Employer Health Insurance Mandates and the Risk of Unemployment

Employer health insurance mandates form the basis of many health care reform proposals. Proponents make the case that they will increase insurance, while opponents raise the concern that low-wage workers will see offsetting reductions in their wages and that in the presence of minimum wage laws some of the lowest wage workers will become unemployed. We construct an estimate of the number of workers whose wages are so close to the minimum wage that they cannot be lowered to absorb the cost of health insurance, using detailed data on wages, health insurance, and demographics from the Current Population Survey. We find that 33 percent of uninsured workers earn within $3 of the minimum wage, putting them at risk of unemployment if their employers were required to offer insurance. Assuming an elasticity of employment with respect to minimum wage increase of -0.10, we estimate that 0.2 percent of all full-time workers and 1.4 percent of uninsured full-time workers would lose their jobs because of a health insurance mandate. Workers who would lose their jobs are disproportionately likely to be high school dropouts, minority, and female. This risk of unemployment should be a crucial component in the evaluation of both the effectiveness and distributional implications of these policies relative to alternatives such as tax credits, Medicaid expansions, and individual mandates, and their broader effects on the well-being of low-wage workers.

Trps1 and Its Target Gene Sox9 Regulate Epithelial Proliferation in the Developing Hair Follicle and Are Associated with Hypertrichosis

Hereditary hypertrichoses are a group of hair overgrowth syndromes that are extremely rare in humans. We have previously demonstrated that a position effect on TRPS1 is associated with hypertrichosis in humans and mice. To gain insight into the functional role of Trps1, we analyzed the late morphogenesis vibrissae phenotype of Trps1Δgt mutant mice, which is characterized by follicle degeneration after peg downgrowth has been initiated. We found that Trps1 directly represses expression of the hair follicle stem cell regulator Sox9 to control proliferation of the follicle epithelium. Furthermore, we identified a copy number variation upstream of SOX9 in a family with hypertrichosis that significantly decreases expression of the gene in the hair follicle, providing new insights into the long-range regulation of SOX9. Our findings uncover a novel transcriptional hierarchy that regulates epithelial proliferation in the developing hair follicle and contributes to the pathology of hypertrichosis

A Health Impact Assessment of Proposed Public Transit Service Cuts and Fare Increases in Boston, Massachusetts

Transportation decisions have health consequences that are often not incorporated into policy-making processes. Health Impact Assessment (HIA) is a process that can be used to evaluate health effects of transportation policy. We present a rapid HIA evaluating health and economic effects of proposed fare increases and service cuts to Boston, Massachusetts’ public transit system. We used transportation modeling in concert with tools allowing for quantification and monetization of multiple pathways. We estimated health and economic costs of proposed transit system changes to be hundreds of millions of dollars per year, exceeding the budget gap the transit authority was required to close. Significant health pathways included crashes, air pollution, and physical activity. The HIA enabled stakeholders to advocate for more modest fare increases and service cuts, which were eventually adopted. This HIA was among the first to quantify and monetize multiple pathways linking transportation decisions with health and economic outcomes, using approaches that could be applied in different settings. Including health costs in transportation decisions can lead to policy choices with both economic and public health benefits

