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Parmet WE. The Plenary Power Meets the Police Power: Federalism at the Intersection of Health & Immigration. AMERICAN JOURNAL OF LAW & MEDICINE 2019; 45:224-246. [PMID: 31722634 DOI: 10.1177/0098858819860611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
On January 8, 2019, shortly after his inauguration, California's Governor Gavin Newsom announced a proposal to provide health coverage to undocumented immigrants up to age 26. That same day, New York Mayor Bill de Blasio offered a $100 million plan to cover 600,000 uninsured New Yorkers, regardless of immigration status. These proposals from public officials on opposite sides of the continent stood in stark contrast to the Trump Administration's demand for a wall at the southern border, and its proposed public charge regulations that are expected to lead millions of lawfully present immigrants and their families to forego health insurance.
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Affiliation(s)
- Wendy E Parmet
- Mathews University Distinguished Professor of Law and Professor of Public Policy & Urban Affairs, Northeastern University
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2
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Wong ES, Maciejewski ML, Hebert PL, Fortney JC, Liu CF. Spillover Effects of Massachusetts Health Reform on Mental Health Use by VA and Medicare Dual Enrollees. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 46:145-153. [PMID: 30343347 DOI: 10.1007/s10488-018-0900-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Older veterans can obtain care from the Veterans Affairs Health System (VA), Medicare or both. We examined whether their use of mental health care was impacted by capacity effects stemming from younger, uninsured veterans' enrolling in VA to satisfy the individual mandate within Massachusetts Health Reform (MHR). Using administrative data, we applied a difference-in-difference approach to compare pre-post changes in mental health use following MHR implementation. Findings indicated MHR was associated with increases in use through Medicare and the probability of dual VA-Medicare use. These results provide support for the possibility that limited capacity led to care seeking outside VA.
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Affiliation(s)
- Edwin S Wong
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, HSR&D MS-152, Seattle, WA, 98108, USA. .,Department of Health Services, University of Washington, Seattle, WA, USA.
| | - Matthew L Maciejewski
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Paul L Hebert
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, HSR&D MS-152, Seattle, WA, 98108, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - John C Fortney
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, HSR&D MS-152, Seattle, WA, 98108, USA.,Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - Chuan-Fen Liu
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, HSR&D MS-152, Seattle, WA, 98108, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
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Pines JM, Zocchi M, Moghtaderi A, Black B, Farmer SA, Hufstetler G, Klauer K, Pilgrim R. Medicaid Expansion In 2014 Did Not Increase Emergency Department Use But Did Change Insurance Payer Mix. Health Aff (Millwood) 2018; 35:1480-6. [PMID: 27503974 DOI: 10.1377/hlthaff.2015.1632] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 2014 twenty-eight states and the District of Columbia had expanded Medicaid eligibility while federal and state-based Marketplaces in every state made subsidized private health insurance available to qualified individuals. As a result, about seventeen million previously uninsured Americans gained health insurance in 2014. Many policy makers had predicted that Medicaid expansion would lead to greatly increased use of hospital emergency departments (EDs). We examined the effect of insurance expansion on ED use in 478 hospitals in 36 states during the first year of expansion (2014). In difference-in-differences analyses, Medicaid expansion increased Medicaid-paid ED visits in those states by 27.1 percent, decreased uninsured visits by 31.4 percent, and decreased privately insured visits by 6.7 percent during the first year of expansion compared to nonexpansion states. Overall, however, total ED visits grew by less than 3 percent in 2014 compared to 2012-13, with no significant difference between expansion and nonexpansion states. Thus, the expansion of Medicaid coverage strongly affected payer mix but did not significantly affect overall ED use, even though more people gained insurance coverage in expansion states than in nonexpansion states. This suggests that expanding Medicaid did not significantly increase or decrease overall ED visit volume.
