Three Years In--Changing Plan Features in the U.S. Health Insurance Marketplace

Background: A central objective of recent U.S. healthcare policy reform, most notably the Affordable Care Act\u27s (ACA) Health Insurance Marketplace, has been to increase access to stable, affordable health insurance. However, changing market dynamics (rising premiums, changes in issuer participation and plan availability) raise significant concerns about the marketplaces\u27 ability to provide a stable source of healthcare for Americans that rely on them. By looking at the effect of instability on changes in the consumer choice set, we can analyze potential incentives to switch plans among price-sensitive enrollees, which can then be used to inform policy going forward. Methods: Data on health plan features for non-tobacco users in 2512 counties in 34 states participating in federally-facilitated exchanges from 2014 to 2016 was obtained from the Centers for Medicaid & Medicare Services. We examined how changes in individual plan features, including premiums, deductibles, issuers, and plan types, impact consumers who had purchased the lowest-cost silver or bronze plan in their county the previous year. We calculated the cost of staying in the same plan versus switching to another plan the following year, and analyzed how costs vary across geographic regions. Results: In most counties in 2015 and 2016 (53.7 and 68.2%, respectively), the lowest-cost silver plan from the previous year was still available, but was no longer the cheapest plan. In these counties, consumers who switched to the new lowest-cost plan would pay less in monthly premiums on average, by $51.48 and$55.01, respectively, compared to staying in the same plan. Despite potential premium savings from switching, however, the majority would still pay higher average premiums compared to the previous year, and most would face higher deductibles and an increased probability of having to change provider networks. Conclusion: While the ACA has shown promise in expanding healthcare access, continued changes in the availability and affordability of health plans are likely to result in churning and switching among enrollees, which may have negative ramifications for their health going forward. Future healthcare policy reform should aim to stabilize marketplace dynamics in order to encourage greater care continuity and limit churning

Three years in – changing plan features in the U.S. health insurance marketplace

Abstract Background A central objective of recent U.S. healthcare policy reform, most notably the Affordable Care Act’s (ACA) Health Insurance Marketplace, has been to increase access to stable, affordable health insurance. However, changing market dynamics (rising premiums, changes in issuer participation and plan availability) raise significant concerns about the marketplaces’ ability to provide a stable source of healthcare for Americans that rely on them. By looking at the effect of instability on changes in the consumer choice set, we can analyze potential incentives to switch plans among price-sensitive enrollees, which can then be used to inform policy going forward. Methods Data on health plan features for non-tobacco users in 2512 counties in 34 states participating in federally-facilitated exchanges from 2014 to 2016 was obtained from the Centers for Medicaid & Medicare Services. We examined how changes in individual plan features, including premiums, deductibles, issuers, and plan types, impact consumers who had purchased the lowest-cost silver or bronze plan in their county the previous year. We calculated the cost of staying in the same plan versus switching to another plan the following year, and analyzed how costs vary across geographic regions. Results In most counties in 2015 and 2016 (53.7 and 68.2%, respectively), the lowest-cost silver plan from the previous year was still available, but was no longer the cheapest plan. In these counties, consumers who switched to the new lowest-cost plan would pay less in monthly premiums on average, by $51.48 and$55.01, respectively, compared to staying in the same plan. Despite potential premium savings from switching, however, the majority would still pay higher average premiums compared to the previous year, and most would face higher deductibles and an increased probability of having to change provider networks. Conclusion While the ACA has shown promise in expanding healthcare access, continued changes in the availability and affordability of health plans are likely to result in churning and switching among enrollees, which may have negative ramifications for their health going forward. Future healthcare policy reform should aim to stabilize marketplace dynamics in order to encourage greater care continuity and limit churning.https://deepblue.lib.umich.edu/bitstream/2027.42/144501/1/12913_2018_Article_3198.pd

A target-cell limited model can reproduce influenza infection dynamics in hosts with differing immune responses

