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.

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.

 

How Do Community-based Field Workers View the Impact of Their Research Participation on Their Lives

An  article recently published in BMC Public Health explored the way community-based field workers viewed the impact of research participation on their lives. Authored by Christabelle S. Moyo, Joseph Francis and Pascal O. Bessong, the article — Perceptions of community-based field workers on the effect of a longitudinal biomedical research project on their sustainable livelihoods — reports findings of a study conducted with 16 individuals who had worked as community-based field workers in the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) South Africa which was initiated in 2009. Recruited from the community, the field workers were trained to collect data on childhood illnesses, vaccination history, feeding habits; and to collect biospecimens such as tool and urine following standard protocols that governed eight field sites in the project’s network.

To understand the way the field workers viewed the impact of their work in the lives, the researchers undertook a qualitative research project in January and February 2016. The methodology consisted of one-on-one interviews and focus group discussions with 16 former field workers and five community members who were not directly involved in the project. Benefits reported by the MAL-ED community-based field workers included:

  • Knowledge about child growth and malnutrition
  • Acquisition of knowledge & various skills
  • Knowledge about conducting research and data collection
  • Received financial benefits
  • Acquired physical assets
  • Experience working with children
  • Personal development
  • Social capital benefits (greater social network)
  • Understanding of water and sanitation issues

The article can be accessed from BMC Public Health.

Decisive action by communities can reduce health disparities and improve lives

From the article by Risa Lavizzo-Mourey and Victor Dzau on STAT

Our choices for good health depend on our choices for everything else in life: a good education, safe and decent housing, a secure job that allows us to support our families.

What happens when those choices don’t exist? Ask Alpha Whitaker.

Whitaker, a single mom in Indianapolis who put herself through college, had to turn down a dream job because she didn’t have a safe way to get to work. Her bus route ended 10 blocks from the job, and she would have had to walk through a dangerous neighborhood — twice — every day.

In choosing safety, Whitaker gave up a job with full health benefits, a 401(k) plan to help her save for her daughter’s education, and a salary that would have allowed her family to move to a safer neighborhood. These things — financial security, health insurance, education, and neighborhood — influence health.

Fortunately, Indianapolis is one of many US communities working to create better choices for their residents in transportation, public safety, and employment. In doing so, they are creating better choices for health as well.

On the surface, the link might not be obvious. But as “Communities in Action: Pathways to Health Equity,” a new report from the National Academy of Medicine’s Culture of Health program shows, health equity and equal opportunity are inextricably linked. The report, commissioned by the Robert Wood Johnson Foundation, defines health equity as the state in which everyone has a chance to attain their full health potential.

Americans today live shorter, sicker lives than people in other developed countries. Across America, health varies by income, education, race and ethnicity, geography, sexual identity, and disability status. We pay a high price for these health disparities in lost lives, wasted potential, and squandered resources. They also affect national security: Some 26 million young adults are unqualified to serve in the United States military because of persistent health problems, poor education, or convictions for a felony. The report estimates that racial health disparities are projected to cost health insurers $337 billion between 2009 and 2018.

“Communities in Action” spotlights how communities are working together to create pathways to health equity. By addressing factors well beyond access to health insurance, cities like Indianapolis, Buffalo, Minneapolis, San Antonio, and Los Angeles are seeding the conditions needed to enjoy full, healthy lives.

Take the Indianapolis Congregation Action Network (IndyCAN), a multiracial, multifaith group that took on limited access to bus routes. That transportation issue created barriers to good jobs and opportunity. Working with a variety of stakeholders, including the residents most affected, IndyCAN helped pass a regional transit referendum to triple bus service in Indianapolis, fuel economic development, and increase access to jobs. Because all residents understood that improved bus service would benefit everyone in the community in a range of ways, the referendum passed last November — with the Indianapolis Chamber of Commerce as a leading champion.

This is just one example of what a community can do to promote health equity. “Communities in Action” explores many other efforts to curb violence, boost education, improve social connectedness, and expand access to healthy foods — all of which create the opportunity for healthier lives. Although their approaches differ, these community efforts consistently bring a shared vision for promoting health equity, building and harnessing community capacity, and involving many different sectors to enlist broad buy-in.

