As Some Holdout States Revisit Medicaid Expansion, New Data Show It Pays Off

From the article by Shefali Luthra on Kaiser Health News:

Although the GOP-controlled Congress is pledging its continued interest — despite stalls and snags — to dismantle Obamacare, some “red state” legislatures are changing course and showing a newfound interest in embracing the health law’s Medicaid expansion.

And a study out Wednesday in Health Affairs adds to these discussions, percolating in places such as Kansas, Georgia, Virginia, North Carolina and Maine. Thirty-one states plus the District of Columbia already opted to pursue the expansion, which provided federal funding to broaden eligibility to include most low-income adults with incomes up to 138 percent of the federal poverty level (about $16,000 for an individual).

Researchers analyzed data from the National Association of State Budget Officers for fiscal years 2010 to 2015 to assess the fiscal effects of expansion’s first two years.

Their findings address arguments put forth by some GOP lawmakers, who say the expansion will add to the nation’s budget deficit and saddle states with additional coverage costs, forcing them to skimp on other budget priorities like education or transportation.

The researchers concluded that when states expanded eligibility for the low-income health insurance program they did see larger health care expenditures — but those costs were covered with federal funding. In addition, expansion states didn’t have to skimp on other policy priorities — such as environment, housing and other public health initiatives — to make ends meet.

“This is a potential big benefit, not only to people who get coverage, but to state economies,” said Benjamin Sommers, an associate professor of health policy and economics at Harvard University’s public health school, and the study’s first author.

This finding — that states expanding Medicaid didn’t encounter unforeseen budget problems — shouldn’t be surprising.

“Expansion is basically free” to the states, agreed Massachusetts Institute of Technology economist Jonathan Gruber, one of Obamacare’s architects who worked with Sommers to systematically compare the budgets of all 50 states to examine Medicaid expansion’s impact. “That’s the big insight,” he said. “There’s no sort of hidden downside.”

And that may be part of what’s fueling this renewed interest, said Edwin Park, vice president for health policy at the left-leaning Center for Budget and Policy Priorities. These states are seeing the federal windfall their neighbors received while trying to navigate public health concerns like opioid addiction, he said. They “are looking at how their neighbors or expansion states have done, and see the benefits,” Park said. “The primary argument against the expansion on the state level has been it’s going to break the bank. The research demonstrates that’s not the case.”

But a caveat: The data used in this analysis reflected only years during which the federal government picked up 100 percent of the tab for expanding Medicaid eligibility and therefore could overestimate the benefit to state budgets. That’s because in 2017 that federal support begins to taper off, and by 2020 states have to pay 10 percent of the expansion costs themselves.

Read the full article.

This one chart shows how far behind the US lags in healthcare

From the article by Christopher Ingraham on the World Economic Forum Website:

Is the money we’re spending on health care keeping us alive?

On a certain level, that’s the big test of any health-care system — and the United States is failing.

According to chart below, U.S. life expectancy continues to lag far behind other developed countries, despite spending way more on medical treatments aimed at keeping us alive.

US Healthcare lagsThe chart, courtesy of Oxford economist Max Roser, plots per-capita health-care spending against life expectancy for the world’s wealthiest countries over the past 40-plus years. Each country gets one line, which plots its trajectory on those measures over time.

Looking at the chart, two things become clear: As Roser notes, the big takeaway is that, in wealthy countries, more spending on health leads to a longer life expectancy.

But there’s a secondary finding: Not all health-care spending is created equal. In the United States, the inflation-adjusted per-capita annual health spending has exploded from 1970, when it was less than $500 a year, to 2014, when it was about $9,000 a year.

That’s $2,000 more per person per year than the second highest-spending country on the chart, Switzerland. But despite that big spending, growth in American life expectancy has been anemic. Essentially, we spend a lot of money but haven’t seen much in the way of life expectancy gains because of it.

Read the full article.

Workers Who Give Care To The Homebound Often Can’t Afford To Get Their Own

From the article by Shefali Luthra on Kaiser Health News:

For more than two decades, Celeste Thompson, 57, a home care worker in Missoula, Mont., had not had regular contact with a doctor — no annual physicals and limited sick visits. She also needed new glasses.

Like many others who work in the lower rungs of the health care system, she has worked hard to keep her clients healthy by feeding them, dressing them and helping them navigate chronic conditions.

