Creating Healthier, More Equitable Communities

The period before pregnancy is critically important for the health of a woman and her infant, yet not all women have access to health insurance during this time. Rebecca Myerson of the University of Wisconsin-Madison, Samuel Crawford of the University of Southern California, and Laura R. Wherry of New York University evaluated whether increased access to health insurance under the Affordable Care Act (ACA) Medicaid expansions affected ten preconception health indicators, including the prevalence of chronic conditions and health behaviors, birth control use and pregnancy intention, and the receipt of preconception health services.

Paid family and medical leave has important health benefits for parents and their children, but access to job-protected leave is limited and highly disparate in the United States. Increasingly, state and local governments have established policies such as paid leave to support parents and other caregivers. While these policies have been crucial in enabling more workers to take leave, their effects have been weakened due to only partial coverage of job protection laws. As part of their ongoing work evaluating the 2017 San Francisco Paid Parental Leave Ordinance, investigators Julia M. Goodman (Oregon Health & Science University/Portland State University) and William H. Dow (University of California, Berkeley) published an issue brief examining paid leave protections in the California Bay Area.

The advent of just-in-time scheduling technology and practices in the mid-1990s has led to increased schedule instability, resulting in a growing movement to address the need for predictable, stable schedules for workers paid low wages. Unstable schedules have been associated with earnings instability, increased stress and fatigue, sleep irregularity, and worse mental health outcomes for workers.  In this report, P4A researchers Amelia Coffey, Eleanor Lauderback and H. Elizabeth Peters, along with their partners at the University of Oregon’s Department of Sociology Lola Loustaunau, Larissa Petrucci, Ellen Scott and Lina Stepick, examine Oregon’s implementation of S.B. 828, the first statewide predictive scheduling law in the nation, in its first year.

The Earned Income Tax Credit (EITC) is one of the largest safety net programs in the United States. In 2019, the EITC reached 25 million tax filers at a total cost of $63 billion. Using variation in the federal and state EITC, Breno Braga, Fredric Blavin and Anuj Gangopadhyaya evaluated the long-term impact of EITC exposure during childhood on the health of young adults.

Arkansas implemented Medicaid work requirements in June of 2018. To maintain coverage in the state, adults ages 30-49 were required to work 20 hours a week, participate in “community engagement” activities, or qualify for an exemption. By April 2019, when a federal judge halted the policy, more than 18,000 adults had lost coverage. As an update to research published in 2018, Benjamin D. Sommers, Lucy Chen, Robert J. Blendon, E. John Orav, and Arnold M. Epstein analyzed the policy effects before, during, and after implementation in this Health Affairs brief.

A recent expansion of the federal “public charge” rule allows the government to deny immigrants permanent residency based on their income or health status or if they participate in programs that did not previously trigger the rule, such as Medicaid or the Supplemental Nutritional Assistance Program [SNAP]. Critics contend that this will dissuade individuals from participating in programs or obtaining medical care. In this JAMA Network Open paper, Benjamin D. Sommers, Heidi Allen, Aditi Bhanja, Robert J. Blendon, John Orav, and Arnold M. Epstein examine perceptions of the new public charge rule and its potential impacts on public program participation and medical care among low-income adults in Texas.

Paid family leave policies have the potential to reduce health disparities, yet access to paid leave remains limited and unevenly distributed in the United States. The US is the only OECD country that does not provide paid leave for new parents, and just 8 states and the District of Columbia have passed partially-paid family leave policies. In a new paper, Julia Goodman of the OHSU-PSU School of Public Health, Will Dow of UC Berkeley, and Holly Elser of Stanford University examine the impact of the 2017 San Francisco Paid Parental Leave Ordinance (PPLO), the first in the US to provide parental leave with full pay. 

Local governments are often innovators of public health policymaking, and local control over public health issues that are vital to addressing social inequities. But states are increasingly preempting, or prohibiting, local control over public health issues. In a new paper, Jennifer Pomeranz and Diana Silver of the New York University School of Global Public Health, systematically identified strategies to pass, obscure, or enhance preemption in five policy areas.