On the Road to Universal Children's Health Coverage: An Update on the KidsWell Campaign

The Patient Protection and Affordable Care Act (ACA), enacted in 2010, held great promise for expanding insurance coverage to millions of uninsured Americans. Starting in 2014, it expanded Medicaid eligibility to low-income adults with family income below 138 percent of the federal poverty level. It also offered premium subsidies to people with income up to four times the poverty level so they could purchase private insurance through federal or state health insurance exchanges. While most of those expected to gain insurance coverage for the first time are adults, children stand to gain as well, since children are more likely to have health care coverage when their parents do too (DeVoe et al. 2015). In 2014, about 3.9 million children were estimated to be eligible but not enrolled in Medicaid or the Children's Health Insurance Program (CHIP), representing roughly two-thirds of all uninsured children (Kaiser Family Foundation 2015). This brief looks at the KidsWell Campaign, a multilevel effort designed to ensure access to health insurance for all children. It summarizes evaluation findings on two research questions: (1) to what extent has state grantees' participation in KidsWell strengthened advocacy networks and capacities so far? and (2) which advocacy activities do grantees believe to be most effective in securing policy advances for children's health care coverage

KidsWell: Securing Coverage for Children by Advocating for the ACA

The expansion of Medicaid eligibility to low income adults and subsidies to purchase private insurance are arguably the most significant provisions of the Affordable Care Act (ACA). To the extent these measures reduce rates of uninsured parents, they could also help to close the gap in children's coverage, 7.2 million of whom were uninsured in 2012 (Finegold 2013). States are on the front-line of ACA implementation: their success in enrolling uninsured parents and their children depends on the effectiveness of state policies and systems for operating one-stop shopping portals, conducting outreach to low income families, helping them apply for insurance, and creating consumer-friendly communication about families' coverage options and their costs. This brief examines how children's advocates in New Mexico and New York have tried to shape state decisions on ACA implementation policies and their achievements to date

Aiming High: Foundation Support for State Advocates Brings Universal Children’s Health Coverage Within Reach

To help close the children’s health insurance coverage gap in the United States, in 2011 the Atlantic Philanthropies created the Kids- Well Campaign. KidsWell’s theory of change posits that if advocates could leverage new funding and coverage opportunities created by the Patient Protection and Affordable Care Act, they could expand the number of children with health insurance coverage. This article presents the major results of the KidsWell evaluation, which found substantial progress in achieving KidsWell interim policy changes and coverage outcomes. But advocates still have a full agenda, which means grantees and funders need to redouble efforts to educate the larger field about the type of advocacy that can legally be supported by funders, the gains in children’s coverage achieved in part with such support, and what remains at stake for children’s coverage. While other funders may not be able to make investments comparable to Atlantic’s, advocacy networks and capacities have already been built and valuable knowledge has been gained through the KidsWell effort. Funders could target future investment to states and activities needing a short-term boost to exploit windows of political opportunity or to fight threats to children’s coverage. Such support is still needed to continue momentum toward universal health insurance coverage for all children

Expanding the diversity of mycobacteriophages: insights into genome architecture and evolution.

Mycobacteriophages are viruses that infect mycobacterial hosts such as Mycobacterium smegmatis and Mycobacterium tuberculosis. All mycobacteriophages characterized to date are dsDNA tailed phages, and have either siphoviral or myoviral morphotypes. However, their genetic diversity is considerable, and although sixty-two genomes have been sequenced and comparatively analyzed, these likely represent only a small portion of the diversity of the mycobacteriophage population at large. Here we report the isolation, sequencing and comparative genomic analysis of 18 new mycobacteriophages isolated from geographically distinct locations within the United States. Although no clear correlation between location and genome type can be discerned, these genomes expand our knowledge of mycobacteriophage diversity and enhance our understanding of the roles of mobile elements in viral evolution. Expansion of the number of mycobacteriophages grouped within Cluster A provides insights into the basis of immune specificity in these temperate phages, and we also describe a novel example of apparent immunity theft. The isolation and genomic analysis of bacteriophages by freshman college students provides an example of an authentic research experience for novice scientists

Doppler Ultrasonography for the Noninvasive Measurement of Uterine Artery Volume Blood Flow Through Gestation in the Pregnant Sheep

Accurate noninvasive quantification of volume blood flow in the uterine arteries (UtAs) would have clinical and research benefits. We evaluated the correlation and agreement between uterine artery volume blood flow (UtABF) as calculated (cUtABF) from color/pulsed-wave Doppler acquisitions and that measured (mUtABF) by bilateral perivascular transit-time flow probes in 6 pregnant sheep at 2 gestational ages. Out of 22 Doppler acquisitions, 19 were successful. The overall correlation between cUtABF and mUtABF was 0.55 (n ¼ 19, P ¼ .01). Calculated UtABF and mUtABF were significantly correlated in late gestation (n ¼ 11, r ¼ 0.71, P ¼ .01) but not at mid-gestation (n ¼ 8, r ¼ .02, P ¼ .96). By Bland-Altman analysis, the mean cUtABF/mUtABF was 1.15 with 95% limit of agreement (0.26 to 2.56), similar to results previously achieved using power/pulsed-wave Doppler. Despite the acceptable correlation, the limits of agreement between Doppler and transit-time flow probe measurements remain wide. This makes Doppler ultrasonography less than a desirable method to quantify UtABF in studies where accurate quantification is required.PublishedN/