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Dear John,
This month's issue of Health Affairs features original research about
the effects of Medicaid expansion, how the expanded Child Tax Credit
affected adults' mental health, the effects of behavioral health cost
sharing, social vulnerability and the hospital star rating system,
equity in health professionals' education, COVID-19 mortality, and
more.
Read The Issue
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Medicaid Expansion
Maria Steenland and Laura Wherry examine postpartum hospitalization
rates in eight states
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and find a "17 percent decrease in the occurrence of sixty-day
postpartum hospitalizations among people with Medicaid-financed
deliveries" in states that expanded Medicaid under the Affordable Care
Act compared with people in states that did not.
They conclude that expansion led to improved postpartum health for
low-income populations.
Asako Moriya and Sujoy Chakravarty find that after the 2014 Medicaid
expansion, Black-White disparities in preventable hospitalizations
decreased
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in both expansion and nonexpansion states, with the size of the decrease
greater in expansion states.
Black-White disparities in emergency department (ED) visits increased in
all states. The authors find no significant changes in Hispanic-White
disparities in preventable hospitalizations or ED visits.
Read More
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Behavioral Health
To provide financial assistance during the pandemic, Congress
temporarily expanded the Child Tax Credit to reach more families and
provide a larger credit per child.
Using survey data, Akansha Batra and coauthors find that this expansion
was associated
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with "reduced anxiety symptoms among low-income adults with children, as
well as greater mental health benefits among Black and Hispanic people
than among White people."
From 2010 through 2014, Medicare phased in cost-sharing parity for
outpatient mental health and substance use disorder (MHSUD) services,
thereby reducing cost-sharing levels.
Vicki Fung and coauthors find that among White beneficiaries, the policy
change was associated with an increase in relative rates of MHSUD
specialty visits
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and medication use and a decrease in ED visits and hospitalizations
related to MHSUD.
However, reductions in cost sharing were "associated with smaller or no
gains in MHSUD use for racial and ethnic minority beneficiaries compared
with White beneficiaries," yielding wider racial and ethnic disparities.
Read More
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Hospitals
In 2016 the Centers for Medicare and Medicaid Services began reporting
hospital star ratings as a summary measure of hospital quality. Steven
Spivack and coauthors explore whether hospitals that serve socially
vulnerable populations
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are disadvantaged in these ratings.
Although overall ratings are lower for hospitals caring for higher
proportions of patients who are dually eligible for Medicare and
Medicaid, there was inconsistency across elements of quality, such as
mortality, safety, and patient experience.
Read More
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Equity
To better understand barriers to diversity in the physician workforce,
Louisa Holaday and coauthors investigate debt among medical residents by
race and ethnicity.
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They determine that disparities in debt among postgraduate medical
resident trainees mirror broader national trends in wealth disparity.
Black trainees were mostly likely to have debt, and "all trainees from
populations that are underrepresented in medicine were generally more
likely to have debt compared with Asian and White trainees."
J. Michael McWilliams and coauthors examine spending among
community-dwelling, fee-for-service Medicare beneficiaries
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with an eye to risk-adjustment methods, which, they argue, "should
encourage the desired level and distribution of spending, not entrench
the status quo."
They find "that adding social factors, particularly race and ethnicity,
to the [Hierarchical Condition Categories] model can entrench health
disparities instead of reducing them, by lowering population-based
payments to more accurately predicted levels of spending."
Read More
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COVID-19
Using health plan data from twelve states during the first year of the
COVID-19 pandemic, H. Stephen Kaye and Joseph Caldwell examine excess
mortality among recipients of Medicaid home
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community-based services who are younger than age sixty-five.
Excess mortality rates for this group of people with disabilities were
7.4 times those of community-dwelling Medicaid beneficiaries of the same
age not receiving home and community-based services and 26.6 times those
of the general population.
M. Kate Bundorf and coauthors draw on data from the second year of the
pandemic
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to report that rates of employer-sponsored health insurance coverage
stayed relatively flat in 2021, despite rising employment. About eight
million people gained coverage in 2021 and early 2022, they estimate,
driven primarily by increases in Medicaid and other public coverage.
Read More
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Order The Issue
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This month, we're hosting a number of events that cover topics such as
national health care spending in 2021
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and the effect of Medicaid expansion on postpartum hospitalization
rates.
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Additional events this month include:
* January 19: Policy Spotlight: One-On-One with Benjamin Sommers, Deputy
Assistant Secretary for Health Policy, HHS
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(1/19)
* January 24: Insider Professional Development: Promoting Your Research
& Expertise on Digital, Social, PR and Media
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(1/24)
View Full Event Schedule
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The University of Miami Herbert Business School
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Business of Health Care Conference
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on February 24. Industry leaders will tackle cost, staffing, access,
consolidation, technology, and other pressing challenges. Participate
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in person or via livestream in this signature event hosted by a leader
in health management education
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Listen To These Podcasts
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This month, we'll feature authors from the January issue discussing
topics like food insecurity, employer-sponsored insurance coverage and
more.
Recently, Health Affairs Editor-in-Chief Alan Weil interviewed Jennifer
Ng'andu, managing director at the Robert Wood Johnson Foundation of
the Healthy Children and Families Program, to discuss how key federal
income support policies relate to positive health outcomes.
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Check out our podcasts, and subscribe on Spotify
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or wherever you prefer to listen.
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About Health Affairs
Health Affairs is the leading peer-reviewed journal
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health care, and policy. Published monthly by Project HOPE, the journal
is available in print and online. Late-breaking content is also found
through healthaffairs.org <healthaffairs.org>, Health Affairs Today
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Update <[link removed]>. Â
Project HOPE <[link removed]> is a global health and
humanitarian relief organization that places power in the hands of local
health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.
Copyright © Project HOPE: The People-to-People Health Foundation, Inc.
Health Affairs, 1220 19th Street, NW, Suite 800, Washington, DC 20036, United States
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