The Deficit Reduction Act's (DRA) Citizenship Documentation Requirements for Medicaid Through the Eyes of State Officials in December 2006 and January 2007

Based on interviews, summarizes how state officials expect the 2005 citizenship documentation requirement for Medicaid to affect efforts to simplify application processes and enrollment in Medicaid and State Children's Health Insurance Programs

Covering Kids & Families Evaluation: Lasting Legacies of Covering Kids & Families

Outlines results of a survey of Medicaid and State Children's Health Insurance Program officials in forty-six states on the impact of RWJF's initiative to increase outreach and enrollment, including grantees' strategies, effectiveness, and sustainability

Covering Kids & Families Evaluation: Sustaining the Effects of Covering Kids & Families on Policy Change

Presents results of a follow-up survey of Medicaid and State Children's Health Insurance Program officials to assess the policy and procedural changes shaped by Covering Kids & Families, RWJF's initiative to expand enrollment in these programs

Covering Kids & Families Evaluation: Public Coverage Versus No Coverage for Children: Perceptions and Experiences of Parents in Four Cities

Based on interviews, examines the perceptions and experiences that shape parents' decisions on enrolling their children in Medicaid and State Children's Health Insurance Programs. Considers remaining challenges, including language barriers

Dynamics of Race, Culture and Key Indicators of Health in the Nation's 100 Largest Cities and Their Suburbs

Profiles the 2000 status of, and changes since 1990, in rates of health and health-related measures to identify patterns in race/ethnicity, foreign-born status, language use, poverty, income, low birth weight, teen births, prenatal care, and tuberculosis

PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010: Advancing Health Equity for Racially and Ethnically Diverse Populations

Racial/ethnic disparities in health and health care in the United States are persistent and well documented. Communities of color fare far worse than their white counterparts across a range of health indicators: life expectancy, infant mortality, prevalence of chronic diseases, self-rated health status, insurance coverage, and many others.1 As the nation’s population continues to become increasingly diverse—people of color are projected to comprise 54% of the U.S. population by 2050 and more than half of U.S. children by 20232— these disparities are likely to grow if left unaddressed. Recent health care reform legislation, while not a panacea for eliminating health disparities, off ers an important fi rst step and an unprecedented opportunity to improve health equity in the United States. Reforming the nation’s health care system was President Obama’s top domestic priority when he was sworn into offi ce in January 2009. Th e road to reform was complex and unoffi cially started in summer of 2009 when House and Senate committees began to draft legislation. On November 7, 2009, the House of Representatives passed its health care reform proposal, Th e Aff ordable Health Choices Act of 2009 (H.R. 3962). On December 24, 2009, the Senate passed its own proposal for health care reform, Th e Patient Protection and Aff ordable Care Act (H.R. 3590)*, which was a merged version of the Senate Finance Committee’s America’s Health Future Act (S.1796) and the Senate Committee on Health, Education, Labor, and Pensions’ Aff ordable Health Choices Act (S. 1697).† Eff orts to reconcile diff erences between the Senate and House bills were stymied by the death of Senator Edward Kennedy (D-MA), a lifelong proponent of health care reform and critical force in securing a proposal’s passage in the Senate. Faced with limited options and expecting that a compromise bill could not get Senate support, the House passed the Senate’s proposal and Th e Patient Protection and Aff ordable Care Act (ACA) was signed into law by President Obama on March 23, 2010 (Pub. L. No. 111-148).‡ On March 30, 2010, the ACA was amended by Th e Health Care and Education Reconciliation Act of 2010 (H.R. 4872). According to Congressional Budget Offi ce (CBO) estimates, the ACA, as reconciled by H.R. 4872, will reduce the defi cit by $143 billion over the next decade and decrease the number of non-elderly uninsured by 32 million, leaving 23 million uninsured— approximately one-third of whom would be undocumented immigrants.3 Th is report provides a comprehensive review of general and specifi c ACA provisions with the potential to signifi cantly improve health and health care for millions of diverse populations and their communities. Th e narrative that follows identifi es these provisions, discusses why they are important, and considers challenges that may lie ahead in implementing them. We have organized this presentation in three major sections. Th e next section discusses provisions that explicitly address health disparities, such as those concerning data collection by race/ethnicity, workforce diversity, cultural competence, health disparities research, health disparities initiatives in prevention, and health equity in health insurance reform, and discusses their implications for racially and ethnically diverse communities. Section III describes general provisions, including health insurance reforms, access to care, quality improvement, cost containment, public health and social determinants of health, all of which are likely to have major implications for diverse communities. An accompanying appendix identifi es these provisions, provides a timetable and, where identifi ed in the legislation, the federal agencies responsible for implementation, as well as allocations as of June 30, 2010. Section IV discusses issues that will be critical in realizing the full potential of health care reform and highlights questions and directions for the future, particularly in context of important priorities for reducing racial/ethnic health disparities that were left unaddressed

Development of an Antimicrobial Stewardship Intervention Using a Model of Actionable Feedback

We describe the development of an audit and feedback intervention to improve antibiotic prescribing in the neonatal intensive care unit (NICU) using a theoretical framework. Participants included attending physicians, neonatal fellows, pediatric residents, and nurse practitioners. The intervention was based on the “model of actionable feedback” which emphasizes that feedback should be timely, individualized, nonpunitive, and customized to be effective. We found that real-time feedback could not be provided for the parameters established in this study, as we had to collect and analyze numerous data elements to assess appropriate initiation and continuation of antibiotics and required longer intervals to examine trends in antibiotic use. We learned during focus groups that NICU clinicians strongly resisted assigning individual responsibility for antibiotic prescribing as they viewed this as a shared responsibility informed by each patient's laboratory data and clinical course. We were able to create a non-punitive atmosphere thanks to written informed consent from NICU attendings and assurance from leadership that prescribing practices would not be used to assess job performance. We provided customized, meaningful feedback integrating input from the participants. Adapting the principles of the “model of actionable feedback” to provide feedback for antimicrobial prescribing practices proved challenging in the NICU setting

Quality of Life in the Nation's 100 Largest Cities and Suburbs: New and Continuing Challenges for Improving Health and Well-Being

Examines the progress made in the largest U.S. cities and their suburbs in alleviating poverty, improving educational achievement, and reducing unemployment and violent crime from 1990 to 2000

Health Care Proposals of the 2008 Democratic and Republican Presidential Nominees: Implications for Improving Acc ess, Affordability and Quality for America’s Minorities

In this election year, affordable health care is among the top issues for voters. Recognizing the need for action, the Republican and Democratic nominees have made health care reform a centerpiece of their respective presidential platforms. Each believes his approach will work best to expand health insurance coverage, reduce costs and improve quality for the world’s most costly health care system. Of greatest concern are the 47 million Americans without health insurance—half of whom are minorities. As the U.S. grows more racially and ethnically diverse, so, too, does the significance of disparities in chronic disease rates, shorter life spans and access to affordable, high quality health care. High uninsured rates and racial/ethnic disparities are the primary reasons why the United States lags behind the world’s most developed countries on most indicators of health status