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

Review: Global Decadence, Race, and Futures of Decadence Studies Conference, Online, 31 March - 1 April 2023

Comments from the closing roundtable serve as the point of departure for our review of the ‘Global Decadence, Race, and the Future of Decadence Studies’ conference, held virtually from 31 March to 1 April 2023. Sponsored by the Jefferson Scholars Foundation, the University of Virginia Arts and the Office of the Provost & the Vice Provost of the Arts, and the Decadence Research Centre at Goldsmiths, University of London, the event was a short but profound glimpse into the current state of the field of decadence studies.&nbsp

Passage and reversal effects on gene expression of bovine meniscal fibrochondrocytes

The knee meniscus contains a mixed population of cells that exhibit fibroblastic as well as chondrocytic characteristics. Tissue engineering studies and future therapies for the meniscus require a large population of cells that are seeded on scaffolds. To achieve this, monolayer expansion is often used as a technique to increase cell number. However, the phenotype of these cells may be significantly different from that of the primary population. The objective of this study was to investigate changes in meniscal fibrochondrocytes at the gene expression level over four passages using quantitative real-time reverse transcriptase polymerase chain reaction. Cells from the inner two-thirds of bovine medial menisci were used. Four extracellular matrix (ECM) molecules, commonly found in the meniscus, were investigated, namely collagen I, collagen II, aggrecan and cartilage oligomeric matrix protein (COMP). In addition, primary and passaged meniscus fibrochondrocytes were placed on surfaces coated with collagen I or aggrecan protein to investigate whether any gene expression changes resulting from passage could be reversed. Collagen I expression was found to increase with the number of passages, whereas collagen II and COMP expression decreased. Collagen I and aggrecan surface coatings were shown to downregulate and upregulate collagen I and COMP expression levels, respectively, in passaged cells. However, decreases in collagen II expression could not be reversed by either protein coating. These results indicate that although monolayer expansion results in significant changes in gene expression in meniscal fibrochondrocytes, protein coatings may be used to regain the primary cell expression of several ECM molecules

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

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

STUDYING mRNA TRANSPORT AND REGULATION OF RETROGRADE INJURY SIGNALING ASSOCIATED AXONAL TRANSCRIPT LEVELS IN THE CONTEXT OF AXONAL REGENERATION

This dissertation focuses on a detailed mechanism of mRNA transport during development of hippocampal neurons, and regulation of retrograde injury signaling (RIS)-associated genes in the context of regeneration. Damaged neurons in the CNS are unable to regenerate leading to neuronal degeneration and cell death. Identifying mechanisms that promote axonal regeneration of the damaged fibers is beneficial. First, I set to explore the detailed quantification of mRNA transport during the development of hippocampal neurons. Rigorous quantitative assessment of mRNA transport concluded that mRNA transport is driven by the functional demands of the cell. I measured the velocity, directionality and the duration of mRNA particles. In the axons, net velocity was highest at day 7 in vitro, which coincides with the initial stage of synapse formation. Within dendrites, it continues to increase through day 12 in vitro coinciding with an increased duration of synaptic contact, suggesting role of protein synthesis in context of sustained synaptic connectivity. Next, I set to explore regulations of genes involved in RIS process, a process stimulated upon injury and required for axonal regeneration. Investigation of regulation of RIS associated axonal transcript levels led to development of a whole hippocampal explant culture system. The hippocampal explant culture system enabled examination of axonal gene and protein expression independent of neuronal cell bodies. The study of RIS process suggests a novel biphasic increase in axonal gene expression (1 & 24 hrs post-injury). These genes are tightly and differentially regulated contributing to early synthesis of corresponding axonal proteins in hippocampal neurons. Additionally, importin β-dependent activity at the nucleus then appears to modulate a second wave (24 hrs) of RIS-associated transcripts, which are likely to further support axonal outgrowth. These studies provide insight into a powerful set of axonal processes that may be exploited to enhance CNS regeneration and repair

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

The Health Costs of Gun Violence: How the U.S. Compares to Other Countries

In the following seven charts, we illustrate how gun violence affects Americans compared to people in 13 other high-income countries. The data are drawn from the Institute for Health Metrics and Evaluation's (IHME) Global Burden of Disease database, the Small Arms Survey's Global Firearms Holdings database, and the U.S. Government Accountability Office's Firearm Injuries: Health Care Service Needs and Costs report (see "Data Sources and Methods" for details)

Following the ACA Repeal-and-Replace Effort, Where Does the U.S. Stand on Insurance Coverage? Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, MarchJune 2017

Issue: After Congress's failure to repeal and replace the Affordable Care Act, some policy leaders are calling for bipartisan approaches to address weaknesses in the law's coverage expansions. To do this, policymakers will need data about trends in insurance coverage, reasons why people remain uninsured, and consumer perceptions of affordability.Goal: To examine U.S. trends in insurance coverage and the demographics of the remaining uninsured population, as well as affordability and satisfaction among adults with marketplace and Medicaid coverage.Methods: Analysis of the Commonwealth Fund Affordable Care Act Tracking Survey, March–June 2017.Findings and Conclusions: The uninsured rate among 19-to-64-year-old adults was 14 percent in 2017, or an estimated 27 million people, statistically unchanged from one year earlier. Uninsured rates ticked up significantly in three subgroups: 35-to-49-year-olds, adults with incomes of 400 percent of poverty or more (about $48,000 for an individual), and adults living in states that had not expanded Medicaid. Half of uninsured adults, or an estimated 13 million, are likely eligible for marketplace subsidies or the Medicaid expansion in their state. Four of 10 uninsured adults are unaware of the marketplaces. Adults in marketplace plans with incomes below 250 percent of poverty are much more likely to view their premiums as easy to afford compared with people with higher incomes. Policies to improve coverage include a federal commitment to supporting the marketplaces and the 2018 open enrollment period, expansion of Medicaid in 19 remaining states, and enhanced subsidies for people with incomes of 250 percent of poverty or more