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.
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.
Do Stricter Immunization Laws Improve Coverage? Evidence from the Repeal of Non-Medical Exemptions for School Mandated Vaccines
The rising rate of non-medical exemptions is a driving force behind our nationwide measles crisis. Chelsea J. Richwine, Avi Dor, and Ali Moghtaderi of George Washington University examine the effect of California’s 2016 decision to repeal all non-medical exemptions on immunization coverage in a new working paper.
Public health practitioners and tobacco control advocates agree that pre-emption (a higher level of government stripping lower levels of government of their authority over a specific subject matter) has an adverse impact on tobacco control efforts. Pre-emptive state laws may prohibit local tobacco control measures, such as restrictions on marketing and promotion of tobacco products, licensure of tobacco products, smoking in public or private sites, and on youth access to tobacco products.
State pre-emption is an emerging and highly contentious policy movement with potentially significant consequences on population health. Yet robust analyses to examine whether pre-emption affects health have yet to be conducted. Furthermore, pre-emption’s effect on geographic inequities in health has been largely neglected in policy debates. But it is becoming increasingly clear that state pre-emption laws could reshape the spatial distribution of health, with profound consequences for health care delivery systems and state and local budgets.
How State Pre-emption is Associated with Evidence-Based Policymaking and Health Equity Across Populations
Local governments are often on the forefront of enacting innovative public health policy, and local control over public health issues is especially vital to address social inequities. Pre-emption removes the ability of local governments to enact these laws and may hinder public health policy adoption and diffusion within a state and across the country.
In January 2020, the Supreme Court allowed the Department of Homeland Security to implement a new rule regarding the definition of “public charge.” Our team is collecting primary data from two distinct populations to explore awareness of the public charge rule, sources of information about the rule, and how the rule may affect decisions on obtaining medical care and participating in public programs.