Read the full article.

Sentinel Communities: Mobile, Alabama

The Sentinel Communities project — a part of the Robert Wood Johnson Foundation’s Culture of Health Initiative — will track health outcomes in 30 cities to understand

  • Local health care landscape
  • How challenges can be addressed in areas with different geographic and historic landscapes
  • How communities make progress or address barriers in improving population health.

The Sentinel Communities were chosen to reflect the nation’s diversity in terms of demographics, geography, and approaches to health. The following, drawn from the first report about Mobile, AL., provide some context for health issues in city.

 

  • In addition to an overall 25% poverty rate for Mobile, significant income inequality exists between black and white residents, with black households earning about half the median income as white ones.
  • While educational attainment has increased among white residents, the percentage of black residents with a bachelor’s degree or higher declined between 2010 and 2014.
  • Despite progress, Mobile residents have a lower life expectancy and higher rates of teen pregnancy, obesity, smoking, and uninsurance than the national average.
  • Even with the introduction of a new Regional Care Organization that may improve insurance coverage for residents, Mobile remains a federally designated health care shortage area.

 

See the full report for charts on indicators such as income, teen pregnancy, mortality, and educational attainment as well as some of the initiatives currently in place to address health issues.

 

Highlights from the Commonwealth Fund Scorecard on State Health System Performance

From the Commonwealth Fund:

The 2017 edition of the Commonwealth Fund Scorecard on State Health System Performance finds that nearly all state health systems improved on a broad array of health indicators between 2013 and 2015. During this period, which coincides with implementation of the Affordable Care Act’s major coverage expansions, uninsured rates dropped and more people were able to access needed care, particularly those in states that expanded their Medicaid programs. On a less positive note, between 2011–12 and 2013–14, premature death rates rose slightly following a long decline. The Scorecard points to a constant give-and-take in efforts to improve health and health care, reminding us that there is still more to be done.

According to the 2017 scorecard, Alabama’s performance relative to the baseline score set in 2013 included:

  • Drop from 39 to 47 in overall performance.
  • Drop from 27 to 34 in terms of access Dropped from 36 to 42 in terms of prevention and treatment
  • Remain at 41 in terms of avoidable hospital use and cost
  • Drop from 41 to 45 in terms of healthy lives

See the full Alabama scorecard.

Treatment Gaps Persist Between Low- And High-Income Workers, Even With Insurance

From the article by Michelle Andrews on Kaiser Health News:

Low-wage workers with job-based health insurance were significantly more likely than their higher-income colleagues to wind up in the emergency department or be admitted to the hospital, in particular for conditions that with good primary care shouldn’t result in hospitalization, a new study found.

At the same time, low-wage workers were much less likely to get preventive care such as mammograms and colonoscopies, even though many of those services are available without cost-sharing under the 2010 health law.

There’s no single reason for the differences in health care use by workers at different wage levels, said Dr. Bruce Sherman, an assistant clinical professor at Case Western Reserve University in Cleveland and the study’s lead author, which was published in the February issue of Health Affairs.

Finances often play a role. Half of workers with employer-sponsored insurance are enrolled in plans with a deductible of at least $1,000 for single coverage. As deductibles and other out-of-pocket costs continue to rise, low-wage workers may opt to pay the rent and put food on the table rather than keep up-to-date with regular doctor visits and lab work to manage their diabetes, for example.

Likewise, convenient access to care can be problematic for workers at the lower end of the pay scale.

“Individuals are penalized if they leave work to seek care,” Sherman said. “So they go after hours and their access to care is limited to urgent care centers or emergency departments.”

The study examined the 2014 health care claims, wage and other data of nearly 43,000 workers at four self-funded companies that offered coverage through a private health insurance exchange. Workers were stratified into four categories based on annual maximum wages of $30,000, $44,000, $70,000 and more than $70,000.

Workers in the lowest wage category were three times more likely to visit the emergency department than top earners, and more than four times more likely to have avoidable hospital admissions for conditions such as bacterial pneumonia or urinary tract infections. But they used preventive services only half as often, the study found.

Read the full article.