The Impact of Program Changes on Enrollment, Access, and Utilization in the Oregon Health Plan Standard Population

In February 2003, in an effort to expand Medicaid coverage within tight fiscal constraints, the Oregon Health Plan (OHP) underwent a significant redesign of benefits, cost-sharing and premium structure. The OHP2 redesign resulted in two tiers of coverage, OHP Plus and OHP Standard, and a premium subsidy program. The OHP Plus benefit package and cost sharing structure is similar to the original OHP and serves the federally-mandated Medicaid populations: children and pregnant women, low-income elderly and individuals meeting the SSI definition of disability. OHP Standard, designed for Oregon’s expansion population,1 includes a reduced benefit package, expanded co-pays and increased premiums. Premium rules were also tightened for the OHP Standard group: individuals are now disqualified from benefits for non-payment of premiums and locked-out from OHP for six months following a disqualification. In addition, monthly premiums are no longer waived for certain groups.(e.g., homeless, zero income). In order to assess the impact of recent program changes, a mail-return survey was conducted between November 2003 and February 2004 with a random sample of OHP beneficiaries who were enrolled as of February 2003, immediately before the program changes were implemented. The survey assessed issues related to enrollment, health care access, health care use, and financial and health status and covered a six-month period following the OHP changes. A total of 2,783 individuals completed surveys, 1,405 individuals in OHP Plus and 1,378 in OHP Standard. This report presents descriptive survey results for the 1,378 OHP Standard enrollees and addresses the impact of recent program changes on 3 key outcomes: enrollment, health care access, and utilization

The Impacts of Medicaid Expansion on Rural Low-Income Adults: Lessons From the Oregon Health Insurance Experiment.

Medicaid expansions through the Affordable Care Act began in January 2014, but we have little information about what is happening in rural areas where provider access and patient resources might be more limited. In 2008, Oregon held a lottery for restricted access to its Medicaid program for uninsured low-income adults not otherwise eligible for public coverage. The Oregon Health Insurance Experiment used this opportunity to conduct the first randomized controlled study of a public insurance expansion. This analysis builds off of previous work by comparing rural and urban survey outcomes and adds qualitative interviews with 86 rural study participants for context. We examine health care access and use, personal finances, and self-reported health. While urban and rural populations have unique demographic profiles, rural populations appear to have benefited from Medicaid as much as urban. Qualitative interviews revealed the distinctive challenges still facing low-income uninsured and newly insured rural populations

The Effect Of Medicaid On Medication Use Among Poor Adults: Evidence From Oregon.

Oregon\u27s 2008 Medicaid expansion significantly increased the use of prescription medications in 2009-10

Citizenship Documentation Requirement for Medical Eligibility: Effects on Oregon Children

BACKGROUND AND OBJECTIVES: The Deficit Reduction Act (DRA) of 2005 mandated Medicaid beneficiaries to document citizenship. Using a prospective cohort (n=104,375), we aimed to (1) determine characteristics of affected children, (2) describe effects on health insurance coverage and access to needed health care, and (3) model the causal relationship between this new policy, known determinants of health care access, and receipt of needed health care. METHODS: We identified a stratified random sample of children shortly after the DRA was implemented and used state records and surveys to compare three groups: children denied Medicaid for inability to document citizenship, children denied for other reasons, and children accepted for coverage. To combat survey nonresponse, we used Medicaid records to identify differences between responders and nonrespondents and created survey weights to account for these differences. Weighted simple and multivariable logistic regression described the complete, originally identified population. RESULTS: Children denied Medicaid for inability to document citizenship were likely to be US citizens, were medically and socially more vulnerable than their peers, and went on to have gaps in health insurance coverage and unmet health care needs. The DRA led to persistent loss of insurance coverage, which decreased access to needed health care. Having a usual source of care was an effect modifier in this relationship. CONCLUSIONS: Our findings demonstrate the negative consequences of the DRA and support the use of automated methods of citizenship verification allowed under the Patient Protection and Affordable Care Act

The Impact of Program Changes on Health Care for the OHP Standard Population: Early Results from a Prospective Cohort Study

The purpose of this study is to assess the impact of benefit changes on the Oregon Health Plan (OHP) Standard Population across three domains: Enrollment; Access to care; Utilizatio

The Effect of Medicaid on Dental Care of Poor Adults: Evidence from the Oregon Health Insurance Experiment.

