What Directions for Public Health Under the Affordable Care Act?

Outlines opportunities for public health efforts under the 2010 healthcare reform law, such as building prevention into insurance expansion and boosting innovation in population health, as well as challenges, such as budget constraints

The Role of Prevention in Bending the Cost Curve

Examines how much disease prevention, including those funded in the 2010 healthcare reform law such as diabetes and HIV prevention, smoking cessation, community interventions, and reducing racial/ethnic disparities, can help slow health spending growth

Potential Savings Through Prevention of Avoidable Chronic Illness Among CalPERS State Active Members

Analyzes chronic disease-related health expenditures among state employees that can be targeted by lifestyle interventions. Estimates potential savings from reductions in chronic conditions

Monitoring the Impact of Health Reform on Americans 50-64: Medicaid Expansion and Marketplace Implementation Increased Health Coverage

This survey shows that the share of 50- to 64-year-olds without health insurance fell between December 2013 and March 2014. In states that expanded their Medicaid programs, a greater share of previously uninsured adults gained coverage, particularly among groups that have traditionally faced barriers to obtaining it. The survey also found that the newly insured differed in key ways from those who reported being insured for all of the past 12 months. On average, more were low income, and more reported that they had had trouble paying medical bills. This paper is part of a series that looks at the experience of 50- to 64-year-olds during the first open enrollment period of the Affordable Care Act (ACA)

A Conceptual Map of Structural Racism in Health Care

Longstanding racial and ethnic disparities in health care experiences contribute to profoundly inequitable health and life outcomes in the United States. Researchers, policymakers, practitioners, advocates, and communities seeking to eradicate these disparities must understand and intervene in their root causes. In this brief, we develop a conceptual map of structural racism in health care that demonstrates the connections between (1) mental models that, in often unnoticed ways, guide how society thinks and acts; (2) inequitable structures, including laws and policies that codify the distribution of and access to resources; and (3) racial and ethnic disparities in health care experiences and outcomes

Monitoring the Impact of Health Care Reforms on Americans 50-64: Awareness and Coverage Expectations

This survey found widespread awareness among Americans ages 50 to 64 about the new health insurance Marketplace that had been created by the Affordable Care Act (ACA). Those with the most to gain from the ACA -- the uninsured and those with nongroup (individual) insurance -- expressed the greatest interest in using the Marketplace to learn about new coverage options. Most of those already insured expected to keep their same source of coverage in 2014, whereas the uninsured had mixed expectations. This paper is part of a series that looks at the experiences of 50- to 64-year-olds during the ACA's first open enrollment period

Monitoring the Impact of Health Reform on Americans 50-64: Use of Insurance Marketplaces

This survey found that 9 out of 10 Americans ages 50 to 64 were aware of the new health insurance Marketplace that had been created by the Affordable Care Act (ACA). The survey found that, despite widespread awareness of the Marketplace among this age group, relatively few who knew about the Marketplace were interested in using it to acquire new coverage. The survey also found that 50- to 64-year-olds' use of the Marketplace varied widely by health insurance status and income. This paper is part of a series that looks at the experiences of 50- to 64-year-olds during the ACA's first open enrollment period

How We Can Pay for Health Care Reform

Describes savings and revenue sources and policies to reduce healthcare spending that could finance comprehensive reform with a public option, such as reducing physician and hospital payments, investing in prevention programs, and capping tax exclusions

WP 2018-389

Recent research has found, in some groups of Americans, dramatic increases in deaths due to drug overdose and suicide and an overall stagnation of trends toward increased longevity. This study examines the link between mortality of older working age (45 to 64) adults and local economic downturns in the U.S. to evaluate the role of economic shifts in various causes of death and their related mortality trends. Specifically, we estimate regression models to test the hypotheses that the longevity effects of poor economic prospects are reflected through (1) increased suicide, drug overdose, and other “deaths of despair” and (2) other causes of death linked to exposure to economic and social stress such as heart and cerebrovascular disease. To avoid the problem of endogeneity of local economic conditions to mortality conditions, we measure the local economic shock of lost employment with predicted employment based on baseline industrial composition and national trends in employment by industry. We find evidence consistent with prior research that among non-Hispanic white adults, midlife mortality has increased since 1990, particularly among those with low educational attainment. We also find that “deaths of despair” are important contributors to that trend. However, we find that while distress in local, area economies does predict increased mortality for chronic disease, it predicts decreased mortality from suicides, opioids, and other substance abuse. This finding suggests caution in the application of the construct of despair in explaining recent mortality patterns.Social Security Adminstration, Award number RRC08098401-10, R-UM18-07https://deepblue.lib.umich.edu/bitstream/2027.42/148126/1/wp389.pdfDescription of wp389.pdf : Working pape

Obesity across America: Geographic Variation in Disease Prevalence and Treatment Options

More than 4 in 10 adults in the US are affected by obesity, defined as experiencing an accumulation of body fat higher than what is considered healthy for a given height. Obesity is associated with increased risks for serious health conditions such as type 2 diabetes, hypertension, stroke, and various cancers. People of all genders, of all races and ethnicities, and in all geographic areas experience obesity.This report examines existing data and research to comprehensively describe the scope and prevalence of obesity and available obesity treatments in the US. We look at the current state-level prevalence of obesity and changes in state-level obesity prevalence from 2011 to 2020. We also examine current county-level obesity prevalence and which counties have the highest and lowest levels of obesity and related comorbidities. Then, we describe insurance coverage for four obesity treatment options (screening and counseling, nutritional counseling, pharmacotherapy, and bariatric surgery) for four insurance plans (fee-for-service Medicaid, Medicaid managed care, state employee health plans, and state essential health benefits benchmark plans)