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Affiliation(s)
- Jesse M Pines
- Jesse M. Pines is the director of the Center for Healthcare Innovation and Policy Research and a professor of emergency medicine and of health policy and management at George Washington University, in Washington, D.C
| | - Mark Zocchi
- Mark Zocchi is a senior research associate in the Center for Healthcare Innovation and Policy Research, George Washington University
| | - Ali Moghtaderi
- Ali Moghtaderi is a postdoctoral fellow in the Center for Healthcare Innovation and Policy Research, George Washington University
| | - Bernard Black
- Bernard Black is the Nicholas D. Chabraja Professor at Northwestern University, in Evanston, Illinois
| | - Steven A Farmer
- Steven A. Farmer is the associate director of the Center for Healthcare Innovation and Policy Research and an associate professor of medicine and of health policy and management at George Washington University
| | - Greg Hufstetler
- Greg Hufstetler is vice president, Reimbursement and Regulatory Affairs, at Reimbursement Technologies Inc., a billing and financial management company in Conshohocken, Pennsylvania
| | - Kevin Klauer
- Kevin Klauer is chief medical officer-emergency medicine at TeamHealth Inc., a national multispecialty integrated physician group practice based in Knoxville, Tennessee
| | - Randy Pilgrim
- Randy Pilgrim is the enterprise chief medical officer at Schumacher Clinical Partners, a multispecialty physician management and staffing group based in Lafayette, Louisiana
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Maclean JC, Saloner B. Substance Use Treatment Provider Behavior and Healthcare Reform: Evidence from Massachusetts. HEALTH ECONOMICS 2018; 27:76-101. [PMID: 28224675 DOI: 10.1002/hec.3484] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/31/2016] [Accepted: 12/15/2016] [Indexed: 06/06/2023]
Abstract
We examine the impact of the 2006 Massachusetts healthcare reform on substance use disorder (SUD) treatment facilities' provision of care. We test the impact of the reform on treatment quantity and access. We couple data on the near universe of specialty SUD treatment providers in the USA with a synthetic control method approach. We find little evidence that the reform lead to changes in treatment quantity or access. Reform effects were similar among for-profit and non-profit facilities. In an extension, we show that the reform altered the setting in which treatment is received, the number of offered services, and the number of programs for special populations. These findings may be useful in predicting the implications of major health insurance expansions on the provision of SUD treatment. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Johanna Catherine Maclean
- Department of Economics, Temple University, Philadelphia, PA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
- Institute of Labor Economics (IZA), Bonn, North Rhine-Westphalia, Germany
| | - Brendan Saloner
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Berenson J, Li Y, Lynch J, Pagán JA. Identifying Policy Levers And Opportunities For Action Across States To Achieve Health Equity. Health Aff (Millwood) 2017; 36:1048-1056. [DOI: 10.1377/hlthaff.2017.0004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Julia Berenson
- Julia Berenson ( ) is a research associate in the Center for Health Innovation at the New York Academy of Medicine and a PhD candidate in the School of Social Work at Columbia University, both in New York City
| | - Yan Li
- Yan Li is a research scientist in the Center for Health Innovation, New York Academy of Medicine, and an assistant professor in the Department of Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai, both in New York City
| | - Julia Lynch
- Julia Lynch is an associate professor of political science at the University of Pennsylvania, in Philadelphia
| | - José A. Pagán
- José A. Pagán is director of the Center for Health Innovation, New York Academy of Medicine, a professor in the Department of Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai, and adjunct senior fellow of the Leonard Davis Institute of Health Economics, University of Pennsylvania, in Philadelphia
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Fort DG, Herr TM, Shaw PL, Gutzman KE, Starren JB. Mapping the evolving definitions of translational research. J Clin Transl Sci 2017; 1:60-66. [PMID: 28480056 PMCID: PMC5408839 DOI: 10.1017/cts.2016.10] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/10/2016] [Accepted: 10/11/2016] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Systematic review and analysis of definitions of translational research. MATERIALS AND METHODS The final corpus was comprised of 33 papers, each read by at least 2 reviewers. Definitions were mapped to a common set of research processes for presentation and analysis. Influence of papers and definitions was further evaluated using citation analysis and agglomerative clustering. RESULTS All definitions were mapped to common research processes, revealing most common labels for each process. Agglomerative clustering revealed 3 broad families of definitions. Citation analysis showed that the originating paper of each family has been cited ~10 times more than any other member. DISCUSSION Although there is little agreement between definitions, we were able to identify an emerging consensus 5-phase (T0-T4) definition for translational research. T1 involves processes that bring ideas from basic research through early testing in humans. T2 involves the establishment of effectiveness in humans and clinical guidelines. T3 primarily focuses on implementation and dissemination research while T4 focuses on outcomes and effectiveness in populations. T0 involves research such as genome-wide association studies which wrap back around to basic research. CONCLUSION We used systematic review and analysis to identify emerging consensus between definitions of translational research phases.
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Affiliation(s)
- Daniel G. Fort
- Department of Preventive Medicine, Feinberg School of Medicine, Division of Health and Biomedical Informatics, Northwestern University, Chicago, IL, USA
| | - Timothy M. Herr
- Department of Preventive Medicine, Feinberg School of Medicine, Division of Health and Biomedical Informatics, Northwestern University, Chicago, IL, USA
| | - Pamela L. Shaw
- Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karen E. Gutzman
- Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Justin B. Starren
- Department of Preventive Medicine, Feinberg School of Medicine, Division of Health and Biomedical Informatics, Northwestern University, Chicago, IL, USA
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Wong ES, Maciejewski ML, Hebert PL, Batten A, Nelson KM, Fihn SD, Liu CF. Did Massachusetts Health Reform Affect Veterans Affairs Primary Care Use? Med Care Res Rev 2016; 75:33-45. [DOI: 10.1177/1077558716669432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Massachusetts Health Reform (MHR), implemented in 2006, introduced new health insurance options that may have prompted some veterans already enrolled in the Veterans Affairs Healthcare System (VA) to reduce their reliance on VA health services. This study examined whether MHR was associated with changes in VA primary care (PC) use. Using VA administrative data, we identified 147,836 veterans residing in Massachusetts and neighboring New England (NE) states from October 2004 to September 2008. We applied difference-in-difference methods to compare pre–post changes in PC use among Massachusetts and other NE veterans. Among veterans not enrolled in Medicare, VA PC use was not significantly different following MHR for Massachusetts veterans relative to other NE veterans. Among VA–Medicare dual enrollees, MHR was associated with an increase of 24.5 PC visits per 1,000 veterans per quarter ( p = .048). Despite new non-VA health options through MHR, VA enrollees continued to rely on VA PC.
