Who Are the Remaining Uninsured and Why Haven't They Signed Up for Coverage? Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, FebruaryApril 2016

The number of uninsured people in the United States has declined by an estimated 20 million since the Affordable Care Act went into effect in 2010. Yet, an estimated 24 million people still lack health insurance. Goal: To examine the characteristics of the remaining uninsured adults and their reasons for not enrolling in marketplace plans or Medicaid. Methods: Analysis of the Commonwealth Fund ACA Tracking Survey, February–April 2016. Key findings and conclusions: There have been notable shifts in the demographic composition of the uninsured since the law's major coverage expansions went into effect in 2014. Latinos have become a growing share of the uninsured, rising from 29 percent in 2013 to 40 percent in 2016. Whites have become a declining share, falling from half the uninsured in 2013 to 41 percent in 2016. The uninsured are very poor: 39 percent of uninsured adults have incomes below the federal poverty level, twice the rate of their overall representation in the adult population. Of uninsured adults who are aware of the marketplaces or who have tried to enroll for coverage, the majority point to affordability concerns as a reason for not signing up

How Will the Affordable Care Act's Cost-Sharing Reductions Affect Consumers' Out-of-Pocket Costs in 2016?

Health insurers selling plans in the Affordable Care Act's marketplaces are required to reduce cost-sharing in silver plans for low- and moderateincome people earning between 100 percent and 250 percent of the federal poverty level. In 2016, as many as 7 million Americans may have plans with these cost-sharing reductions. In the largest markets in the 38 states using the federal website for marketplace enrollment, the cost-sharing reductions substantially lower projected out-of-pocket costs for people who qualify for them. However, the degree to which consumers' out-of-pocket spending will fall varies by plan and how much health care they use. This is because insurers use deductibles, out-of-pocket limits, and copayments in different combinations to lower costsharing for eligible enrollees. In 2017, marketplace insurers will have the option of offering standard plans, which may help simplify consumers' choices and lead to more equal cost-sharing

How Deductible Exclusions in Marketplace Plans Improve Access to Many Health Care Services

Only by knowing which health care services are excluded from their insurance plan's deductible can consumers take full advantage of their coverage and ensure timely access to needed care. This is particularly important for people with higher incomes who do not qualify for the Affordable Care Act's cost-sharing reductions and individuals who do not use a lot of health care services and are therefore unlikely to reach their annual deductible. This analysis of silver-tier plans offered in the largest markets in states using HealthCare.gov for marketplace enrollment finds that 30 of 37 plans exclude primary care visits, as well as generic drugs, from the deductible. In 24 of these plans, specialist visits and prescriptions for preferred brand-name drugs are excluded as well. The number of excluded services varies considerably by market

The specialized thoracic skeletomuscular system of the myrmecophile Claviger testaceus (Pselaphinae, Staphylinidae, Coleoptera)

External and internal structures of the thorax of the myrmecophile beetle Claviger testaceus (Clavigeritae, Pselaphinae) were examined and documented with state-of-the-art visualization techniques. Following a general trend in the omaliine lineage (Staphylinidae), the skeletal elements of the pro- and pterothorax in Claviger reach a maximum degree of compactness, with largely reduced inter- and intrasegmental sutures and skeletal elements linked with the flight apparatus. The musculature, especially metathoracic direct and indirect flight muscles, also shows a high degree of reduction. Two forms of wings were found among individuals of C. testaceus, both non-functional and representing an advanced stage of reduction. However, that wing vestiges are still present and the metanotum, only slightly reduced, suggests that loss of flight in this species is likely the result of a young evolutionary process. Several structures are linked with myrmecophilous habits: small body size facilitates transportation of beetles by ant workers and makes it easier to move inside nest tunnels; the remarkably compact body and mechanically robust appendages make the beetles less vulnerable to attacks by ant mandibles; the improved elytral interlocking mechanism and unusually expanded epipleura enhance the protection of vulnerable dorsal parts of the pterothorax and anterior abdomen; and glands associated with trichomes on the posterolateral elytral angle produce secretions attractive for ants. Various modifications of the thorax and anterior abdomen lead to an optimization of intimate associations with ants. The morphological syndrome enabling these beetles to cope with life in ant colonies evolved in several steps. This is suggested by an increasing solidification of the thoracic skeleton in related non-myrmecophilous groups and also by less modified related clavigerites;for instance, ant-associated tropical species are still able to fly.Introduction Materials and methods - Studied species - Light microscopy - Micro-computed tomography (μCT) - Scanning electron microscopy (SEM) - Terminology Results - Prothorax - Pterothorax - Anterior abdominal segments Discussion - Phylogenetic background - Musculature - Elytral locking system and flightlessness - Myrmecophilous habits Conclusion