The Economic Burden of Prematurity in Canada

Background Preterm birth is a major risk factor for morbidity and mortality among infants worldwide, and imposes considerable burden on health, education and social services, as well as on families and caregivers. Morbidity and mortality resulting from preterm birth is highest among early (< 28 weeks gestational age) and moderate (28–32 weeks) preterm infants, relative to late preterm infants (33–36 weeks). However, substantial societal burden is associated with late prematurity due to the larger number of late preterm infants relative to early and moderate preterm infants. Methods The aim in this study was to characterize the burden of premature birth in Canada for early, moderate, and late premature infants, including resource utilization, direct medical costs, parental out-of-pocket costs, education costs, and mortality, using a validated and published decision model from the UK, and adapting it to a Canadian setting based on analysis of administrative, population-based data from Québec. Results Two-year survival was estimated at 56.0% for early preterm infants, 92.8% for moderate preterm infants, and 98.4% for late preterm infants. Per infant resource utilization consistently decreased with age. For moderately preterm infants, hospital days ranged from 1.6 at age two to 0.09 at age ten. Cost per infant over the first ten years of life was estimated to be $67,467 for early preterm infants,$52,796 for moderate preterm infants, and id="mce_marker"0,010 for late preterm infants. Based on population sizes this corresponds to total national costs of id="mce_marker"23.3 million for early preterm infants, $255.6 million for moderate preterm infants,$208.2 million for late preterm infants, and $587.1 million for all infants. Conclusion Premature birth results in significant infant morbidity, mortality, healthcare utilization and costs in Canada. A comprehensive decision-model based on analysis of a Canadian population-based administrative data source suggested that the greatest national-level burden is associated with moderate preterm infants due to both a large cost per infant and population size while the highest individual-level burden is in early preterm infants and the largest total population size is in late preterm infants. Although the highest medical costs are incurred during the neonatal period, greater resource utilization and costs extend into childhood

A Previously Healthy Adolescent With Acute Psychosis and Severe Hyperhidrosis

A previously healthy 15-year-old boy presented with 3 months of progressive psychosis, insomnia, back and groin pain, and hyperhidrosis. On examination, the patient was disheveled, agitated, and soaked with sweat, with systolic blood pressure in the 160s and heart rate in the 130s. Aside from occasional auditory and visual hallucinations, his neurologic examination was normal. The patient was admitted for an extensive workup, including MRI of the brain and spine and lumbar puncture, which were normal. Through collaboration with various pediatric specialists, including psychiatry and neurology, a rare diagnosis was ultimately unveiled

California Restorative Justice in Education: Stakeholders Finding Common Ground in Concepts and Practices

Restorative Justice in Education (RJE) is a positive alternative to zero tolerance disciplinary policies that can help reduce school suspensions and dropouts, reduce revenue losses, and improve the lives of youth and communities. This article describes work to define core practices in Restorative Justice in Education (RJE) efforts in California to enable practitioners to employ standardized concepts and develop programs whose outcomes can be evaluated. One hundred and seventy-four practitioners and stakeholders attended regional meetings to discuss and prioritize promising practices. These discussions were then analyzed, and the concepts were categorized into core and supportive practices in order to develop agreed-upon working definitions. Codification of concepts enables RJE practitioners and stakeholders to develop standardized practices and further RJE’s role in advancing equity in schools

La question de l’impasse thérapeutique en clinique transculturelle

La consultation transculturelle de l’hôpital Avicenne est souvent un lieu où convergent des patients aux parcours longs, douloureux, émaillés de traumatismes et de ruptures et des équipes en difficulté devant la complexité et la lourdeur de certaines situations. Désarroi et sentiment d’impasse sont doublement vécus avec un risque renforcé d’errance thérapeutique voire d’incompréhension et de malentendus si ce n’est de rejet. Le dispositif transculturel par la médiatisation de l’interaction patient-thérapeute permet l’élaboration d’un compromis qui préserve la position du thérapeute tout en étant cohérent avec les représentations culturelles du patient.The transcultural consultation service at the Avicenne hospital is often a setting where patients with long, painful trajectory tainted with trauma and break-ups and teams of professionals overwhelmed by the complexity of certain situations both converge. Confusion and feelings of deadlock are doubly experienced with a reinforced risk of therapeutic wandering, lack of comprehension and misunderstanding if not reject. The transcultural mechanism that mediates the interaction between patient and therapist allows the elaboration of a compromise preserving the position of the therapist while being coherent with the patient’s cultural representations.La consulta transcultural del hospital Avicenne es con frecuencia un lugar donde convergen los pacientes de trayectorias largas, dolorosas, plagadas de traumas y rupturas, y los equipos en dificultad ante la complejidad y la pesadez de ciertas situaciones. Se viven el doble de desasosiegos y sentimientos de impase con un riesgo reforzado de divagación terapéutica, es decir, incomprensión y malentendidos, si no es que rechazo. El dispositivo transcultural permite, por medio de la mediatización de la interacción paciente-terapeuta, la elaboración de un compromiso que preserva la posición del terapeuta al mismo tiempo que es coherente con las representaciones culturales del paciente.A consulta transcultural do hospital Avicenne é freqüentemente um local para onde convergem pacientes que têm percursos longos, dolorosos, carregados de traumatismos e de rupturas e das equipes em dificuldade diante da complexidade e do peso de certas situações. Transtorno e sentimento de impasse são duplamente vivenciados com um risco acompanhado de errância terapêutica, ou mesmo de incompreensão e de equívocos quando não de rejeição. O dispositivo transcultural pela mediatização da interação paciente-terapeuta permite a elaboração de um meio-termo que preserva a posição do terapeuta, estando, ao mesmo tempo, coerente com as representações culturais do paciente