But because of the low wages and the hourly structure of this industry — which analysts estimate is worth nearly $100 billion annually and projected to grow rapidly — workers like Thompson often don’t have health insurance. Many home health agencies, 80 percent of which are for-profit, don’t offer coverage, or their employees don’t consistently clock enough hours to be eligible. They generally earn too much to qualify for public aid but too little to afford the cost of premiums.

“It’s a social justice issue. We have a workforce that is the backbone of long-term [care] services, and they themselves don’t have coverage,” said Caitlin Connolly, who runs a campaign to increase home care wages at the National Employment Law Project, an advocacy organization.

In 2015, Montana opted in to the 2010 health law’s expansion of Medicaid, the state-federal low-income health insurance program. Thompson, who was making about $10 an hour, immediately signed up.

Her vision care was among the first things she focused on. She had not visited an eye doctor in nine years — a problem because her job includes keeping track of patients’ pill bottles and making sure they take the right medications. “I had to use a magnifying glass to see small print,” said Thompson, who now wears bifocals. Her doctor has since warned her she may need a stronger correction soon.

…Thompson is part of a large population of home-based caregivers who might be affected by such changes. From 2010 to 2014, about half a million of these workers gained new health insurance through Obamacare, estimates PHI, a New York-based nonprofit that researches this slice of the labor force and advocates for improved working conditions, in a March issue brief.

Most home care workers’ gains came from living in states that, like Montana, expanded Medicaid. But even with Obamacare in place, many home health workers — perhaps 1 in 5 — remain uninsured. By contrast, about 8.6 percent of all Americans lack coverage.

Read the full article.

Call for Papers: Community-Academic Partnerships in Health Research in the Southeast

From the call issued by the Gulf States Health Policy Center and Progress in Community Health Partnerships:

Progress in Community Health Partnerships (PCHP) and the Gulf States Health Policy Center (GS-HPC) are collaborating to release this Call for Papers on the theme of “Community-Academic Partnerships in Health Research in the Southeast.”

This PCHP special issue aims to include articles on best practices in community-academic partnerships for improving health outcomes in the Southeast region of the United States, defined as Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Virginia, and West Virginia, as a regional particularly vulnerable to health disparities. To this effect, we are inviting papers and products (see Author Guidelines) presenting research that was conducted by partnerships of community members and academics. We place a priority on manuscripts co-authored by community members and academics and those that include the community perspective of the research process. The call is open to all areas of health policy and/or health research, focusing on the community-academic process and/or results.

Download the full call for papers.

Talking About Equity: Promoting the Curb-Cut Effect

From the Annie E. Casey Foundation Blog:

In a recent Stanford Social Innovation Review article, Angela Glover Blackwell shows how developing policies to create equity can improve everyone’s lives. She does it with a simple example: curb cuts.

Glover Blackwell, CEO and cofonder of PolicyLink, a grantee within Casey’s equity and inclusion portfolio, cites the push by citizens with disabilities and advocates in the late 1970s to make communities more accessible for wheelchairs. When the federal Americans with Disabilities Act required that curb cuts and sidewalk ramps be installed everywhere, the new accessibility didn’t just make a difference for the disability community. The curb cuts and ramps created a new way for mothers with strollers, cyclists, delivery workers, scooter riders, kids on bicycles and just about every pedestrian to travel streets more safely and easily. The Casey Foundation believes the same principles can be applied to improving outcomes for children in the United States.

“Creating policy that is explicit about eliminating an inequity around race or ethnicity is one of the most effective paths to creating better opportunities and outcomes for all children, not just one group,” says Nonet Sykes, director of racial and ethnic equity and inclusion at Casey. “Using tools, such as the Racial Equity Impact Assessment, can help leaders fine-tune pieces of legislation for targeted investment.”

Glover Blackwell cites other policies that have had similar results — such as seat belt laws and the G.I. Bill of the 1940s — as further evidence of the curb-cut effect.

She writes that applying curb-cut thinking to transportation infrastructure or employment policy would significantly boost the GDP of the country’s 150 largest metropolitan regions. Further, she notes, policies to create equitable opportunities for children of color could strengthen our economy for generations, especially since children of color will soon comprise the majority of kids in the United States.

 

Read the full article.