We consider a hierarchy of ordinary differential equation models that describe the within-host viral kinetics of influenza infections: the IR model explicitly accounts for an immune response to the virus, while the simpler, target-cell limited TEIV and TV models do not. We show that when the IR model is fitted to pooled experimental murine data of the viral load, fraction of dead cells, and immune response levels, its parameters values can be determined. However, if, as is common, only viral load data are available, we can estimate parameters of the TEIV and TV models but not the IR model. These results are substantiated by a structural and practical identifiability analysis. We then use the IR model to generate synthetic data representing infections in hosts whose immune responses differ. We fit the TV model to these synthetic datasets and show that it can reproduce the characteristic exponential increase and decay of viral load generated by the IR model. Furthermore, the values of the fitted parameters of the TV model can be mapped from the immune response parameters in the IR model. We conclude that, if only viral load data are available, a simple target-cell limited model can reproduce influenza infection dynamics and distinguish between hosts with differing immune responses

Development of a “Universal” Phantom for Standardization of Chemical Exchange Saturation Transfer (CEST) MRI

https://openworks.mdanderson.org/sumexp22/1039/thumbnail.jp

The effect of relationship status on communicating emotions through touch

Research into emotional communication to date has largely focused on facial and vocal expressions. In contrast, recent studies by Hertenstein, Keltner, App, Bulleit, and Jaskolka (2006) and Hertenstein, Holmes, McCullough, and Keltner (2009) exploring nonverbal communication of emotion discovered that people could identify anger, disgust, fear, gratitude, happiness, love, sadness and sympathy from the experience of being touched on either the arm or body by a stranger, without seeing the touch. The study showed that strangers were unable to communicate the self-focused emotions embarrassment, envy and pride, or the universal emotion surprise. Literature relating to touch indicates that the interpretation of a tactile experience is significantly influenced by the relationship between the touchers (Coan, Schaefer, & Davidson, 2006). The present study compared the ability of romantic couples and strangers to communicate emotions solely via touch. Results showed that both strangers and romantic couples were able to communicate universal and prosocial emotions, whereas only romantic couples were able to communicate the self-focused emotions envy and pride

Fisheries Surveys Are Essential Ocean Observing Programs in a Time of Global Change: A Synthesis of Oceanographic and Ecological Data From U.S. West Coast Fisheries Surveys

As climate change and other anthropogenic impacts on marine ecosystems accelerate in the 21st century, there is an increasing need for sustained ocean time series. A robust and collaborative network of regional monitoring programs can detect early signs of unanticipated changes, provide a more holistic understanding of ecosystem responses, and prompt faster management actions. Fisheries-related surveys that collect fisheries-independent data (hereafter referred to as “fisheries surveys”) are a key pillar of sustainable fisheries management and are ubiquitous in the United States and other countries. From the perspective of ocean observing, fisheries surveys offer three key strengths: (1) they are sustained due to largely consistent funding support from federal and state public sector fisheries agencies, (2) they collect paired physical, chemical, and biological data, and (3) they have large and frequently overlapping spatial footprints that extend into the offshore region. Despite this, information about fisheries survey data collection can remain poorly known to the broader academic and ocean observing communities. During the 2019 CalCOFI Symposium, marking the 70th anniversary of the California Cooperative Oceanic Fisheries Investigations (CalCOFI), representatives from 21 ocean monitoring programs on the North American West Coast came together to share the status of their monitoring programs and examine opportunities to leverage efforts to support regional ecosystem management needs. To increase awareness about collected ocean observing data, we catalog these ongoing ocean time series programs and detail the activities of the nine major federal or state fisheries surveys on the U.S. West Coast. We then present three case studies showing how fisheries survey data contribute to the understanding of emergent ecosystem management challenges: marine heatwaves, ocean acidification, and contaminant spills. Moving forward, increased cross-survey analyses and cooperation can improve regional capacity to address emerging challenges. Fisheries surveys represent a foundational blueprint for ecosystem monitoring. As the international community moves toward a global strategy for ocean observing needs, fisheries survey programs should be included as data contributors.publishedVersio

The structure of a "xylan" from kenaf (Hibiscus cannabinus)

"April, 1987.""Portions of the work were used by LD and EB as partial fulfillment of the requirements for the Master of Science degree at the Institute of Paper Chemistry.""This paper has been submitted for consideration for publication in Cellulose Chemistry and Technology.

