Strengthening Integration of Health Services and Systems

Unfettered access to contraception is a critical component of reproductive autonomy. Allowing people to control choices related to their own childbearing and to independently plan their families results in improved economic, social, and health outcomes for people capable of pregnancy and their families, such as improved mental health and well-being, increased educational attainment and workforce participation, and financial stability.

Since the early 1990s, Medicaid has been critical in providing insurance coverage for pregnant women with low incomes in the United States - pregnancy-related Medicaid coverage is available to women with incomes up to 200 percent of the federal poverty level in most states. Building on existing studies tracking changes in Medicaid coverage and uninsurance under the law, researchers Emily M. Johnston, Stacey McMorrow, Clara Alvarez Caraveo and Lisa Dubay examined data for new mothers with Medicaid-covered prenatal care in this study published in Health Affairs.

Two pandemics upended our nation this year. The novel coronavirus (COVID-19) continues to sicken, kill, and reshape the lives of people everywhere, and is also testing our nation’s healthcare, public health, education, and social protection systems like never before. The second pandemic is one that has been with us since well before our nation’s founding but has come into much sharper focus this past year. Like a virus, it has infected virtually every aspect of our society including our laws and policies, a central focus of the Policies for Action (P4A) research program: systemic racism and its attendant social, economic, and political injustices. Although this time last year, the need for sound policy research was clear – especially in light of growing inequality in health and wealth, and the conditions that drive and are shaped by these – 2020 made these needs more visible and more urgent. As P4A enters its sixth year, a strong and growing community of policy researchers across the country, supported by a stellar National Advisory Committee, are generating a host of research findings crucially needed at this moment.

In an article recently published in JAMA Network Open, Heidi Allen, Sarah H. Gordon, Dennis Lee, Aditi Bhanja and Benjamin D. Sommers use data from Colorado to compare individuals with similar incomes across coverage types, highlighting the key differences between Medicaid and Marketplace insurance.

Research suggests that one in seven children in the United States have a diagnosable mental health condition. But despite efforts to increase access to care through school-based mental health services, most youth with a mental health condition do not receive the treatment they need. Telehealth services, however, have the potential to increase access to school-based mental health treatment by reducing districts’ need for on-site personnel—of which there is a national shortage—without compromising the quality of care. Therefore, states should consider maintaining the telehealth flexibilities they enacted in response to the COVID-19 pandemic as a means to improve access to critical school-based mental health services for youth, even after the public health emergency ends.

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.

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.

Even as the COVID-19 pandemic raged, state legislators continued to quietly pass laws that consolidate power in state capitals and take away local governments’ authority to protect public health. Oklahoma is the latest example.

The Affordable Care Act (ACA), which turns 10 on March 23, dramatically changed Medicaid, making it available to millions of previously ineligible low-income adults. As some states continue to debate whether to expand Medicaid and policymakers propose more far-reaching changes to the program, it is critical to provide timely evidence on how the program is working and what the potential effect of major changes would be.

Policies for Action is entering its fifth year with a growing community of researchers across the country and a maturing pipeline of research to support critical policy development. Find out how we're expanding the quality and reach of our work in 2020.

Approximately 16 percent of children in the U.S. live in families with incomes below the federal poverty threshold. This early-life exposure to poverty may have negative long-term health effects. In a new working paper, Hansoo Ko, Renata Howland, and Sherry Glied of the P4A Research Hub at New York University Robert F. Wagner Graduate School of Public Service, estimate the causal impacts of the Supplemental Security Income program on child health outcomes and medical expenditures.