Strengthening Integration of Health Services and Systems

In a Culture of Health, health systems balance clinical care with prevention-oriented public health and community-based social services, improving health outcomes while driving down costs. This integration is driven by increasing access to care, improving the patient experience, and establishing the connections needed to help people live healthier lives.

Commentary

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.

Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, and Postpartum Contraception

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.

Consequences of Work Requirements in Arkansas: Two-Year Impacts on Coverage, Employment, and Affordability of Care

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.

Assessment of Perceptions of the Public Charge Rule Among Low-Income Adults in Texas

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.

Commentary

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.

Contraceptive Access Policies as a Gateway to Improved Health and Equity

Quality preventive medical care remains one of the most important tools for mitigating diseases like cancer, hypertension and heart disease, which are leading causes of death and disability in the U.S. However, due to persistent social and economic inequities, preventive services remain inaccessible to many people.

Income Support and Children's Health Trajectories

Approximately 16 percent of children in the U.S. live in families with incomes below the federal poverty threshold, potentially creating negative long-term effects that are experienced over the life-course. The Supplemental Security Income (SSI) program provides cash assistance to low-income children with disabilities, expanding family budgets and potentially allowing low-income parents to better protect the health of vulnerable children. However, few studies have evaluated the impact of this policy.

Commentary

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.

Commentary

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.

The Effects of Income on Children’s Health: Evidence from Supplemental Security Income Eligibility under New York State Medicaid

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.