A general scheme for modeling gamma-ray burst prompt emission

We describe a general method for modeling gamma-ray burst prompt emission. We find that for the burst to be produced via the synchrotron process unphysical conditions are required -- the distance of the source from the center of the explosion ($R_\gamma$) must be larger than $\sim 10^{17}$cm and the source Lorentz factor \gta 10^3; for such a high Lorentz factor the deceleration radius ($R_d$) is less than $R_\gamma$ even if the number density of particles in the surrounding medium is as small as $\sim 0.1$ cm$^{-3}$. The result, $R_\gamma > R_d$, is in contradiction with the early x-ray and optical afterglow data. The synchrotron-self-Compton (SSC) process fares much better. There is a large solution space for a typical GRB prompt emission to be produced via the SSC process. The prompt optical emission accompanying the burst is found to be very bright (\lta 14 mag; for $z\sim2$) in the SSC model, which exceeds the observed flux (or upper limit) for most GRBs. Continuous acceleration of electrons can significantly reduce the optical flux and bring it down to the observed limits. (Abridged)Comment: Published in MNRAS Jan 2008, 56 page

Comparison of Body Composition Measurements using a New Caliper, Two Established Calipers, Hydrostatic Weighing, and BodPod

Purposes: (1) To compare the Lafayette Instruments (LI) skinfold caliper to the Lange (L) and Harpenden (H) calipers using a diverse subject population. (2) To determine the validity of the LI caliper in a subset of subjects by comparing body compositions from skinfold thicknesses to those measured by hydrostatic weighing (HW) and air displacement plethysmography (ADP). (3) To compare measurements obtained by experienced (EX) and inexperienced (IX) technicians using all three calipers. Methods: Skinfold measurements were performed by both EX and IX technicians using three different calipers on 21 younger (21.2 ± 1.5 yrs) and 20 older (59.2 ± 4 yrs) subjects. Body compositions were calculated using the Jackson-Pollock seven-site and three-site formulas. HW and ADP tests were performed on a subset of subjects (10 younger, 10 older). Results: No significant differences existed between LI and L or H when measurements were made by EX. Further, the LI-EX measurements were highly correlated to both H-EX and L-EX. No significant differences existed in the subgroup between LI-EX and HW or ADP. Skinfold determinations made by EX and IX were similar. Conclusions: Similar body compositions determined using LI, H, and L suggest that LI determines body composition as effectively as H and L. High correlations between the three calipers support this notion. Similar results between LI and HW/ADP subgroup suggest that the LI caliper may be a valid method of measuring body composition. Overall, performance by IX was similar to EX and suggests similar ease of use for all three calipers

Inference and Evolutionary Analysis of Genome-Scale Regulatory Networks in Large Phylogenies

Changes in transcriptional regulatory networks can significantly contribute to species evolution and adaptation. However, identification of genome-scale regulatory networks is an open challenge, especially in non-model organisms. Here, we introduce multi-species regulatory network learning (MRTLE), a computational approach that uses phylogenetic structure, sequence-specific motifs, and transcriptomic data, to infer the regulatory networks in different species. Using simulated data from known networks and transcriptomic data from six divergent yeasts, we demonstrate that MRTLE predicts networks with greater accuracy than existing methods because it incorporates phylogenetic information. We used MRTLE to infer the structure of the transcriptional networks that control the osmotic stress responses of divergent, non-model yeast species and then validated our predictions experimentally. Interrogating these networks reveals that gene duplication promotes network divergence across evolution. Taken together, our approach facilitates study of regulatory network evolutionary dynamics across multiple poorly studied species. Keywords: regulatory networks; network inference; evolution of gene regulatory networks; evolution of stress response; yeast; probabilistic graphical model; phylogeny; comparative functional genomicsNational Science Foundation (U.S.) (Grant DBI-1350677)National Institutes of Health (U.S.) (Grant R01CA119176-01)National Institutes of Health (U.S.) (Grant DP1OD003958-01