Health Care Systems and 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.

Does Private Insurance Provide More Medical Care?

Ten years after the passing of the Affordable Care Act—the most comprehensive health care reform of the past half-century—most of the previously uninsured continue to lack coverage. Policymakers and members of the public have expressed growing support for expanding the role of public financing of health care. The “public option” and “Medicare for All” have emerged as important contenders for health policy reform. Both policies are rooted in widening access to the lower prices of the public system to make health care more affordable for all.

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.

A Healthy Start to Life: How Medicaid Expansion Improves Pregnancy and Birth Outcomes

Birth outcomes, including infant mortality and low birth weight, are shockingly poor in the U.S. Researchers will assess whether the ACA increased intended pregnancies, reduced prepregnancy smoking, and affected contraception and birth outcomes among women covered by Medicaid--and whether these changes reduced disparities across racial and ethnic groups.

Medicaid Work Requirements: Results from the First Year in Arkansas

In June 2018, Arkansas became the first state to implement work requirements in Medicaid. Benjamin D. Sommers, Anna L. Goldman, Robert J. Blendon, E. John Orav, and Arnold M. Epstein of Harvard University provide the first independent assessment of early changes in beneficiary coverage and employment after the work requirements went into effect.

Cross-post

A new University of Michigan analysis reviews 46 studies evaluating interventions for "super-utilizers" of emergency department and prehospital care in the U.S. Here, the authors share their thoughts on the importance of their findings.

Interventions to Decrease Use in Prehospital and Emergency Care Settings Among Super-Utilizers in the United States: A Systematic Review

“Super-utilizers” have been the subject of much attention as health care systems work to reduce costs and provide better care. As part of their work to understand best practices for addressing the medical and social needs of high-need/high-cost patients, Samantha Iovan, Paula Lantz, Katie Allan, and Mahshid Abir published a systematic review examining interventions that are being implemented to address super-utilizers in prehospital and emergency care settings in the U.S.

Commentary

Across the country, changes to Medicaid policy are under way. They hold the potential to dramatically alter the landscape of health care for millions of low-income individuals.