mobility is less clear.

The policy implications of this paper are:
• Coverage expansions, including the ACA, are likely to result in a healthier and more productive pool of potential workers, and this effect is likely to increase labor supply.
• But not many studies have examined the full chain of relationships directly, by following recipients of expanded coverage to see if their improved health causally increased labor supply, so further work is needed in evaluating coverage expansions.

The Impact of Massachusetts Health Insurance Reform on Labor Mobility

Source: Norma B. Coe, Wenliang Hou, Alicia H. Munnell, Patrick J. Purcell, Matthew S. Rutledge, Center for Retirement Research at Boston College, 2016
(Full paper not available at the link, contact the authors for info)

From the abstract:
This paper examines the impact of the Massachusetts Health Insurance reform of 2016 on job mobility and employment exit using administrative data from the Social Security Administration. The Massachusetts reform mandated that every resident have insurance coverage, and facilitated this initiative by requiring employers to offer coverage, as well as expanding Medicaid and creating health insurance exchanges with subsidized premiums. These elements provided the basis for the Patient Protection and Affordable Care Act (ACA), passed nationwide in 2010, so the experience of workers in Massachusetts provides evidence on how the ACA may affect labor market efficiency. Of particular interest is the extent to which Massachusetts’ reform reduced “job lock” – the phenomenon where workers stay with employers to maintain their health insurance coverage, rather than move to a more productive match at another employer (especially a small firm unlikely to offer coverage) or exit employment entirely. The project measures differential effects by age, gender, and firm size, and tries to disentangle the effects of the employer mandate and the individual mandate by identifying individuals who cross state lines between home and work.

Trend analysis and regression estimates indicate that Massachusetts residents were actually less likely to move to new employers after the reform, relative to workers in neighboring states that did not make structural changes to their health insurance market.

Estimates of whether Massachusetts workers moved from large firms, which likely offered insurance, to small firms is statistically insignificant.

Employment transitions were largely unaffected by the Massachusetts reform, though some select groups saw increases in employment exits that may be consistent with the easing of job lock.

What if More States Expanded Medicaid in 2017? Changes in Eligibility, Enrollment, and the Uninsured

Source: Matthew Buettgens and Genevieve M. Kenney, Robert Wood Johnson Foundation & Urban Institute, Quick Strike Series, July 2016

From the summary:
If the 19 states that have not expanded Medicaid did so in 2017, up to 5 million fewer people would be uninsured with the largest drops coming in Texas, Georgia and Florida.

Key Findings:
Groups that could see the largest uninsurance drops, if the states expand Medicaid:
– Adults without kids (3.6 million)
– White, non-Hispanics (2.4 million)
– People with only a high school education (2.2 million)
– Full-time workers (1.3 million)
– Hispanics (1.2 million) and Black, non-Hispanics (1.2. million)

19% fewer medical errors after team training

Source: Amy McCaig, Futurity, July 15, 2016

Team training for health care employees can reduce patient mortality by 15 percent, a new study has found. The approach can also reduce medical errors by 19 percent. Team training aims to improve team-based knowledge, skills, attitudes, and problem-solving interactions. It focuses on developing coordination, cooperation, communication, leadership, and other team-based skills. Team members train in specific roles while performing specific tasks and interact or coordinate to achieve a common goal or outcome…..