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Affiliation(s)
- Edwin S. Wong
- VA Puget Sound Health Care System, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | | | - Paul L. Hebert
- VA Puget Sound Health Care System, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Adam Batten
- VA Puget Sound Health Care System, Seattle, WA, USA
| | - Karin M. Nelson
- VA Puget Sound Health Care System, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | | | - Chuan-Fen Liu
- VA Puget Sound Health Care System, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
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Terriquez V, Joseph TD. Ethnoracial inequality and insurance coverage among Latino young adults. Soc Sci Med 2016; 168:150-158. [PMID: 27658119 PMCID: PMC5066580 DOI: 10.1016/j.socscimed.2016.08.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/25/2016] [Accepted: 08/22/2016] [Indexed: 11/24/2022]
Abstract
Previous research has demonstrated that Latino young adults are uninsured at higher rates relative to other ethnoracial groups. Recent implementation of the 2010 Affordable Care Act (ACA) has increased access to health insurance for young adults, in part by maintaining health coverage through their parents until age 26. This paper examines patterns of Latino young adults' insurance coverage during early ACA implementation by addressing three questions: 1) To what extent do Latino young adults remain uninsured relative to their peers of other ethnoracial groups? 2) How do young adults' family socioeconomic background, immigrant characteristics, college enrollment, and employment status mediate their coverage? And, 3) do patterns of insurance coverage differ for employer-provided coverage versus other sources of coverage (including parents’ health insurance)? Using a 2011 representative sample of U.S.-born and 1.5-generation immigrant young adults in California, we find that Latinos are more likely than other ethnoracial groups to remain uninsured. While they are as likely as similar peers to obtain employer-provided health insurance, they are less likely to possess insurance through other sources (including their parents). This study contributes to our understanding of the limits of the ACA in reducing disparities in insurance coverage for Latinos by highlighting the importance of family socioeconomic background, immigrant characteristics, college enrollment, and employment in shaping coverage among this age group. We examine ethnoracial disparities in Latino young adults' health insurance coverage. Latino young adults exhibit low rates of insurance coverage during early ACA implementation. Family SES, four-year college enrollment, and employment status predict coverage. Legal status, language use, and immigrant generation predict insurance coverage. In spite of low overall coverage, Latinos access coverage from employers similar to other groups.
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Joseph TD. What Health Care Reform Means for Immigrants: Comparing the Affordable Care Act and Massachusetts Health Reforms. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2016; 41:101-116. [PMID: 26567382 DOI: 10.1215/03616878-3445632] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The 2010 Patient Protection and Affordable Care Act (ACA) was passed to provide more affordable health coverage to Americans beginning in 2014. Modeled after the 2006 Massachusetts health care reform, the ACA includes an individual mandate, Medicaid expansion, and health exchanges through which middle-income individuals can purchase coverage from private insurance companies. However, while the ACA provisions exclude all undocumented and some documented immigrants, Massachusetts uses state and hospital funds to extend coverage to these groups. This article examines the ACA reform using the Massachusetts reform as a comparative case study to outline how citizenship status influences individuals' coverage options under both policies. The article then briefly discusses other states that provide coverage to ACA-ineligible immigrants and the implications of uneven ACA implementation for immigrants and citizens nationwide.
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Brown LD. The fox and the grapes: is real reform beyond reach in the United States? JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2012; 37:587-609. [PMID: 22466045 DOI: 10.1215/03616878-1597439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
As the challenges of maintaining (or, in the US case, attaining) affordable universal coverage multiply, the debate about what constitutes "real" reform intensifies in Western health care systems. The reality of reform, however, lies in the eyes of myriad beholders who variously enshrine consumer responsibility, changes in payment systems, reorganization, and other strategies -- or some encompassing combination of all of the above -- as the essential ingredient(s). This debate, increasingly informed by the agendas of health services researchers and health policy analysts, arguably serves as much or more to becloud as to clarify the practical options policy makers face and remains severely imbalanced with respect to the institutional sectors on which it concentrates, the fields of knowledge on which it draws, and the roles it envisions for markets and the state.
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