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

Ly6cLo non-classical monocytes promote resolution of rhesus rotavirus-mediated perinatal hepatic infammation

Perinatal hepatic inflammation can have devastating consequences. Monocytes play an important role in the initiation and resolution of inflammation, and their diverse functions can be attributed to specific cellular subsets: pro-inflammatory or classical monocytes (Ly6c(Hi)) and pro-reparative or non-classical monocytes (Ly6c(Lo)). We hypothesized that inherent differences in Ly6c(Hi) classical monocytes and Ly6c(Lo) non-classical monocytes determine susceptibility to perinatal hepatic inflammation in late gestation fetuses and neonates. We found an anti-inflammatory transcriptional profile expressed by Ly6c(Lo) non-classical monocytes, and a physiologic abundance of these cells in the late gestation fetal liver. Unlike neonatal pups, late gestation fetuses proved to be resistant to rhesus rotavirus (RRV) mediated liver inflammation. Furthermore, neonatal pups were rendered resistant to RRV-mediated liver injury when Ly6c(Lo) non-classical monocytes were expanded. Pharmacologic inhibition of Ly6c(Lo) non-classical monocytes in this setting restored susceptibility to RRV-mediated disease. These data demonstrate that Ly6c(Lo) monocytes promote resolution of perinatal liver inflammation in the late gestation fetus, where there is a physiologic expansion of non-classical monocytes, and in the neonatal liver upon experimental expansion of these cells. Therapeutic strategies directed towards enhancing Ly6c(Lo) non-classical monocyte function may mitigate the detrimental effects of perinatal liver inflammation

The Community Rehabilitation Assessment: patient and clinician-reported outcomes in ambulatory rehabilitation

ObjectivesThe interRAI Community Rehabilitation Assessment (CRA) is a comprehensive health assessment designed to collect essential health and function information for rehabilitation care planning, benchmarking, and evaluation of clinic and home-based programs. A portion of the CRA is completed through patient self-report. The objective of this study was to demonstrate how the CRA can be used to describe the baseline clinical characteristics of patients participating in ambulatory rehabilitation programs and measure change across numerous domains of function, health, and wellbeing over time.DesignCohort study.Setting and participantsIn total, 709 patients were assessed with the CRA across 25 ambulatory clinics in Ontario, Canada between January 1st, 2018, to December 31st, 2018. We examined sub-groups of patients receiving rehabilitation following stroke (n = 82) and hip or knee total joint replacement (n = 210).MethodsFrequency responses and means were compared between admission and discharge from the ambulatory rehabilitation programs. Measures of interest included self-reported difficulty in completing instrumental activities of daily living, locomotion, fear of falling, and pain.ResultsSignificant improvement relative to at admission was detected for the overall cohort and both sub-samples on individual instrumental activities of daily living, stair difficulty, use of mobility aides, distance walked, fear of falling, and pain.Conclusions and implicationsThe standardized and comparable information collected by the CRA is expected to provide clinicians, clinic, and health system administrators with essential health and function information that can be used for care planning, benchmarking, and evaluation