The Insidiousness of Unconscious Bias in Schools

From the article by Seth Gershnson and Thomas S. Dee at Brookings:

Humans frequently make automatic decisions at a subconscious level. The human brain’s capacity for reflexive decisionmaking is what Nobel Laureate Daniel Khaneman calls “System 1” (as opposed to the more analytical, thoughtful, deliberate decision making of “System 2”) in the best-selling “Thinking, Fast and Slow.” This evolutionary adaptation was, and is, sometimes necessary for survival. However, these automatic responses occur via the rapid processing of new information through existing patterns of thought. Thus, because our automatic responses are shaped by our lived experiences and the broader social contexts in which we live and work, a pervasive byproduct of reflexive decisionmaking is unconscious bias (UB), which is also referred to as implicit bias or implicit social cognition.

Specifically, UB is the phenomenon in which stereotypes, positive or negative, influence decisions and behaviors without the individual consciously acting on the stereotype or being aware that he or she is doing so. Moreover, UB can occur even when individuals know or believe the stereotype to be false.

The insidiousness of UB is that it can create self-fulfilling prophecies that create and perpetuate inequities between in- and out-groups, even when the initial stereotype was incorrect (and there was no pre-existing difference between in- and out-group members). This post outlines some promising interventions we identify in a recent report, commissioned by Google’s Computer Science Education Research Division, that can short-circuit the recursive processes and self-fulfilling prophecies triggered by UB.

In this report, we argue that the consequences of UB may be particularly salient in the hierarchical environments of schools. Specifically, UB likely perpetuates socio-economic, gender, and racial gaps in educational outcomes such as academic performance, engagement with school, course and major choice, and persistence in higher education, particularly among historically disadvantaged and underrepresented groups such as low-income and racial-minority students. These gaps in educational outcomes then manifest in corresponding workplace disparities in pay, promotions, and employment.

Indeed, there is ample evidence of UB in educational settings, both in experimental labs and “in the field” with real individuals who were unaware of their participation in an experiment. For example, Moss-Racusin and colleagues conducted a lab experiment in which science faculty at research universities reviewed fictitious applications for a hypothetical lab assistant position and systematically rated male “applicants” higher than otherwise-identical female “applicants.” In a similar field experiment, Milkman and colleagues emailed meeting requests from fictitious prospective doctoral students to professors and found that white male “students” received more, and faster, responses than female and non-white students, particularly in higher-paying STEM careers like computer science and engineering. A recent field experiment conducted by one of us and colleagues found that the instructors of online courses were nearly twice as likely to respond to discussion-forum comments placed by students who were randomly assigned white-male names. Consistent with a UB interpretation, the pro-male bias was observed among both male and female faculty in these studies. The K-12 context is also ripe with suggestive, quasi-experimental evidence of pervasive UB in the form of systematic grading biases and student-teacher racial match effects.

Additionally, individuals from stereotyped out-groups themselves react negatively to seemingly innocuous environmental factors, such as the demographic composition of a classroom, the race or sex of an instructor or proctor, and even the design and decoration of the classroom. One example of this is the phenomenon of stereotype threat, whereby the mere threat of being stereotyped by a white (male) instructor, even when no outright bias is expressed, may distract black (female) students, ultimately leading to poor performance on exams and even disengagement from school.

Read the full article.

 

Competencies Needed for Community-Engaged Dissemination and Implementation Research

An article recently published in Translational Behavioral Medicine proposes a conceptual framework for assessing a researcher’s readiness to engage in dissemination and implementation research with community stakeholders. The authors, all affiliated with the North Carolina Clinical and Translational Sciences Institute, started with a table that included community engagement principles as defined by NIH, potential domains areas for competencies, and potential competencies. Through a process of development, evaluation, and refinement, the researchers developed a list of 40 competencies for community-engaged dissemination and implementation (CEDI) research that fit within 9 domains.  These domains were:

  • Perceived value of CE in D&I research: The researcher’s attitude toward the potential for enhancing D&I research processes and outcomes through community engagement
  • Introspection and openness: The researcher’s willingness and/or ability to examine their own preconceptions and to be receptive of others’ beliefs and opinions
  • Knowledge of community characteristics: The researcher’s willingness and/or ability to learn about the community’s characteristics and prior experiences
  • Appreciation for stakeholder’s experience with and attitudes toward research: The researcher’s willingness and/or ability to assess how the community’s research attitudes and experiences may affect the partnership
  • Preparing the partnership for collaborative decision-making: The researcher’s willingness and/or ability to organize the partnership in a way that facilitate dialogues, collective decision-making, and coordinated action
  • Collaborative planning for the research design and goals: The researcher’s willingness and/or ability to adapt to the attitudes and needs of community stakeholders when defining the research process
  • Communication effectiveness: The researchers’ willingness and/or ability to clearly present ideas, listen to community partners, and work through issues
  • Equitable distribution of resources and credit: The researcher’s willingness and/or ability to share resources for conducting the research and credit for outcomes of the research
  • Sustaining the partnership: The researcher’s willingness and/or ability to invest in a long-term relationship with community stakeholders

The individual competencies associated with each of these domains provide specific actions and/or attitudes to help assess readiness to undertake CEDI research. The authors describe this framework as a “first step toward development of a readiness assessment for researchers interested in conducting CEDI.”

The article is available from Translational Behavioral Medicine.

Upcoming HDRG Meetings

The Health Disparities Research Group (HDRG) is a multidisciplinary assembly of faculty, students, staff, and community representatives with a vision “to become an integral facilitator in eliminating health disparities through partnerships with our community.” Held the 3rd Friday of each month throughout the academic year, the meetings provide an opportunity to share research and cultivate a positive atmosphere for community-engagement in addressing health disparities.

The next meeting is April 21 at 1:00 pm in Bio-medical Library Room 222-A. Dr. C. Kenneth Hudson will provide an update on the project “The Impact of Labor Force/Labor Market Status On Access To Health Care”.

In May, Dr. Erick Goldschmidt, Director of the Spring Hill College Foley Center for Community Service, will share about their work.

 

NIMHD Health Disparities Research Institute

From the NIMHD Website:

The National Institute on Minority Health and Health Disparities (NIMHD) will host the Health Disparities Research Institute (HDRI) from August 14 – 18, 2017. The HDRI aims to support the research career development of promising minority health/health disparities research scientists early in their careers and stimulate research in the disciplines supported by health disparities science.

The program will feature lectures, mock grant review, seminars, small group discussions on research relevant to minority health and health disparities. It will also include sessions with NIH scientific staff engaged in related health disparities research across the various institutes and centers.

Lectures and seminars will include:

  • Population science and health disparities
  • Research design and measurement approaches
  • Intervention Science methods
  • Healthcare disparities and outcomes research
  • Community-based participatory research
  • Grant writing and mock grant review

The didactics and small discussion groups will be structured based on areas of interest of participants. This will also include consultation on the development of research interests into an application – R21, R01, K award, as well as consultation on research strategies and methodologies for proposed studies.

For more information on the Health Disparities Research Institute and how to register, see the NIMHD website.

 

National Minority Health Month 2017: Bridging Health Equity Across Communities

Did you know that your zip code can be a predictor of your health? Along with your income and education level, where you are born, grow, live, work, play, learn, and age determines your quality of health. The choices you make each day about what to eat, when to work out and whether or not to see a doctor are important. The condition of your surroundings, or the social determinants of health, is the other part of the foundation upon which better health is built. However, many Americans, particularly racial and ethnic minority populations, are significantly impacted by the social determinants of health and the resulting disparities, or inequities, in health and health care.

Each April during National Minority Health Month, the U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) raises awareness about health disparities, their causes and the impact they have on minority communities and on the nation as whole. This year, the HHS OMH is proud to join its partners in communities throughout the country as we build bridges to help end disparities in health and health care. Bridging health equity across communities extends beyond public health—it focuses attention on the indirect social and economic conditions in which we live. By addressing the social determinants of health and working together across sectors, we can help eliminate health disparities and advance health equity for everyone.

National Minority Health Month 2017 is focused on access to transportation that makes it possible to get to a well visit; neighborhoods where it is possible to exercise or play outdoors; and accessible grocery stores that make it possible to eat a well-balanced diet. Through collaboration with those who lead efforts to improve education, the safety of our neighborhoods, and other aspects of our communities, we can improve living conditions and help individuals live longer and healthier lives.

See the resource website developed by the Office of Minority Health for ideas and activities you can do around National Minority Health Month.