Reporting on Pathways to Health Insurance Coverage: California's Experience

The Affordable Care Act opened new and expanded pathways to public health insurance coverage. Since 2014, many states have broadened their eligibility criteria for Medicaid, and have introduced new access points for Medicaid enrollment. During this time, publicly subsidized health insurance coverage also became available through state health insurance exchanges and through the federal health insurance marketplace. Recognizing there is a great deal to learn about who applies for and obtains these types of public coverage, the federal government and some states have established new data reporting efforts on how people use both new and existing pathways to health insurance coverage. In 2014 and 2015, Mathematica Policy Research supported the launch of such a reporting effort in California, with funding from the California Health Care Foundation. In this brief, we describe California's experience in reporting on applications, eligibility determinations, enrollments and coverage renewals for public insurance, highlight some of the practical implications of California's first few reports, and offer lessons for other states that are launching comparable reporting efforts. Key Findings: The open enrollment period drives enrollment growth for both qualified health plans and Medi-Cal, even though Medi-Cal enrollment remains open year-round. Insurance coverage was more stable over time than expected. During the second open enrollment period, 92 percent of individuals enrolled in qualified health plans in California renewed their coverage from the previous year. During that same period about 80 percent of Medi-Cal beneficiaries remained eligible for coverage. California's experience with reporting on public insurance coverage suggests that significant effort is needed to carefully define measures, produce data that are meaningful to multiple audiences, and communicate findings clearly. Public data reporting can be a powerful tool for advancing transparency and identifying areas for improvement. State officials in California now have an opportunity to examine local variation in application and enrollment measures to identify policy or process differences that might be driving different outcomes across the state

The Effect of Unrewarded Exploration Upon Maze Learning in Rats

This experiment deals with the phenomenon of latent learning. It was specifically designed to measure the effect of prior unrewarded maze exploration upon subsequent performance under condition of both positive and negative reinforcement

VOCALIZATION SUBSYSTEM RESPONSES TO A TEMPORARILY INDUCED UNILATERAL VOCAL FOLD PARALYSIS

Healthy voicing is thought to be dependent on a dynamic balance of three interactive subsystems: respiration, phonation, and resonance. Theoretically, multiple patterns of subsystem interactions likely underlie healthy voice production; however surprisingly little quantitative data exists defining the nature of these subsystem production patterns and interactions across individuals. The central aim of this study was to quantify the interactions of the vocalization subsystems in a non-perturbed and perturbed condition (induced unilateral vocal fold paralysis) in 10 vocally healthy participants. Respiratory inductance plethysmography, laryngeal aerodynamics, and acoustic formant data were used to measure the proportional contributions of, and changes to, the three vocal subsystems during voice production tasks. The overall hypothesis was that individuals would demonstrate distinctive patterns of change in voice subsystem interaction across vocalization conditions, resulting in characteristic vocalization profiles. Using Dynamics Systems Theory (DST) as a guide, we hypothesized that analysis of group data alone would hide important individual variability that would help better understand differences in subsystem regulation across individuals. Additionally, in accordance with DST, we hypothesized that although there would be individual variability during voice production tasks, only a small group of characteristic subsystem patterns would emerge, permitting subgrouping of individuals into unique vocalization profiles. Results demonstrated that group data masked important aspects of individual performance. Despite all individuals demonstrating paramedian paralysis on visualization during the perturbation phase, unique subsystem patterning strategies for coping with the acute vocal fold paralysis were observed. Despite individual variability, subgroups were able to be determined which revealed commonalities in the dominant physiologic strategies of subsystem regulation across individuals. A dynamic systems state space model was constructed as a visual aid to demonstrate that the changes noted between voicing conditions were not random, but rather formed specific trajectories. Implications for translation of these results into clinical practice are discussed

The Evolution And Description Of A Process For Planning An Effective Composition Course.

PhDLanguageUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/189764/2/7717927.pd