OBJECTIVE: To evaluate the effect of Medicaid coverage on dental care outcomes, a major health concern for low-income populations. DATA SOURCES: Primary and secondary data on health care use and outcomes for participants in Oregon\u27s 2008 Medicaid lottery. STUDY DESIGN: We used the lottery\u27s random selection to gauge the causal effects of Medicaid on dental care needs, medication, and emergency department visits for dental care. DATA COLLECTION: Data were collected for lottery participants over 2 years, including mail surveys (N = 23,777) and in-person questionnaires (N = 12,229). Emergency department (ED) records were matched to lottery participants in Portland (N = 24,646). PRINCIPAL FINDINGS: Medicaid coverage significantly reduced the share of respondents who reported needing dental care (-9.8 percentage points, p \u3c .001) or having unmet dental care needs (-13.5 percentage points, p \u3c 0.001). Medicaid doubled the share visiting the ED for dental care (+2.6 percentage points, p = .003) and the use of anti-infective medications often prescribed for dental care, but it had no detectable effect on uncovered dental care or out-of-pocket spending. CONCLUSIONS: Expansion of Medicaid covering emergency dental care substantially reduced unmet need for dental care, increasing ED dental visits and medication use, while not changing patient use of uncovered dental services

What The Oregon Health Study Can Tell Us About Expanding Medicaid

The recently enacted Patient Protection and Affordable Care Act includes a major expansion of Medicaid to low-income adults in 2014. This paper describes the Oregon Health Study, a randomized controlled trial that will be able to shed some light on the likely effects of such expansions. In 2008, Oregon randomly drew names from a waiting list for its previously closed public insurance program. Our analysis of enrollment into this program found that people who signed up for the waiting list and enrolled in the Oregon Medicaid program were likely to have worse health than those who did not. However, actual enrollment was fairly low, partly because many applicants did not meet eligibility standards.United States. Dept. of Health and Human Services. Office of the Assistant Secretary for Planning and EvaluationCalifornia HealthCare FoundationJohn D. and Catherine T. MacArthur FoundationNational Institute on AgingRobert Wood Johnson FoundationAlfred P. Sloan FoundationUnited States. Social Security Administratio

Reliable, scalable functional genetics in bloodstream-form Trypanosoma congolense in vitro and in vivo.

Animal African trypanosomiasis (AAT) is a severe, wasting disease of domestic livestock and diverse wildlife species. The disease in cattle kills millions of animals each year and inflicts a major economic cost on agriculture in sub-Saharan Africa. Cattle AAT is caused predominantly by the protozoan parasites Trypanosoma congolense and T. vivax, but laboratory research on the pathogenic stages of these organisms is severely inhibited by difficulties in making even minor genetic modifications. As a result, many of the important basic questions about the biology of these parasites cannot be addressed. Here we demonstrate that an in vitro culture of the T. congolense genomic reference strain can be modified directly in the bloodstream form reliably and at high efficiency. We describe a parental single marker line that expresses T. congolense-optimized T7 RNA polymerase and Tet repressor and show that minichromosome loci can be used as sites for stable, regulatable transgene expression with low background in non-induced cells. Using these tools, we describe organism-specific constructs for inducible RNA-interference (RNAi) and demonstrate knockdown of multiple essential and non-essential genes. We also show that a minichromosomal site can be exploited to create a stable bloodstream-form line that robustly provides >40,000 independent stable clones per transfection-enabling the production of high-complexity libraries of genome-scale. Finally, we show that modified forms of T. congolense are still infectious, create stable high-bioluminescence lines that can be used in models of AAT, and follow the course of infections in mice by in vivo imaging. These experiments establish a base set of tools to change T. congolense from a technically challenging organism to a routine model for functional genetics and allow us to begin to address some of the fundamental questions about the biology of this important parasite

“Our Relationship? It’s the Odd Mucky Weekend, Not a One Night Stand”: Journalists and aid agencies in the UK, and the current challenges to sourcing in humanitarian disasters

In humanitarian crises, the sources that journalists employ have always helped determine which stories achieve a high media profile, as well as play a part in framing the story. In particular, aid agencies acted as powerful gatekeepers to disaster zones, providing flights, transport, fixers and translators to journalists–and more recently, text, images and resources for the social web. Questions have been raised around transparency and objectivity in such reporting as a result. This paper draws on 40 semi-structured qualitative interviews with UK national journalists (broadcast, print and online) and aid agencies belonging to the UK's Disasters Emergency Committee. As a result, this paper builds on journalism studies looking at boundary (re)negotiations in journalism and the source-media relationship to show the current patterns in what has been described as a “mutually exploitative” relationship. It compares and contrasts what assistance journalists say they accept from aid agencies and what aid agencies report. It examines how both sides are often unwilling to acknowledge the close association. It will also look at how the increasing professionalisation of NGO operations including the employment of former journalists and producing their own content may be affecting the power dynamics. Finally, it asks whether the slow emergence of scandals means this relationship has not only affected stories that are covered but those that are not

The Leucine-Rich Amelogenin Peptide Alters the Amelogenin Null Enamel Phenotype

The amelogenin proteins secreted by ameloblasts during dental enamel development are required for normal enamel structure. Amelx null (KO) mice have hypoplastic, disorganized enamel similar to that of human patients with mutations in the AMELX gene, and provide a model system for studies of the enamel defect amelogenesis imperfecta. Because many amelogenin proteins are present in developing enamel due to RNA alternative splicing and proteolytic processing, understanding the function of individual amelogenins has been challenging