VegMachine.net. Online land cover analysis for the rangelands

VegMachine.net is an online land cover monitoring tool unded by the Fitzroy Basin Association (FBA). The tool focuses primarily on Queensland, but has functionality for much of Australia’s rangelands. The website went live in July 2016 and recently logged the 1000th user session. Users can view seven different seasonal time series of cover products across the landscape and interactively interrogate and graph ground cover change in six different on-the-fly and email delivered reports. Results can then be exported for use in other software. To date, users have generated over 400 VegMachine® FORAGE ground cover reports which provide paddock-by-paddock, landtype-by-landtype analysis of ground cover change from 1990 to the present. Detailed help is available in multiple formats, including website popups and a dedicated YouTube channel. The web application was designed for two main user groups; technically equipped RD&E personnel including those servicing land manager clients, and a subset of the grazier community willing to operate the service themselves. Initial rollout of the application focused primarily on training events for government agency, private consultancy and natural resource management (NRM) staff in regional Queensland. These users form the core of the current user base. In this paper, we outline the development of VegMachine.net. We demonstrate the primary functionality of the website, provide an overview of user experience including a case study and discuss major learnings and future directions

VegMachine.net. online land cover analysis for the Australian rangelands

This paper documents the development and use of the VegMachine.net land cover monitoring tool. From 2002 to 2015, VegMachine® software was used by government agencies, natural resource management (NRM) groups and individual pastoralists in northern Australia to assess and benchmark vegetation cover levels. In 2016 the VegMachine.net website was launched to build a wider user base and assure service continuity. Users can now graph historical (1990-) cover on one or more user defined areas of interest (AOI), produce comprehensive paddock-by-paddock property monitoring reports, and view a range of land cover raster images through the website map panel. In its first 32 months of operation 913 users logged 1604 sessions on the website and more than 1000 of the website's most comprehensive monitoring reports were distributed to users. Levels of use varied 26% of users (n = 237) have used the website more than once, and within this group a smaller set of regular users (n = 36) have used the site more than five times, in many cases to provide analyses to multiple clients. We outline four case studies that document the significant impact VegMachine.net has had on users including graziers, government agencies, NRM groups and researchers. We also discuss some possible paths forward that could widen the user base and improve retention of first time users. © 2019 The State of Queensland (through the Department of Agriculture and Fisheries) 2019 Open Access

To Enroll or Not to Enroll? Why Many Americans Have Gained Insurance Under the Affordable Care Act While Others Have Not

According to the most recent Commonwealth Fund Affordable Care Act Tracking Survey, March–May 2015, an estimated 25 million adults remain uninsured. To achieve the Affordable Care Act's goal of near-universal coverage, policymakers must understand why some people are enrolling in the law's marketplace plans or in Medicaid coverage and why others are not. This analysis of the survey finds that affordability—whether real or perceived—is playing a significant role in adults' choice of marketplace plans and the decision whether to enroll at all. People who have gained coverage report significantly more positive experiences shopping for health plans than do those who did not enroll. Getting personal assistance— from telephone hotlines, navigators, and insurance brokers, among other sources— appears to make a critical difference in whether people gain health insurance

How High Is America's Health Care Cost Burden? Findings from the Commonwealth Fund Health Care Affordability Tracking Survey, July-August 2015

One-quarter of privately insured working-age adults have high health care cost burdens relative to their incomes in 2015, according to the Commonwealth Fund Health Care Affordability Index, a comprehensive measure of consumer health care costs. This figure, which is based on a nationally representative sample of people with private insurance who are mainly covered by employer plans, is statistically unchanged from 2014. When looking specifically at adults with low incomes, more than half have high cost burdens. In addition, when privately insured adults were asked how they rated their affordability, greater shares reported their premiums and deductible costs were difficult or impossible to afford than the Index would suggest. Health plan deductibles and copayments had negative effects on many people's willingness to get needed health care or fill prescriptions. In addition, many consumers are confused about which services are free to them and which count toward their deductible

Are Marketplace Plans Affordable? Consumer Perspectives from the Commonwealth Fund Affordable Care Act Tracking Survey, March-May 2015

Most employers who provide health insurance to employees subsidize their premiums and provide a comprehensive benefit package. Before the Affordable Care Act, people who lacked health insurance through a job and purchased it on their own paid the full cost of their plans, which often came with skimpy benefit packages and high deductibles. Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, March–May 2015, indicate that the law's tax credits have made premium costs in health plans sold through the marketplaces roughly comparable to employer plans, at least for people with low and moderate incomes. At higher incomes, the phase-out of the subsidies means that adults in marketplace plans have higher premium costs than those in employer plans. Overall, larger shares of adults in marketplace plans reported deductibles of $1,000 or more, compared with those in employer plans, though these differences were narrower among lowand moderate-income adults

National Trends in the Cost of Employer Health Insurance Coverage, 2003-2013

Looking at trends in private employer-based health insurance from 2003 to 2013, this issue brief finds that premiums for family coverage increased 73 percent over the past decade—faster than median family income. Employees' contributions to their premiums climbed by 93 percent over that time frame. At the same time, deductibles more than doubled in both large and small firms. Workers are thus paying more but getting less protective benefits. However, the study also finds that while premiums continued to rise through 2013, the rate of growth slowed between 2010 and 2013, following implementation of the Affordable Care Act. While families experienced slower growth in premium contributions and deductibles over this period, sluggish growth in median family income means families are paying more in premiums and deductibles as a share of their income than ever before